磁共振波谱成像联合弥散加权成像在早产儿脑白质损伤诊断及预后评估中的应用  

Application of Magnetic Resonance Spectroscopy Imaging Combined with Diffusion Weighted Imaging in the Diagnosis and Prognosis Evaluation of Brain White Matter Injury in Premature Infants

作　　者：洪菲[1] 宋磊[1] 季菊花[1] 储晓彬[1] Hong Fei;Song Lei;Ji Ju-hua;CHU Xiao-bin(Department of Pediatrics,Nantong First People's Hospital,Nantong 226000,Jiangsu Province,China)

机构地区：[1]南通市第一人民医院儿科,江苏南通226000

出　　处：《中国CT和MRI杂志》2024年第2期28-31,共4页Chinese Journal of CT and MRI

基　　金：2020年江苏省妇幼健康科研项目(F202065);2022年南通市科技项目(MS22022026);2023年南通市卫生健康委员会科研课题(MSZ2023013,QNZ2023030)。

摘　　要：目的探讨磁共振波谱成像(MRS)联合弥散加权成像(DWI)在早产儿脑白质损伤早期诊断以及其预后评估中的应用价值。方法选取2021年1月-2023年1月102例脑白质损伤早产儿作为病例组,同期选取98例非脑白质损伤早产儿作为对照组,记录两组早产儿相关临床指标,并在出生后7d实施MRS、DWI检查,比较两组MRS代谢指标、DWI参数差异,使用点二列相关性检验MRS代谢指标、DWI参数与早产儿脑白质损伤的关系,并绘制受试者工作曲线(ROC)分析MRS联合DWI对早产儿脑白质损伤的早期诊断价值。予以病例组患儿长期随访,在矫正年龄6个月时使用Gesell发育诊断量表将患儿分为预后不良组与预后良好组,比较并分析2组患儿MRS代谢指标、DWI参数对早产儿脑白质损伤预后的评估价值。结果病例组N-乙酰天冬氨酸(NAA)、NAA/Cr、rADC明显低于对照组,肌酸(Cr)明显高于对照组,差异有统计学意义(P<0.05)。经点二列相关性检验显示NAA、NAA/Cr、rADC与早产儿脑白质损伤存在负相关关系(r<0,P<0.05);Cr与早产儿脑白质损伤存在正相关关系(r>0,P<0.05)。绘制ROC显示NAA、Cr、NAA/Cr以及rADC对早产儿脑白质损伤诊断具有较低的诊断价值,AUC分别为0.629、0.630、0.605、0.603;MRS联合DWI具有良好的诊断价值,AUC为0.713。随访结果显示102例患儿中21例为边缘状态,53例为发育异常,共74例为预后不良组,另28例发育良好为预后良好组。预后不良组患儿NAA、NAA/Cr、rADC明显低于预后良好组,Cr明显高于预后良好组,差异有统计学意义(P<0.05)。经点二列相关性检验显示NAA、NAA/Cr、rADC与脑白质损伤患儿预后不良存在负相关关系(r<0,P<0.05);Cr与预后不良存在正相关关系(r>0,P<0.05)。绘制ROC曲线显示NAA、NAA/Cr以及rADC对脑白质损伤患儿预后具有较低的评估价值,AUC分别为0.641、0.639、0.688;Cr、MRS联合DWI对脑白质损伤患儿预后具有良好的评估价值,AUC分别为Objective To explore the application value of magnetic resonance spectroscopy(MRS)combined with diffusion weighted imaging(DWI)in the early diagnosis and prognosis evaluation of brain white matter injury in premature infants.Methods 102 premature infants with brain white matter injury from January 2021 to January 2023 were selected as the case group,while 98 premature infants without brain white matter injury were selected as the control group.Clinical indicators related to premature infants were recorded in both groups,and MRS and DWI examinations were performed 7 days after birth.The differences of MRS metabolic indexes and DWI parameters between the two groups were compared.The relationship between MRS metabolic indexes,DWI parameters and white matter injury in premature infants was tested by point two column correlation.The receiver operating curve(ROC)was drawn to analyze the early diagnostic value of MRS combined with DWI for white matter injury in premature infants.Long term follow-up was given to the case group of children.At the corrected age of 6 months,the children were divided into a poor prognosis group and a good prognosis group using the Gesell developmental diagnostic scale.The evaluation value of MRS metabolic indicators and DWI parameters on the prognosis of premature brain white matter injury in the two groups of children was compared and analyzed.Results The N-acetylaspartic acid(NAA),NAA/Cr,rADC in the case group were significantly lower than those in the control group,while creatine(Cr)was significantly higher than that in the control group,with statistical significant differences(P<0.05).The point two column correlation test showed a negative correlation between NAA,NAA/Cr,rADC and brain white matter injury in premature infants(r<0,P<0.05).There was a positive correlation between Cr and white matter damage in premature infants(r>0,P<0.05).ROC curve showed that NAA,Cr,NAA/Cr and rADC had low diagnostic value in the diagnosis of brain white matter injury in premature infants,with AUC of 0.629

关 键 词：磁共振波谱成像 弥散加权成像 脑白质损伤 早产儿 预后 

分 类 号：R722[医药卫生—儿科] R730.7[医药卫生—临床医学]