缺氧缺血性脑病患儿表观扩散系数与行为神经测定评分的相关性研究

The correlation between apparent diffusion coefficient and neonatal behavioral neurological assessment in hypoxic ischemic encephalopathy

目的：探讨缺氧缺血性脑病（HIE）新生儿大脑ADC值与临床行为神经测定（NBNA）评分的相关性，从影像角度评价ADC值在HIE早期诊断中的价值。方法选取109例日龄在7 d内的HIE患儿行常规MRI和DWI检查，根据HIE分级标准分为轻度组43例、中度组38例、重度组28例；同期收集24例正常足月儿作为对照组。所有受试者均进行NBNA评分，并测量双侧额叶深部白质、顶叶深部白质、侧脑室旁白质、内囊后肢、丘脑腹外侧核、豆状核、胼胝体压部及脑干8个部位的ADC值。采用单因素方差分析比较各组间ADC值，采用Pearson相关分析各部位ADC值与NBNA评分的相关性。结果除豆状核和脑干外，额叶深部、顶叶深部、侧脑室旁白质和内囊后肢、丘脑腹外侧核及胼胝体压部的ADC值随脑损伤程度加重而依次减低。轻、中、重度组额叶深部白质ADC值分别为（1.82±0.33）×10-3、（1.77±0.34）×10-3、（1.62±0.31）×10-3 mm2/s，顶叶深部白质ADC值分别为（1.81±0.34）×10-3、（1.79±0.27）×10-3、（1.72±0.31）×10-3 mm2/s，侧脑室旁白质ADC值分别为（1.27±0.15）×10-3、（1.23±0.12）×10-3、（1.15±0.17）×10-3 mm2/s，内囊后肢ADC值分别为（1.08±0.09）×10-3、（0.97±0.07）×10-3、（0.84±0.06）×10-3 mm2/s，丘脑腹外侧核ADC值分别为（1.13±0.07）×10-3、（1.08±0.13）×10-3、（1.00±0.13）×10-3 mm2/s，胼胝体压部ADC值分别为（1.27±0.22）×10-3、（1.18±0.16）×10-3、（1.00±0.23）×10-3 mm2/s，3组间差异均有统计学意义（F值分别为61.27、16.27、23.26、72.70、26.73、66.09，P值均〈0.05）。轻、中、重度组NBNA评分分别为（36.8±1.4）、（33.5±1.6）、（29.3±2.6）分。额叶深部白质、顶叶深部白质、侧脑室旁白质、内囊后肢、丘脑腹外侧核及胼胝体压部ADC值与NBNA评分均呈正相关（r值分别为0.60、0.49、0.54、0.67、0.56、0.65，P值均〈0.05）。结论 HIE新生儿大脑相关ROI ADC值与NBNA评分具有相关性，二者结合能够更准确、客观地评价HIE脑损伤。

Objective To explore the correlation between apparent diffusion coefficient（ADC）and neonatal behavioral neurological assessment（NBNA） of newborns with hypoxic ischemic encephalopathy （HIE）,and to evaluate ADC in the early diagnosis of HIE from the imaging perspective. Method One hundred and nine neonates aged 0—7 days with HIE underwent conventional MRI and DWI. According to HIE grading standards, there were 43 neonates in the mild group, 38 in the moderate group, 28 in the severe group, and meanwhile 24 normal neonates with the same ages were selected as the control group. All cases were assessed with NBNA, and ADC values of bilateral frontal white matter, parietal white matter, periventricular white matter, posterior limb of the internal capsule（PLIC）, ventral lateral nucleus of＆nbsp;thalamus, lenticular nucleus, splenium of the corpus callosum, brainstem were measured. ADC values of different groups were compared by analysis of variance, and the correlations between ADC values of all ROIs and NBNA were analyzed by Pearson correlation. Results Except lenticular nucleus and the brainstem, ADC values of frontal white matter, parietal white matter, periventricular white matter and PLIC, ventral lateral nucleus of thalamus, splenium of the corpus callosum were decreased in the mild, moderate, severe group. In the mild, moderate, and severe group, the ADC values of frontal deep white matter were（1.82± 0.33）× 10-3,（1.77 ± 0.34）× 10-3 and（1.62 ± 0.31）× 10-3 mm2/s,while they were（1.81 ± 0.34）× 10-3,（1.79 ± 0.27）× 10-3 and（1.72 ± 0.31）× 10-3 mm2/s for the parietal deep white matter,（1.27 ± 0.15）× 10-3,（1.23 ± 0.12）× 10-3 and（1.15 ± 0.17）× 10-3 mm2/s for the periventricular white matter,（1.08 ± 0.09）× 10-3,（0.97 ± 0.07）×10-3 and（0.84±0.06）×10-3 mm2/s for the PLIC,（1.13±0.07）×10-3 ,（1.08±0.13）×10-3 and（1.00± 0.13）× 10-3 mm2/s for the ventral lateral nucleus of thalamus,（1.27 ± 0.22）× 10-3,（1.18 ± 0.16）× 10-3 and （1.00 ± 0.23）× 10-3 mm2/s for the splenium of the corpus callosum. There were statistically significant differences between the 3 groups （F=61.27,16.27, 23.26, 72.70, 26.73, 66.09,all P〈0.05）. In the mild, modreate and severe group, NBNA were（36.8 ± 1.4） in the mild group,（33.5 ± 1.6） in the moderate,and （29.3 ± 2.6） in the severe group. There was positive correlation between ADC values of frontal white matter, parietal white matter, periventricular white matter and PLIC, ventral lateral nucleus of thalamus, splenium of the corpus callosum and NBNA scores（r=0.60,0.49,0.54,0.67,0.56,0.65,all P〈0.05）. Conclusions There are correlations between ADC values of the related ROIs of HIE and NBNA scores. Combining two aspects might diagnose the brain injury of HIE more accurately and objectively.