常规MRI联合DWI及ADC对早产儿局灶性脑白质损伤的诊断价值  

The Application of Conventional MRI Combined with Diffusion Weighted Imaging and Apparent Diffusion Coefficientin Punctate White Matter Lesions

作　　者：顾海磊 唐文伟[1] 田忠甫 郑金霞[1] 王莉莉 朱晴 GU Hailei;TANG Wenwei;TIAN Zhongfu(Department of Radiology,Womens Hospital of Nanjing Medical University,Nanjing Maternity and Child Health Care Hospital,Nanjing,Jiangsu Province 210004,P.R.China)

机构地区：[1]南京医科大学附属妇产医院,南京市妇幼保健院放射科,210004

出　　处：《临床放射学杂志》2022年第2期314-318,共5页Journal of Clinical Radiology

基　　金：江苏省南京市卫生科技发展专项资金项目(编号:YKK19116)。

摘　　要：目的探讨常规MRI联合扩散加权成像(DWI)及表观扩散系数(ADC)在早产儿局灶性脑白质损伤(PWML)诊断中的应用价值。方法回顾性分析81例PWML患儿资料,按年龄分为早期组(1~7天)、中期组(8~30天)及晚期组(1~3个月),每组各27例。观察各组PWML患者MRI影像特点,包括T_(1)WI、T_(2)WI、T_(2)-FLAIR、DWI及ADC图像,运用Pearson卡方检验比较每组间各序列对于PWML检出能力有无差异,采用两独立样本t检验比较各组病灶平均表观扩散系数(ADC_(mean))值有无统计学差异,并应用受试者工作特征(ROC)曲线评估ADC_(mean)值在早期组与中、晚期组鉴别中的诊断效能。结果 PWML形态包括点状、片样、簇状及线状,且各期均以点状病灶为主。T_(1)WI高信号、T_(2)WI低信号、T_(2)-FLAIR高信号、DWI高信号及ADC低信号。各期均为T_(1)WI检出数最多,T_(2)WI及T_(2)-FLAIR病灶检出数对比T_(1)WI差异无统计学意义(P>0.05),DWI病灶数对比T_(1)WI差异有统计学意义(P<0.05),三组ADC_(mean)值差异有统计学意义(P<0.05),早期组与中、晚期组ADC_(mean)值对比曲线下面积(AUC)=0.808(95%CI:0.729~0.864,P<0.001),临界值为1.09×10^(-3)mm^(2)/s,敏感度84.91%,特异度60.87%。结论 MRI对PWML诊断具有重要价值,T_(1)WI检出效能最强,而DWI对早期脑白质损伤更为敏感,DWI及ADC_(mean)值可能是评估PWML治疗效果及预后的有效方法,ADC_(mean)>1.09×10^(-3)mm^(2)/s可作为PWML治疗效果及积极预后的评价指标。Objective To investigate the diagnostic value of Conventional MRI combined with diffusion weighted imaging(DWI)and apparent diffusion coefficient(ADC) in punctate white matter lesions(PWML). Methods 81 patients with PWML were divided into three groups, with 27 cases in each group, including early stage group(1-7 days),middle stage group(8-30 days) and late stage group(1-3 months).The MRI imaging features of PWML in each group were observed, including T_(1)WI,T_(2)WI,T_(2)-FLAIR,DWI and ADC images.Pearson Chi-Square test was used to compare the ability of each sequence to detect PWML. Two independent sample t-testswas performed to compare the difference of ADC_(mean) among each group.The ROC curve was used to evaluate the diagnostic efficacy of ADC_(mean) in the differential diagnosis between early group and middle-late stage group. Results The shape of PWML included dot, slice, cluster and line.High signal on T_(1)WI and T_(2)-FLAIR,low signal on T_(2)WI,high signal on DWI and low signal on ADC.The detection ability of T_(2)WI and T_(2)-FLAIR compared with T_(1)WI was not statistical different(P> 0.05).To compared with T_(1)WI,the number of lesions in DWI was considered statistically significant(P< 0.05).ADC_(mean) was statistically significant among the groups(P< 0.05).The ADC_(mean) had a certain diagnostic value in PWML(AUC=0.808,95%CI:0.729-0.864,P< 0.001).The critical value was 1.09×10^(-3)mm^(2)/s, the sensitivity was 84.91%,the specificity was 60.87%. Conclusion There are a great value in the diagnosis of PWML by MRI.T;WI has the strongest detection ability, DWI has more sensitive to early white matter injury.DWI and ADC_(mean)may be effective methods to evaluate the therapeutic effect and prognosis of PWML.ADC_(mean)>1.09×^(-3)mm^(2)/s could be evaluate the therapeutic effect and positive prognosis of PWML.

关 键 词：早产儿 局灶性脑白质损伤 扩散加权成像 表观扩散系数 

分 类 号：R445.2[医药卫生—影像医学与核医学] R722.6[医药卫生—诊断学]