^(18)F-FDG PET在新生儿缺氧缺血性脑病中的临床应用

Cerebral glucose metabolism in neonatal hypoxic-ischemic encephalopathy:a study by ^(18)F-fluorodeoxyglucose positron emission tomography

目的对新生儿缺氧缺血性脑病(hypoxic-ischemic encephalopathy,HIE)患儿应用18氟脱氧葡萄糖(18F-FDG)正电子发射断层显像(PET)测定脑葡萄糖代谢,探讨PET测定脑葡萄糖代谢在新生儿HIE中的临床应用价值。方法选择健康足月新生儿9例、早产儿7例和HIE患儿8例,共24例,在注射37 MBq/kg18F-FDG后应用PET测定脑葡萄糖代谢。结果早产儿和健康足月新生儿脑18F-FDG PET显像,其葡萄糖代谢活性区主要在丘脑较高[SUV值分别为(0.71±0.11)、(1.74±0.41)],在大脑皮层较低;足月新生儿大脑皮层摄取的葡萄糖活性较早产儿为高,结构较为清晰;HIE患儿脑存在明显葡萄糖代谢异常,主要表现为:大脑皮层18F-FDG摄取量不一致,如损伤一侧明显低于对侧,或某区域低于其他区域;全脑葡萄糖代谢偏低,尤其是皮层下白质、丘脑、基底节等部位最明显。结论早产儿和健康足月新生儿脑18F-FDG PET显像有自身特点,HIE患儿脑存在明显葡萄糖代谢异常,应用18F-FDG PET测定脑葡萄糖代谢为判断新生儿脑组织损伤程度提供了新的方法。

Objective To study the clinical value of cerebral glucose metabolism measured by ^18F-fluorodeoxyglucose positron emission tomography （^18 F-FDG PET） in neonatal hypoxic-ischemic eneephalopathy （IdlE）. Methods Totally 24 neonates, including 9 full-term neonates, 7 preterm newborn infants, and 8 neonates in our department from Jan. 2004 to Dee. 2006 were subjected. All of them received ^18F-FDG PET imaging after the informed consent was signed by their parents and our study was approved by the Ethics Committee of Third Military Medical University. ^18F-FDG at a dose of 37 MBq/kg was injected to measure the cerebral glucose metabolism. Results The brain ^18F-FDG PET imaging showed that the uptake of ^18F-FDG was relatively more in the thalamus, and less in the cerebral cortex in the preterm and term newborn infants （P 〈 0.05）. The uptake of ^18F-FDG of the cerebral cortex in the preterm infants was less than that in the full-term infants （P 〈 0.05） , so the structure of brain ^18F-FDG PET imaging was a little fainter in the preterm neonates as compared with that of the full-term newborns. The cerebral glucose metabolism was significantly changed in the neonatal HIE as measured by ^18F-FDG PET. The cerebral uptake of ^18F-FDG was either unbalanced bilaterally or relatively low in some sites as compared with the other areas. Moreover, the uptake of ^18F-FDG in total brain was relatively low in some patients, especially in the areas of the hypophloeodal cerebral white matter, thalamus, and basal ganglia. Conclusion ^18F-FDG PET imaging shows different cerebral glucose metabolism in preterm and term infants. The cerebral glucose metabolism is significantly changed in neonatal HIE as measured by ^18F-FDG PET, so this imaging can be used to evaluate the brain function of neonatal HIE.