三维动脉自旋标记在足月新生儿缺氧缺血性脑病的早期诊断和预后分组中的价值  

Value of 3D arterial spin labeling in early diagnosis and prognostic grouping of full-term neonatal hypoxic-ischemic encephalopathy

作　　者：刘畅[1] 计海霞[2] 田仰华[2] 候唯姝[3] 音大为 邓克学 LIU Chang;JI Haixia;TIAN Yanghua;HOU Weishu;YIN Dawei;DENG Kexue(Department of Radiology,the First Affiliated Hospital of USTC,Division of Life Sciences and Medicine,University of Science and Technology of China,Hefei 230031,China;Department of Neurology,the First Affiliated Hospital of Anhui Medical University,Hefei 230022,China;Department of Radiology,the First Affiliated Hospital of Anhui Medical University,Hefei 230022,China)

机构地区：[1]中国科学技术大学附属第一医院影像中心,合肥230031 [2]安徽医科大学第一附属医院神经内科,合肥230022 [3]安徽医科大学第一附属医院影像中心,合肥230022

出　　处：《磁共振成像》2023年第1期61-66,76,共7页Chinese Journal of Magnetic Resonance Imaging

基　　金：国家自然科学基金(编号:32071054);安徽省自然科学基金(编号:2008085QH381)。

摘　　要：目的探讨三维动脉自旋标记(three-dimensional arterial spin labeling,3D ASL)灌注成像与扩散加权成像(diffusion-weighted imaging,DWI)序列对足月新生儿缺氧缺血性脑病(hypoxic ischemic encephalopathy,HIE)的早期诊断价值以及对患者预后分组的价值。材料与方法回顾性分析2017年12月至2022年5月在我院临床诊断为HIE的足月新生儿共40例和对照组40例的资料,全部于出生3天内接受MRI检查。所有HIE患儿出生1个月后进行新生儿行为神经学评估(Neonatal Behavioral Neurological Assessment,NBNA),根据评分将患儿分为预后良好组和预后不良组,所有受试者同时进行3D ASL和DWI检查,比较脑组织各感兴趣区的脑血流(cerebral blood flow,CBF)和表观扩散系数(apparent diffusion coefficient,ADC),感兴趣区包括双侧基底节、丘脑和额叶深部白质,最终取双侧平均值。研究HIE患儿不同脑区的CBF值与NBNA的相关性以及CBF值的早期变化与HIE患儿预后分组的关系。结果(1)预后不良组基底节和丘脑的CBF值高于预后良好组,差异有统计学意义(P<0.001);(2)丘脑CBF值的受试者工作特征(receiver operating characteristic,ROC)曲线下面积为0.973,敏感度和特异度为97.5%、90.2%;ADC值的ROC曲线下面积为0.881,敏感度和特异度为82.5%、92.7%;(3)基底节区及丘脑的CBF值与NBNA评分高度相关(r=-0.8196,P<0.001;r=-0.8504,P<0.001)。结论足月新生儿出生后3天内的3D ASL结果与NBNA评分高度相关,可以早期诊断并预测患儿短期预后,以改善HIE患儿的整体预后效果,为临床治疗方案的选择提供参考依据。Objective:To investigate the value of 3D arterial spin labeling(3D ASL)perfusion imaging and diffusion weighted imaging(DWI)for the early diagnosis of hypoxic-ischemic encephalopathy(HIE)in term neonates and the predictive value of 3D ASL for patient prognosis.Materials and Methods:A total of 40 cases of full-term neonates clinically diagnosed with HIE in our hospital from December 2017 to May 2022 and 40 control group were selected.All HIE neonates were divided into favourable outcome and adverse outcome groups according to their prognosis,and all subjects underwent 3D ASL and DWI simultaneously to compare cerebral blood flow(CBF)and apparent diffusion coefficient(ADC)in each region of interest and analyze the agreement.The areas of interest included bilateral basal ganglia,thalamus,and frontal white matter,and the final average was bilaterally taken.To investigate the correlation between CBF value of HIE in neonates and Neonatal Behavioral Neurological Assessment(NBNA),the relationship between early changes of CBF value and prognosis of neonates with HIE.Results:(1)The CBF values of basal ganglia and thalamus in the poor prognosis group were higher than those in the good prognosis group,and the difference was statistically significant(P<0.001);(2)The area under the ROC curve for CBF values was 0.973,and the specificity and sensitivity of CBF values were 90.2%and 97.5%;the area under the receiver operating characteristic(ROC)curve for ADC values was 0.881,and the sensitivity and specificity were 82.5%and 92.7%;(3)CBF values in the basal ganglia and thalamus were highly correlated with NBNA scores(r=-0.8196,P<0.001;r=-0.8504,P<0.001).Conclusions:ASL findings within 3 days after birth in full-term neonates were highly correlated with NBNA scores.It can diagnose HIE early and predict the outcome of functional brain damage with better diagnostic efficacy than DWI.

关 键 词：新生儿 缺氧缺血性脑病 磁共振成像 扩散加权成像 动脉自旋标记 脑血流量 新生儿行为神经学评估 早期诊断 预后 预测 

分 类 号：R445.2[医药卫生—影像医学与核医学] R722.1[医药卫生—诊断学]