常规磁共振及磁共振波谱成像评估新生儿缺氧缺血性脑病严重程度  

Assessment of Neonatal Hypoxic Ischemic Encephalopathy Severity by Conventional Magnetic Resonance Imaging and Magnetic Resonance Spectroscopy

作　　者：席艳丽[1] 张晓军 王瑞珠 盛会雪 高峰[1] 程锐[2] XI Yanli;ZHANG Xiaojun;WANG Ruizhu(Department of Radiology,The Affiliated Children's Hospital of Nanjing Medical University,Nanjing,Jiangsu Province 210008,P.R.China)

机构地区：[1]南京医科大学附属儿童医院放射科,210008 [2]南京医科大学附属儿童医院新生儿科,210008

出　　处：《临床放射学杂志》2021年第8期1577-1582,共6页Journal of Clinical Radiology

基　　金：南京市卫生科技发展项目(编号:YKK14117)。

摘　　要：目的探讨常规磁共振成像(MRI)和氢质子磁共振波谱成像(1H-MRS)评估足月新生儿缺氧缺血性脑病(HIE)严重程度的诊断价值。方法前瞻性研究78例HIE患儿,按临床标准分为轻度组(42例)、中度组(17例)和重度组(19例),20例正常足月新生儿作为对照组。行常规MRI检查和TE 135 ms、TE 35 ms 1H-MRS扫描,观察不同临床分度HIE患儿脑的MRI异常征象累及范围及部位,比较MRI分度与临床分度的一致性,分析HIE患儿不同临床分度各个感兴趣区(ROI)(豆状核、丘脑、分水岭)代谢物比值的差异。结果重度组HIE患儿脑常规MRI病变范围广泛,部位多以中央区基底核团为主,轻、中度组HIE患儿病变范围较局限,以周围区皮层及脑室旁白质为主,MRI分度与临床分度一致性较好。TE 135 ms时豆状核、丘脑及分水岭区的N-乙酰天门冬氨酸(NAA)/胆碱(Cho)在轻度组和中、重度组间存在显著性差异(P<0.05),且豆状核区NAA/Cho评估HIE严重程度的诊断效能最大;TE 35 ms时豆状核区的乳酸(Lac)/肌酸(Cr)、Lac/Cho、Lac/NAA在轻度组和中、重度组间存在显著性差异(P<0.05),且豆状核区Lac/NAA的诊断效能最大。常规MRI和1H-MRS联合使用后其评估HIE严重程度的诊断效能明显提高。结论常规MRI可从形态学上反映HIE脑损伤程度及模式,1H-MRS根据TE时间选择豆状核区NAA/Cho或Lac/NAA能更加客观地评估HIE脑损伤严重程度,两者联合有重要临床意义。Objective To explore the diagnostic value of conventional magnetic resonance imaging(MRI)and magnetic resonance spectroscopy(1H-MRS)in evaluating the severity of term neonatal with Hypoxic Ischemic Encephalopathy(HIE).Methods In this prospective study,78 children with HIE were divided into mild(42 cases),moderate(17 cases)and severe group(19 cases)according to clinical standards,and 20 normal full-term newborns were includedas the control group.MRI examinations and TE 135 ms and TE 35 ms 1H-MRS scans were performed to observe the range and location of MRI abnormal signs in the brain of children with HIE of different clinical grading,compare the consistency between MRI grading and clinical grading,and analyze the differences of the metabolite ratios in each region of interest(lenticular nucleus,thalamus and watershed)with different clinical grading.Results MRI lesions in children with HIE in the severe group were extensive,mostly in the basal ganglia,while lesions in the mild and moderate groups were limited,mostly in the cortex and white matter.MRI grading and clinical grading had good correlation.When TE was 135 ms,NAA/Cho in the lenticular nucleus,thalamus and watershed had significant differences between the mild group and the moderate to severe group(P<0.05),and the NAA/Cho in the lenticular nucleus had the greatest diagnostic efficacy in evaluating the severity of HIE.When TE 35 ms,Lac/Cr,Lac/Cho and Lac/NAA in the lenticular nucleus had significant differences between the mild group and the moderate to severe group(P<0.05),and Lac/NAA had the greatest diagnostic efficacy in evaluating HIE severity.MRI combined with 1H-MRS can significantly improve the diagnostic efficacy of assessing the severity of HIE.Conclusion MRI can reflect the degree and pattern of brain injury in HIE morphologically.1H-MRS can objectively evaluate the severity of brain injury by selecting NAA/Cho or Lac/NAA in the lenticular nucleus according to the echo time.The combination of the two methods has important clinical significance.

关 键 词：新生儿 缺氧缺血性脑病 磁共振成像 磁共振波谱成像 

分 类 号：R445.2[医药卫生—影像医学与核医学] R742[医药卫生—诊断学]