基于多参数磁共振成像定量分析诊断新生儿胆红素脑病的研究  

Diagnosis of neonatal bilirubin encephalopathy based on quantitative analysis of multiparameter magnetic resonance imaging

作　　者：谭伟婷 罗意 孙伟晟 庄义江 张少君 赵一霖 曾洪武[1] TAN Weiting;LUO Yi;SUN Weisheng;ZHUANG Yijiang;ZHANG Shaojun;ZHAO Yilin;ZENG Hongwu(Department of Radiology,Shenzhen Children's Hospital,Shenzhen 518038,China;Department of Radiology,Shenzhen Children's Hospital of China Medical University,Shenzhen 518038,China;Shantou University Medical College,Shantou 515041,China)

机构地区：[1]深圳市儿童医院放射科,深圳518038 [2]中国医科大学深圳市儿童医院放射科,深圳518038 [3]汕头大学医学院,汕头515041

出　　处：《磁共振成像》2023年第2期27-32,共6页Chinese Journal of Magnetic Resonance Imaging

基　　金：广东省自然科学基金(编号:2022A1515011427);深圳市医疗卫生三名工程项目(编号:SZSM202011005)。

摘　　要：目的探讨基于T1WI、T2WI、表观扩散系数(apparent diffusion coefficient,ADC)图像苍白球(globus pallidus,GP)、壳核(putamen,P)、丘脑(thalamus,T)信号定量分析对新生儿胆红素脑病(neonatal bilirubin encephalopathy,NBE)早期诊断的价值及最优参数。材料与方法收集2018年1月至2022年7月深圳市儿童医院收治的足月NBE患儿临床及影像数据,选取性别及年龄匹配的正常新生儿为对照,在T1WI、T2WI、ADC图使用Carestream Client.pa44026软件测量GP、P、T三个部位信号值。采用两独立样本t检验,比较分析以上三个序列的GP、T的信号值,GP与P在T1WI、T2WI及ADC上的比值(分别以GP/P^(1)、GP/P^(2)、GP/P^(A)表示),T与P在T1WI、T2WI及ADC上的比值(分别以T/P^(1)、T/P^(2)、T/P^(A)表示),并根据受试者工作特征(receiver operating characteristic,ROC)曲线找出诊断NBE的最佳MRI参数;根据急性期胆红素脑损伤评分标准将NBE患儿分为轻、中、重度NBE三组,采用单因素方差分析比较分析三组NBE患儿组间差异。结果NBE患儿共60例,其中轻度22例,中度24例,重度14例;正常对照组31例。两独立样本t检验结果显示:T1WI图像中GP、T信号值及比值(GP/P^(1)、T/P^(1))均高于正常对照组,且差异均有统计学意义(P均<0.010);T2WI及ADC图像中GP、T信号值及比值(GP/P^(2)、T/P^(2)、GP/P^(A)、T/P^(A))差异均无统计学意义(P>0.05)。ROC曲线分析显示:T1WI图像中GP、T信号值的ROC曲线下面积(area under the curve,AUC)分别为0.785、0.870,最佳临界点分别为267.83、295.17;T1WI图像中GP/P^(1)、T/P^(1)的AUC值分别为0.794、0.756,最佳临界点分别为1.41、1.13。单因素方差分析显示:NBE临床严重程度越高,T1WI图像中GP和T信号值越高,GP/P^(1)、T/P^(1)比值越高。结论基于T1WI图像的MRI信号定量分析法能早期、客观诊断NBE,T1WI图像上GP、T的信号值及GP/P^(1)、T/P^(1)比值可以作为早期、准确诊断NBE并动态评价NBE严重程度的MRI参数,为临�Objective:To explore the value and optimal parameters of quantitative analysis of globus pallidus(GP),putamen(P)and thalamus(T)signal intensity on T1WI,T2WI,and apparent diffusion coefficient(ADC)images for the early diagnosis of neonatal bilirubin encephalopathy(NBE).Materials and Methods:We collected the clinical and imaging data of full-term NBE children from January 2018 to July 2022 in Shenzhen Children’s Hospital,and age-and gender-matched normal neonates were selected as controls.The software measureed the signal intensity of GP,P and T.Two independent samples t test was used to compare and analyze the signal intensity of GP,T,the ratio of GP to P on T1WI,T2WI,ADC(GP/P^(1),GP/P^(2),GP/P^(A))and the ratio of T to P on T1WI,T2WI,ADC(T/P^(1),T/P^(2),T/P^(A));We analyzed the receiver operating characteristic(ROC)curve to find the optimal MRI parameters for the diagnosis of NBE.According to the scores of bilirubin induced neurological dysfunction,children with NBE were divided into three groups:mild,moderate and severe,one-way analysis of variance was used to compare and analyze the differences among the three groups of NBE children.Results:There were 60 children with NBE,22 were mild,24 were moderate,14 were severe,and 31 were in the normal control group.The results of two independent samples t test showed that:in T1WI images,the GP and T signal intensity and ratios(GP/P^(1),T/P^(1))were higher than those in the normal control group,and the differences were statistically significant(P<0.010);in T2WI and ADC images,GP,T signal intensity and ratios(GP/P^(2),T/P^(2),GP/P^(A),T/P^(A))were not significantly different(P>0.05).The ROC curve analysis showed that the area under the curve(AUC)of GP and T signal intensity in T1WI images were 0.785,0.870,respectively,and the optimal critical threshold was 267.83 and 295.17,respectively;the AUC of G/P^(1)and T/P^(1)in T1WI images was 0.794 and 0.756,and the optimal critical threshold was 1.41,1.13,respectively.One-way analysis of variance showed that the higher the clini

关 键 词：新生儿 胆红素脑病 磁共振成像 早期诊断 严重程度分级 

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]