新生儿胆红素脑病MRI特征与血清和脑脊液总胆红素的关系分析  

Relationship between MRI features and total bilirubin in serum and cerebrospinal fluid of neonatal bilirubin encephalopathy

作　　者：邵长春 余才锋 姜骏 SHAO Changchun;YU Caifeng;JIANG Jun(Department of Radiology,Shangrao Maternal and Child Healthcare Hospital,Shangrao,Jiangxi,334000,China)

机构地区：[1]上饶市妇幼保健院放射科,江西上饶334000

出　　处：《当代医学》2024年第13期51-55,共5页Contemporary Medicine

摘　　要：目的分析新生儿胆红素脑病MRI的影像学特征及其诊断效能,并分析MRI特征与血清、脑脊液总胆红素的关系。方法回顾性分析2021年5月至2023年4月上饶市妇幼保健院收治的63例高胆红素血症新生儿作为研究对象,根据临床实际实验室检查结果(是否继发胆红素脑病)分为病例组(n=30)与对照组(n=33)。所有患儿均进行实验室检查及颅脑MRI检查,以临床实际实验室检查结果为金标准,分析颅脑MRI诊断效能及影像学特征,比较两组双侧苍白球T_(1)加权成像(T_(1)WI)、T_(2)加权成像(T_(2)WI)信号强度及表观扩散系数(ADC)值、指数化ADC(eADC)值及血清、脑脊液总胆红素水平,比较颅脑MRI阳性与阴性患儿血清和脑脊液总胆红素水平。结果颅脑MRI诊断胆红素脑病的灵敏度为93.33%,特异度为90.91%,准确率为92.06%,与临床实际诊断的一致性较高(Kappa值=0.841)。胆红素脑病患儿MRI表现为双侧苍白球T_(1)WI呈对称性高信号,T_(2)WI等信号,弥散加权成像(DWI)等信号。病例组双侧苍白球T_(1)WI信号强度值均高于对照组,差异有统计学意义(P<0.05)。两组双侧苍白球ADC值、eADC值比较差异无统计学意义。病例组血清和脑脊液总胆红素水平高于对照组,差异有统计学意义(P<0.05)。MRI阳性患儿血清总胆红素、脑脊液总胆红素水平均高于MRI阴性患儿,差异有统计学意义(P<0.05)。结论颅脑MRI诊断新生儿胆红素脑病的准确率高,双侧苍白球T_(1)WI呈对称性高信号为患儿重要影像学特征,患儿MRI特征与血清、脑脊液总胆红素水平有一定关联,可为新生儿胆红素脑病的诊断提供参考。Objective To analyze the features and diagnostic efficacy of MRI in neonatal bilirubin encephalopathy,and analyze the relationship between MRI features and total bilirubin in serum and cerebrospinal fluid.Methods A total of 63 neonates with hyperbilirubinemia admitted to Shangrao Maternal and Child Healthcare Hospital from May 2021 to April 2023 were retrospectively analyzed,and they were divided into the case group(n=30)and the control group(n=33)according to the actual clinical laboratory test results(whether they had secondary bilirubin encephalopathy).All the children underwent laboratory examination and brain MRI examination.The clinical actual laboratory examination results were used as the gold standard to analyze the diagnostic efficacy and imaging characteristics of brain MRI;the signal intensity of bilateral globus pallidus T_(1)weighted imaging(T_(1)WI),T_(2)weighted imaging(T_(2)WI),apparent diffusion coefficient(ADC)value,exponential ADC(eADC)value,serum and cerebrospinal fluid total bilirubin levels were compared between the two groups;the serum and cerebrospinal fluid total bilirubin levels were compared between the children with positive and negative brain MRI.Results The sensitivity,specificity and accuracy of brain MRI in the diagnosis of bilirubin encephalopathy were 93.33%,90.91%and 92.06%,which were consistent with the actual clinical laboratory diagnosis(Kappa value=0.841).MRI findings of children with bilirubin encephalopathy showed symmetrical hyperintensity on T_(1)WI of bilateral globus pallidus,isointensity on T_(2)WI and isointensity on diffusion weighted imaging(DWI).T_(1)WI signal intensity values of left and right globus pallidus in the case group were higher than those in the control group,and the differences were statistically significant(P<0.05);there was no statistically significant difference between the two groups in terms of ADC values and eADC values of left and right globus pallidus.The levels of total bilirubin in serum and cerebrospinal fluid in the case group were higher

关 键 词：新生儿 胆红素脑病 MRI 诊断效能 

分 类 号：R722.1[医药卫生—儿科] R445.2[医药卫生—临床医学]