新生儿缺氧缺血性脑病MR快速评估的临床应用价值

Clinical Application Value of MR Rapid Assessment in Neonatal Hypoxic Ischemic Encephalopathy

目的探讨MR快速评估新生儿缺氧缺血性脑病（HIE）的最优序列组合及其应用价值。方法足月新生儿在出生后10天内由于围产期窒息行MRI,根据日龄分为出生4天以内（Ⅰ组或早期组）和出生4~10天（Ⅱ组或晚期组）两个亚组。两名评估者共同回顾性评估T1WI、T2WI、液体衰减反转恢复（FLAIR）、扩散加权成像（DWI）和矢状位T1WI及不同序列组合对HIE的分度,并计算与参考标准一致性（Kappa值）,确定MRI对HIE快速评价的最优序列组合。结果与参考标准比较,对新生儿HIE的分度评价,DWI在早期组评价的K值为最高（K=0.783）,T1WI在晚期组评价的K值为最高（K=0.704）。横轴位T1WI、T2WI和DWI联合序列评价与参考标准具有高度一致性（K=0.865）,依次增加FLAIR和矢状位T1WI序列到T1WI、T2WI和DWI联合其K值不变。结论MRI横轴位T1WI、T2W和DWI联合是快速评估新生儿HIE的最佳序列组合。

Objective To evaluate the clinical application value of MR rapid assessment in neonatal hypoxic ischemic encephalopathy（HIE）.Methods Term-born neonates underwent MR imaging within 10 days after birth because of perinatal asphyxia.All the neonates were divided into groups I（infants imaged 4 days） and II（infants imaged 4 days after birth）.Two investigators retrospectively interpreted the T1-weighted,T2-weighted,fluid-attenuated inversion recovery（FLAIR）,diffusion-weighted,sagittal T1-weighted MR images for grading of HIE.All assessments were compared with the standard reference by using the Kappa value to determine which techniques were best for grading of HIE.Results As compared with the standard reference,diffusion-weighted imaging（DWI） was the best in group Ⅰ for HIE grading（K =0.783） and T1-weighted imaging in group Ⅱ（K = 0.704）.The combination of T1,T2 and diffusion-weighted imaging performed best in both groups（K = 0.909 and 0.803）,When FLAIR and contrast-enhanced imaging were added,K values did not increase.Conclusion The combination of T1,T2 and diffusion-weighted MR imaging is the best way to quickly assess neonatal HIE.