氢质子磁共振波谱和磁共振弥散加权成像早期诊断新生儿缺氧缺血性脑病的价值探讨

Investigate the value of diffusion weighted MRI and proton MRS in early diagnosing hypoxic-ischemic encephalopathy in full-term infants

目的探讨磁共振弥散加权成像(DWI)的表观弥散系数值(ADC)和氢质子磁共振频谱(1H-MRS)在评价足月新生儿缺氧缺血性脑病(HIE)中的临床价值。方法32例足月HIE患儿和同期10例健康足月新生儿生后10d内行DWI和1H-MRS扫描,记录代谢产物1H-MRS波峰下面积和ADC值,并进行比较。结果(1)HIE组右侧基底节和额叶的乳酸/肌酸比值(Lac/Cr)较对照组升高,N乙酰天门冬氨酸/肌酸比值(NAA/Cr)、胆碱/肌酸比值(Cho/Cr)较对照组降低,差异有统计学意义(P均<0.05);轻度、中度、重度HIE组右侧基底节和额叶的Lac/Cr比值逐渐升高,均高于对照组(P均<0.05),右侧基底节NAA/Cr、Cho/Cr比值逐渐降低,均低于对照组(P均<0.05)。HIE的临床分度与右侧基底节和额叶的Lac/Cr呈正相关,与右侧基底节的NAA/Cr、Cho/Cr呈负相关。(2)HIE组左右两侧豆状核及右侧额叶深部白质ADC值较对照组降低,差异有统计学意义(P<0.05);HIE临床分度与左右两侧豆状核及右侧额叶深部白质的ADC值为负相关。(3)右侧基底节NAA/Cr与左右两侧豆状核ADC值呈正相关。结论DWI和1H-MRS对新生儿HIE的临床诊断有重要临床意义,将两者结合可更好地评价脑损伤的严重程度,为临床诊疗提供有力依据,值得深入研究及推广。

Objective To investigate the value of using diffusion-weighted MR imaging （DWI） and proton magnetic resonance spectroscopy （1H-MRS） in evaluation of term neonates with hypoxic- ischemic encephalopathy （HIE）. Methods A total of 32 term neonates diagnosed HIE （ mild group, moderate group and severe group）and 10 spontaneously delivered normal term neonates received ＇H-MRS and DWI at 10d after birth. Areas of metabolizing production under wave crest and ADC values were recorded for statistical analysis. If P 〈 0. 05 obtain in difference is considered a statistically significant result. Results （ 1 ） Between control group and HIE group, the difference of Lac/Cr NAA/Cr , Cho/Cr in fight basal ganglia and frontal lobe was statistically significant （ P 〈 0. 05 ）. The Lac/Cr, NAA/Cr,Cho/Cr in right basal ganglia and Lac/Cr in right frontal lobe among control group, mild group, moderate group and severe group had statistically significant difference （P 〈 0. 05 ）. Among control group and mild group, control group and severe group, the difference of NAA/Cr in right frontal lobe was statistically significant （P 〈 0. 05 ）. The clinical grading of HIE correlated with Lac/Cr in right basal ganglia and frontal lobe positively, and correlated with NAA/Cr, Cho/Cr in right basal ganglia negatively （P〈 0.01）. （2） Between control group and HIE group, the difference of ADC values in right and left lenticular nucleus, right deep white matter of frontal lobe was statistically significant （P 〈 0. 05 ）. The clinical grading of HIE correlated with ADC values in right and left lenticular nucleus, right deep white matter of frontal lobe negatively （ P 〈 0. 01 ）. （ 3 ） NAA/Cr in right basal ganglia correlated with ADC values in right and left lenticular nucleus positively （P 〈 0. 05 ）. Conclusion DWI and 1 H-MRS have important meaning in HIE clinical diagnosis. Combining DWI and 1H-MRS could enhance early diagnosis and reduce missed diagnosis of HIE in order to better evaluate brain injury and provide more powerful evidence for clinical diagnosis and treatment.