磁共振常规系列及DWI对新生儿缺氧缺血性脑病早期诊断及预后评估的价值探讨

Clinical comparison of conventional MRI and DWI in the early diagnosis and prognostic evaluation of hypoxic-ischemic encephalopathy

目的探讨磁共振常规系列及磁共振弥散加权成像(DWI)对新生儿缺氧缺血性脑病(HIE)的早期诊断及预后评估价值。方法选择2016年1月—2016年3月我院儿科住院部收治的HIE患儿70例为观察组,选择同期正常足月新生儿70例为对照组,均行MRI常规系列和DWI扫描。结果轻中度HIE患儿易损区为皮质及皮质下白质(矢状旁区);重度HIE患儿以中央前回皮质和壳核、丘脑腹外侧核等深部灰质为主;轻度HIE患儿各项ADC值和中度HIE患儿的丘脑腹外侧核ADC值与对照组相比,差异无统计学意义(P>0.05);中、重度HIE患儿内囊后肢、额叶深部白质ADC值以及重度HIE患儿的丘脑腹外侧核ADC值均低于对照组,差异有统计学意义(P<0.05);轻、中、重度HIE患儿的豆状核ADC值与对照组相比,差异无统计学意义(P>0.05)。结论与常规MRI相比,DWI能早期发现HIE病变,可根据ADC值准确判断脑损伤程度,两者联合检查对HIE患儿的早期诊断和预后评估准确性更高。

Objective Top investigate the clinical effects of conventional magnetic resonance imaging（MRI）and diffusion weighted imaging（DWI） in the early diagnosis and prognostic evaluation of hypoxic-ischemic encephalopathy（HIE）. Methods 70 HIE children in the pediatric inpatient department of hospital from January2016 to March 2016 were selected as observation group,and 70 normal full-term infants were selected as control group at the same time. All children were given conventional MRI and DWI scanning. Results The area of vulnerability of mild-moderate HIE children were cortex and subcortical white matter（parasagittal region）;The area of vulnerability of severe HIE children was mainly deep gray matter such as precentral gyrus cortex and putamen,ventrolateralthalamus;The each ADC value of mild HIE children and the ADC value of ventrolateralthalamus of moderate HIE children were compared with control group,there was no statistical difference（P〉0.05）;The ADC value of posterior limb of internal capsule,frontal lobe deep white matter in moderate-severe HIE children,and the ADC value of ventrolateralthalamus in severe HIE children were lower than control group（P〈0.05）;The putamen ADC value of mild,moderate,severe HIE children were compared with control group,there was no statistical difference（P〈0.05）. Conclusion Compared with conventional MRI,DWI can early detect pathological changes of HIE children,and it can accurately judge severity of brain injury according to ADC value. The joint detection of MRI and DWI has higher accuracy in the early diagnosis and prognostic evaluation of HIE children.