磁化传递成像和酰胺质子转移成像联合评价新生儿脑损伤的初步研究

Evaluation of brain injury in neonates by magnetization transfer imaging combined amide proton transfer imaging: a preliminary study

目的应用酰胺质子转移成像(amide proton transfer,APT)联合磁化传递(magnetization transfer,MT)成像对新生儿从脑内环境角度评估新生儿脑损伤。材料与方法新生儿共38名,脑损伤13例,为病例组;常规MRI检查脑内无异常25例为对照组。常规MRI检查后补充APT-MT成像扫描。测量所有新生儿双侧额叶深部白质、基底节区、枕叶深部白质的APT值以及磁化传递率(magnetization transfer ratio,MTR)值(以下用APT/MTR表示),以及病例组病灶区及其对侧的APT/MTR值。采用SPSS 19.0软件进行统计分析。结果 (1)对照组中,额叶深部白质、基底节及枕叶深部白质APT/MTR值均有显著性差异(P<0.05)。(2)对照组中,APT/MTR值随孕龄增长而逐渐升高。(3)病例组病灶内APT/MTR值低于对侧(P<0.05)。结论围产期缺氧缺血是全脑代谢变化,APT-MT成像可从内环境及分子水平评估新生儿脑损伤。

Objective： To evaluate neonatal brain injury at the internal environmental level with the application of amide proton transfer（APT） imaging and magnetization transfer（MT） imaging by measuring the APT and MTR values of the brain. Materials and Methods： A total of 38 neonatal patients who underwent MRI examination were enrolled in the study. Among them, there were 25 newborns with no abnormalities and 13 cases with brain injury who underwent conventional MRI（T1WI, T2 WI, DWI） examination. After obtaining informed consent and permission of clinicians, routine MRI was followed by additional APT-MT scan. APT-MT imaging is single slice scanning, performed at the basal ganglia level in all neonates, and in the case group, with increased localization at the level of lesion, and with the contralateral relatively normal area as self-control. The APT/MTR values of bilateral frontal subcortical white matter, basal ganglia and occipital subcortical white matter were measured for all neonates, as well as the APT/MTR values of the lesion and contralateral areas. Several statistical methods were used for statistical analysis. Results： In the control group, bilateral frontal subcortical white matter, basal ganglia and occipital subcortical white matter had no significant difference in APT/MTR values（P〉0.05）. Between the different parts of the brain, the differences among the APT/MTR of the frontal lobes, basal ganglia, and occipital lobes were significant, P〈0.05. In addition, the APT/MTR values of the above brain regions were found to have a positive correlation with gestational age. In the case group, there were significant differences in APT values between the lesion side and contralateral area, being significantly lower in lesion side than the contralateral side（P〈0.05）. Conclusions： From changes in the p H level in the neonatal brain, APT-MT imaging can help to understand neonatal brain injury.