超声声脉冲辐射力成像技术对新生儿缺氧缺血性脑损伤的初步临床研究

Primary study on brain injury in neonate hypoxic-ischemic encephalopathy by ultrasound acoustic radiation force impulse imaging

目的探讨超声声脉冲辐射力成像(ARFI)技术在评价缺氧缺血性脑病(HIE)新生儿脑损伤情况的临床应用价值。方法早产HIE组31例,足月HIE组20例,日龄、胎龄、性别相匹配;无颅脑损伤早产对照组30例,足月对照组52例。采用Siemens Acuson S2000超声诊断系统,探头为8V3、9L4、14L5、18L6(弹性成像使用9L4、14L5探头,ARFI模式使用4V1探头)。每例受检者均行常规颅脑二维超声及彩色多普勒检查,于ARFI模式下启动声触诊组织量化(VTQ)功能测量颅脑双侧顶叶、丘脑及大脑镰的VTQ值。结果(1)足月儿对照组颅脑顶叶与丘脑VTQ值稳定,即左、右对称,丘脑VTQ值大于顶叶和大脑镰(P<0.05);(2)足月HIE组双侧顶叶及丘脑、大脑镰VTQ值大于足月对照组,早产对照组双侧顶叶VTQ值大于足月对照组,早产HIE组双侧顶叶及右侧丘脑VTQ值大于足月HIE组,早产HIE组双侧顶叶及右侧丘脑VTQ值大于早产对照组,差异具有统计学意义(P<0.05)。结论ARFI能实时、敏感检测新生儿脑部不同部位正常与病变时VTQ值,有望成为新生儿特别是早产儿脑损伤早期诊断手段之一。

Objective To assess the brain injury in early neonate hypoxic-ischemic encephalopathy （HIE） by ultrasound acoustic radiation force impulse imaging （ARFI）. Methods Fifty-one neonate HIEs were classified into two subgroups by gestational age 〈 37 weeks, group prematures HIE, thirty-one with ges- tational age 〈 37 weeks and group term infants HIE, twenty with gestational age ≥37 weeks. Thirty healthy prematures （prematures group） and fifty-two healthy term infants （term infants group ） were enrolled as the control group. The ARFI （ Simens Acuson S2000 Ultrasound with 4V1 transducer） was applied to measure the virtual touch tissue quantification （VTQ） of the bilateral parietal lobe, thalamus the cerebral falx in each subject. Results The value of VTQ was stable in healthy term infants, The value of VTQ were symmetry in bilateral parietal lobe and thalamus and the value of VTQ in thalamus were higher than in the parietal lobe and cerebral falx. The value of VTQ was higher in the bilateral parietal lobe in the prematures group than those in the term infants（P 〈0.05）. Compared with the control group, the value of VTQ in the bilateral pa- rietal lobe and thalamus and the cerebral falx were higher in term infants with HIE （ P 〈 0.05 ）. Compared with the term group, the value of VTQ in the bilateral parietal lobe and the right thalamus were higher in the prematures with HIE （P 〈 0. 05 ）. The value of VTQ in the bilateral parietal lobe and the right thalamus were higher in prematures with HIE than those in the term infants with HIE （ P 〈 0. 05 ）. Conclusions ARFI is a real-time and sensitive method to detect the value of VTQ in the different spots of neonate brain. Thus ARFI is a useful tool to evaluate the brain injury in neonate with HIE, especially in prematures.