早产儿缺氧缺血引起脑白质损伤的波谱成像研究

Study on MRS of leukoencephalopathy caused by hypoxic ischemic brain damage of premature

目的用氢质子磁共振波谱(1H-MRS)成像技术显示早产儿脑白质感兴趣区物质的代谢变化,评估该技术对脑白质病变早期发现、早期诊断、早期治疗的临床价值。方法选择2012年1月至2013年12月泰安市中心医院的早产儿脑白质病患者18例为观察组,经检查排除新生儿缺血缺氧性脑损伤(HIBD)早产儿38例作为对照组。均用选用点分辨波谱(PRESS)序列行三维多体素波谱采集。获得感兴趣区的N-乙酰天门冬氨酸(NAA)、胆碱(Cho)、肌酸(Cr)、乳酸(Lac)等代谢物的相对浓度及NAA/Cr、Cho/Cr、NAA/Cho比值,进行对比分析。结果在缺血缺氧引起的脑白质损伤中Lac、NAA、cr、Lac/cr、Lac/NAA、cho/cr、NAA/cr浓度及比率的变化,在患儿损伤早期、中期及晚期不同。观察组和对照组额叶、基底节Lac/cr、Lac/NAA、cho/cr、NAA/cr左侧顶叶、基底节cho/cr两组间比较差别无统计学意义(P>0.05),其余各项两组间差异有统计学意义(P<0.05)。结论 1H-MRS能早期诊断早产儿脑白质病变,并可用于临床病情监测、预后预测及疗效观察。

Object ive To evaluate the clinical value of 1H-MR spectroscopy （ MRS ） in early discovery,diagnosis and treatment of leukoencephalopathy,with the use of 1H-MRS to show the metabolic changes in ROI of white matter from premature with leukoencephalopathy.Methods In 18 prematures with leukoencephalopathy（as experimental group）and 38 those examined exempt from leukoencephalopathy（as control group） ,3D multi-voxel 1H-MRS were acquired with the use of PRESS（ point resolved spectroscopy） sequence to examine and analyze the relative concentration of NAA,Cho,Cr,Lac,etc,and the ratio of NAA/Cr,Cho/Cr and NAA/Cho in the ROI.Results The change caused by hypoxic-ischemic brain damage in concentration of Lac,NAA,Cr,Lac/Cr,Lac/NAA, Cho/Cr,NAA/Cr and the ratio of NAA/Cr,Cho/Cr and NAA/Cho varied in early,mid and late stages of the leukoencephalopathy.The differences of the ratio of Lac/Cr,Lac/NAA,Cho/Cr,NAA/Cr of frontal lobe and basal ganglia,Cho/Cr of the left parietal lobe and basal ganglia between experimental group and control group were not statistically significant（P〉0.05）,while the differences of the rest ratio between the two groups were statistically significant（P〈0.05）.Conclusions The 1HM-RS can be used for early diagnosing the leukoencephalopathy of premature , and for monitoring the clinical condition,prognosis and curative effect.