扩散张量成像在足月新生儿缺氧缺血性脑病诊断的应用价值

Application of Diffusion Tensor Imaging in Diagnosing Hypoxic Ischemic Encephalopathy in Full-Term Neonates

目的探讨扩散张量成像(DTI)的分数各向异性(FA)值在评价足月新生儿缺氧缺血性脑病(HIE)的应用价值。方法选择36例临床诊断为HIE的足月新生儿,分为轻、中和重度组,随机选择12例健康足月新生儿为对照。所有病例在生后一周内和6个月左右行DTI检查,测量内囊前肢、后肢、额叶白质、颞叶白质、顶叶白质和枕叶白质的FA值,并进行比较。结果出生后一周内DTI检查:中度组额叶、顶叶白质FA值较对照组降低,重度组内囊前肢、额叶、颞叶、顶叶和枕叶白质的FA值较对照组减低;重度组额叶、顶叶、枕叶白质FA值较轻度组减低,重度组额叶白质FA值较中度组降低,均有统计学差异(P<0.05)。6个月后复查:重度组额叶和顶叶白质FA值较对照组低,有统计学差异(P<0.05)。结论 DTI可对足月产HIE患儿脑白质病变进行定量观测,评价其病情,为评估新生儿缺氧缺血性脑病患者的预后提供有效依据,值得临床推广应用。

Objective To evaluate the fractional anisotropy （FA） values measured on diffusion tensor imaging （DTI） in diagnosing hypoxic ischemic encephalopathy （HIE） in full-term neonates. Methods Thirty-six full-term neonates with hypoxic ischemic encephalopathy were enrolled in this study, and the patients were divided into the mild, moderate and severe groups based on the clinical manifestation. Twelve healthy full-term neonates were used as the control group. DTI was carried out in all neonates in the first week after birth and six months after birth. FA values were measured at six regions of interest, including the anterior and posterior limb of internal capsule, white matter in frontal temporal, parietal and occipital lobes, and the results were statistically analyzed. Results Within one week after birth, FA values of the white matter in frontal temporal and parietal lobes in the moderate group were lower than those in the control group, and FA values of the white matter in anterior limb of internal capsule, frontal, temporal, parietal and occipital lobes in the severe group were also lower than those in the control group. In the severe group FA values of the white matter in frontal, parietal and occipital lobes were lower than those in the mild group, and FA values of the white matter in frontal lobes were lower than those in the moderate group, and the differences were statistically significant （P 〈 0. 05 ）. Six months after birth, FA values of thewhite matter in frontal and parietal lobes were lower than those in the control group, and the differences were statistically significant （P 〈 0. 05）. Conclusion DTI can be used in quantitatively determining the white matter changes in full-term neonates with HIE, providing useful information for the evaluation of its prognosis.