基于常规MRI的蛛网膜下腔增宽婴儿脑结构特征与其早期神经行为发育结局关系的研究  

The relationship between brain structural features based on longitudinal MRI andneurobehavioral outcomes in infants with subarachnoid enlargement

作　　者：张雅 赵慧芳[1,2] 刘叶城 郑婕 刘军[1,2] 杨健 金超[1,2] Zhang Ya;Zhao Huifang;Liu Yecheng;Zheng Jie;Liu Jun;Yang Jian;Jin Chao(Department of Medical Imaging,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710006,China;Shaanxi Engineering Research Center of Computational Imaging and Medical Intelligence,Xi'an 710006,China;Department of Medical Imaging,Xi'an Children's Hospital,Xi'an 710003,China)

机构地区：[1]西安交通大学第一附属医院医学影像科,西安710006 [2]陕西省计算影像与医疗智能工程研究中心,西安710006 [3]西安市儿童医院影像科,西安710003

出　　处：《中华解剖与临床杂志》2025年第3期163-170,共8页Chinese Journal of Anatomy and Clinics

基　　金：国家自然科学基金(82271517,81971581);陕西省自然科学基础研究计划(2022JM-464)。

摘　　要：目的探讨基于常规MRI蛛网膜下腔增宽(ESS)婴儿的脑结构特征与其早期神经行为发育结局的关系。方法病例对照研究。纳入2019年1月—2023年6月于西安交通大学第一附属医院常规MRI检查诊断为ESS的116例婴儿,其中男87例、女29例,初检年龄0.7~10.0(4.8±2.2)个月。基于常规MRI T1与T2加权图像测量婴儿额部、颞部及前纵裂池蛛网膜下腔宽度,以及侧脑室Evans指数,评估硬膜下积液及白质髓鞘化发育成熟度。根据婴儿1~3岁随访时的神经发育结局进行分组。采用单因素和多因素logistic回归分析,比较神经行为发育正常组与神经行为发育异常组,以及神经行为发育异常组的3个亚组(运动发育落后、言语发育落后、癫痫)婴儿的临床资料(包括初检年龄、性别、出生体质量、早产、剖宫产,以及窒息、化脓性脑膜炎、先天性心脏病、黄疸、蛛网膜下腔出血等新生儿疾病史)和MRI评估指标(包括额部蛛网膜下腔宽度、前纵裂池蛛网膜下腔宽度、颞部蛛网膜下腔宽度、侧脑室扩大、硬膜下积液、白质髓鞘化程度),分析影响ESS婴儿早期神经行为发育异常的相关因素。结果116例ESS患儿随访至1~3岁,其神经行为发育评估结果:神经发育正常组24例(20.7%);神经发育异常组92例(79.3%),其中运动发育落后59例(50.8%)、言语发育落后22例(19.0%)、癫痫11例(9.5%)。神经行为发育正常组与神经行为发育异常组单因素、多因素logistic回归分析结果显示,初检年龄、侧脑室轻度扩大、早产、白质髓鞘发育延迟均是神经行为发育异常的影响因素(P值均<0.20),其中初检年龄是神经行为发育异常的独立危险因素(OR=1.295,95%CI:1.011~1.657,P=0.041)。神经行为发育正常组与神经行为发育异常3个亚组间单因素及多因素logistic回归分析结果显示:侧脑室轻度扩大(OR=0.244,95%CI:0.065~0.924,P=0.038)、早产(OR=3.646,95%CI:1.073~12.390,P=0.038)是运动发�Objective This study aimed to investigate the relationship between brain structure and early neurobehavioral outcomes in infants with subarachnoid enlargement based on routine MRI.Methods This is a case-control study.A total of 116 infants diagnosed with subarachnoid widening through routine MRI at the First Affiliated Hospital of Xi'an Jiaotong University from January 2019 to June 2023 were included in the study.Among these participants,87 were male and 29 were female,with ages ranging from 0.7 to 10.0(4.8±2.2)months at the time of the first assessment.Measurements taken included the width of the subarachnoid space(covering the frontal and temporal regions,as well the anterior longitudinal fissure),the Evans index of the lateral ventricles,myelination maturity,and clinical neurodevelopment outcomes,based on T1-and T2-weighted MRI images.The infants were grouped based on their neurodevelopmental outcomes at the 1-3-year follow-up.Univariate and multivariate logistic regression analyses were performed to compare the clinical data of infants and MRI evaluation indexes of infants with normal and abnormal neurobehavioral development,as well as among three subgroups with abnormal neurobehavioral development outcomes.This analysis aimed to identify factors affecting early neurobehavioral development in infants with subarachnoid enlargement.Clinical data included age at first inspection,sex,birth weight,preterm birth,mode of delivery,history of asphyxia,suppurative meningitis,congenital heart disease,jaundice,and subarachnoid hemorrhage.MRI evaluation indexes encompassed the width of the frontal subarachnoid space,width of the anterior longitudinal fissure,width of the temporal subarachnoid space,wild lateral ventricle enlargement,subdural effusion,and white matter myelin maturity.Results A total of 116 children were followed up until they were 1 to 3 years old,with the results of the neurobehavioral development assessment indicating the following:24 cases(20.7%)had normal neurodevelopment,while 92 cases(79.3%)exhibite

关 键 词：蛛网膜下腔 蛛网膜下腔增宽 婴幼儿 磁共振成像 早产 早期神经行为发育 预后 

分 类 号：R445.2[医药卫生—影像医学与核医学]