3.0T 1H-MRS扫描技术在新生儿胆红素脑病诊断及预后分析中的应用价值

Value of 3.0T ~1H-MRS Scanning in Diagnosis and Prognosis of Acute Bilirubin Encephalopathy

目的探讨3.0 T氢质子磁共振波谱成像(1H-MRS)技术在新生儿胆红素脑病(ABE)诊断及预后分析中的应用价值。方法选择100例接受3.0 T 1H-MRS扫描新生儿黄疸患儿,记录MRS各代谢物波谱特征,N-乙酰天门冬氨酸(NAA)/肌酸(Cr)、胆碱(Cho)/Cr、NAA/Cho、谷氨酰胺复合物-α(α-Glx)/Cr、谷氨酰胺复合物-β、γ(β、γ-Glx)/Cr、肌醇(mI)/Cr比值。比较不同血清胆红素(TB)水平、ABE患儿和非ABE患儿、不同ABE分级及预后的差异。采用受试者工作特征曲线(ROC)分析MRS对ABE诊断和预后预测效能。结果本组经临床诊断ABE患儿共34例(34.00%),ABE分级轻度19例,中度9例,重度6例,预后良好21例,预后不良13例。ABE患儿MRS图像时苍白球Cr、Cho波峰正常,NAA降低,β、γ-Glx波峰明显增高。β、γ-Glx/Cr比值随TB水平、ABE分级增高而增高(P<0.05),预后不良组β、γ-Glx/Cr比值显著高于预后良好组(P<0.05)。ABE组NAA/Cr低于非ABE组(P<0.05),预后良好组患儿NAA/Cr高于预后不良组(P<0.05)。ABE组mI/Cr高于非ABE组(P<0.05),但不同预后组mI/Cr并无差异(P>0.05)。联合NAA/Cr+β、γ-Glx/Cr+mI/Cr,NAA/Cr+β、γ-Glx/Cr诊断ABE、预测预后的曲线下面积(AUC)分别为0.895、0.971,均大于单独诊断。结论ABE患儿3.0 T 1H-MRS图像可出现异常信号,其中NAA/Cr、β、γ-Glx/Cr可能是诊断ABE和预后预测颇具价值指标。

Objective To explore the application value of 3.0 T proton magnetic resonance spectroscopy(1 H-MRS)in the diagnosis and analysis of prognosis of acute bilirubin encephalopathy.Methods 100 neonates with jaundice who underwent 3.0 T1 H-MRS scanning were selected.The spectral characteristics of metabolites of MRS,and NAA/Cr,Cho/Cr,NAA/Cho,α-Glx/Cr,β、gamma-Glx/Cr and mI/Cr ratio were recorded.The differences of the above indicators between different total serum bilirubin(TB),ABE and non-ABE,different ABE classification and prognosis were compared.ROC was used to analyze the diagnostic and prognostic efficacy of MRS in ABE.Results 34 cases(34.00%)of ABE were clinically diagnosed,19 cases with mild ABE grade,9 cases with moderate ABE grade,6 cases with severe ABE grade,21 cases with good prognosis and 13 cases with poor prognosis.On MRS images of ABE children,the Cr and Ch peaks of globus palli-dus were normal,NAA decreased,and the peaks ofβ、γ-Glx were significantly raised.The ratio ofβ、γ-Glx/Cr increased with the increase of TB level and ABE grade(P<0.05).The ratio ofβ、γ-Glx/Cr in poor prognosis group was significantly higher than that in good prognosis group(P<0.05).NAA/Cr in ABE group was lower than that in non-ABE group(P<0.05),and NAA/Cr in good prognosis group was higher than that in poor prognosis group(P<0.05).The mI/Cr of ABE group was higher than that of non-ABE group(P<0.05),but there was no difference between different prognostic groups(P>0.05).Combined NAA/Cr+β、γ-Glx/Cr+mI/Cr,NAA/Cr+β、γ-Glx/Cr for ABE diagnosis and prognosis prediction were 0.895 and 0.971 respectively,which were greater than that of single diagnosis.Conclusion Abnormal signals may appear on 3.0 T1 H-MRS images in children with ABE.NAA/Cr,beta andβ、γ-Glx/Cr may be valuable indicators for diagnosis and prognosis prediction of ABE.