妊娠期糖尿病孕妇婴儿脑发育异常的MRI半定量研究  

A semi-quantitative MRI study on brain developmental abnormalities in infants of gestational diabetic mothers

作　　者：孙菲 于金红 罗贺丹 苗延巍[2] SUN Fei;YU Jinhong;LUO Hedan;MIAO Yanwei(Department of Radiology,Dalian Women and Children Medical Group,Dalian 116001,China;Department of Radiology,First Affiliated Hospital of Dalian Medical University,Dalian 116011,China;Department of Radiology,Dalian Public Health Clinical Center,Dalian 116031,China)

机构地区：[1]大连市妇女儿童医疗中心(集团)放射科,大连116001 [2]大连医科大学附属第一医院放射科,大连116011 [3]大连市公共卫生临床中心放射科,大连116031

出　　处：《磁共振成像》2024年第12期87-93,共7页Chinese Journal of Magnetic Resonance Imaging

摘　　要：目的探讨基于T1WI、T2WI、T2液体衰减反转恢复(fluid attenuated inversion recovery,FLAIR)、扩散加权成像(diffusion-weighted imaging,DWI)序列半定量分析探究妊娠期糖尿病婴儿(infant of gestational diabetic mothers,IDMs)脑发育异常改变的价值。材料与方法回顾性纳入54例IDMs为观察组(IDMs组),同期无高危围产因素孕妇分娩的70例婴儿作为健康对照(healthy control,HC)组。根据出生胎龄是否小于37周,将IDMs组及HC组分别分为早产儿IDMs A组(27例)、HC A组(33例)和足月儿IDMs B组(27例)、HC B组(37例)。行1.5 T MRI颅脑T1WI、T2WI、T2 FLAIR及DWI序列扫描,选取小脑半球、杏仁核、海马、颞叶白质、豆状核、尾状核、丘脑腹外侧核、内囊后肢、胼胝体压部、额叶白质、枕叶白质、顶叶白质、半卵圆中心及咬肌的最大层面手动绘制设置感兴趣区(region of interest,ROI),测量各ROI的信号强度及表观扩散系数(apparent diffusion coefficient,ADC)值,计算出各个区域/咬肌的T1、T2平均信号强度比值(signal intensity ratio,SIR)(SIR_(T1)、SIR_(T2)、SIR_(T2 FLAIR))。比较各比值及ADC值的组间差异,通过受试者工作特征(receiver operating characteristic,ROC)曲线评价诊断效能,采用DeLong检验比较各曲线下面积(area under the curve,AUC)的差异性。观察MR强度比值与母亲75 g口服葡萄糖耐量试验(Oral Glucose Tolerance Test,OGTT)的血糖水平之间的关联性。结果与HC组相比,IDMs组枕叶、豆状核、尾状核、内囊后肢、丘脑腹外侧核、顶叶、额叶、半卵圆中心的SIR_(T1)、所有区域SIR_(T2)、除枕叶及内囊后肢其他区域的SIR_(T2)FLAIR、颞叶的ADC值均降低(P<0.05)。分层分析后发现,IDMs A组小脑半球、内囊后肢、丘脑腹外侧核、半卵圆中心的SIR_(T1)、所有区域的SIR_(T2)、除枕叶及胼胝体压部外其他部位SIR_(T2)FLAIR均低于HC组;IDMs B组额叶、顶叶的SIR_(T1)、所有区域SIR_(T2)、小脑半球、颞叶的ADC值Objective:To investigate the value of semi-quantitative analysis based on T1WI,T2WI,T2 fluid attenuated inversion recovery(FLAIR),and diffusion-weighted imaging(DWI)sequences in exploring abnormal brain development changes in infants of gestational diabetic mothers(IDMs).Materials and Methods:A total of 54 cases of DMs were retrospectively included as the observation group(IDMs group),while 70 infants born to mothers without high-risk perinatal factors during the same period served as the healthy control(HC)group.Based on whether the gestational age at birth was less than 37 weeks,the IDMs group and the HC group were further divided into preterm infants:27 in the IDMs A group and 33 in the HC A group,and term infants:27 in the IDMs B group and 37 in the HC B group.A 1.5 T MRI was performed using T1WI,T2WI,T2 FLAIR,and DWI sequences.Regions of interest(ROI)were manually drawn on the maximum slices of the cerebellar hemispheres,amygdala,hippocampus,temporal lobe white matter,globus pallidus,caudate nucleus,ventrolateral thalamic nucleus,posterior limb of the internal capsule,splenium of the corpus callosum,frontal white matter,occipital white matter,parietal white matter,centrum semiovale,and masseter muscles,measuring the signal intensity and apparent diffusion coefficient(ADC)values of each ROI.The mean signal intensity ratios(SIR_(T1),SIR_(T2),SIR_(T2 FLAIR))of each region/masseter muscle were calculated.Differences in these ratios and ADC values between groups were compared,and the diagnostic efficacy was evaluated using receiver operating characteristic(ROC)curves,with DeLong's test applied to compare the differences in the area under the curve(AUC).The relationship between MR intensity ratios and maternal 75 g oral glucose tolerance test(OGTT)blood glucose levels was also observed.Results:Compared with the HC group,the IDMs group showed reduced SIR_(T1)in the occipital lobe,globus pallidus,caudate nucleus,posterior limb of the internal capsule,ventrolateral thalamic nucleus,parietal lobe,frontal lobe,and cent

关 键 词：妊娠期糖尿病婴儿 脑发育 磁共振成像 扩散加权成像 信号强度比值 

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]