^1H MRS联合MRI对新生儿缺氧缺血性脑病的诊断价值

The diagnostic value of ^1H MRS combined MRI for the newborns with hypoxic ischemic encephalopathy

目的探讨氢质子磁共振波谱成像(^1H MRS)联合磁共振成像(MRI)对新生儿缺氧缺血性脑病(HIE)的诊断价值。方法选取2014年5月至2017年7月我院收治的HIE新生儿60例,同期选取健康新生儿60例,所有新生儿均给予MRI、^1H MRS检查。结果与健康新生儿比较,HIE新生儿MRI主要特征为,白质、皮质、双基底节区T1WI高信号,幕上脑水肿均数/叶数升高,蛛网膜下腔和弥漫性脑颅出血,^1H MRS主要特征为,见氨酸及谷氨酞复合物a(CLx-a)峰、胆碱(Cho)峰、N-乙酰天门冬氨酸(NAA)峰、肌酸(Cr)峰但NAA峰低或部分病例NAA峰低于Cr峰,HIE新生儿NAA/Cr、NAA/Cho水平明显低于健康新生儿,HIE新生儿CLx-a/Cr、Lac/Cr水平明显高于健康新生儿,差异有统计学意义(P<0.05);在诊断HIE的敏感度、特异度、准确度方面,MRI分别为83.33%、80.00%、81.67%,^1H MRS分别为86.67%、83.33%、85.00%,^1H MRS联合MRI分别为96.67%、95.00%、95.83%,^1H MRS联合MRI明显高于MRI、^1H MRS,差异有统计学意义(P<0.05)。结论与健康新生儿比较,HIE新生儿的MRI、^1H MRS存在明显的异常特征,二者对HIE具有良好的诊断价值,且二者联合时具有更高的诊断价值,值得临床作进一步推广。

Objective：To discuss the diagnostic value of 1 hydrogen proton magnetic resonance spectral imaging（^1 H MRS）combined magnetic resonance imaging（MRI）for the newborns with hypoxic ischemic encephalopathy（HIE）.Methods：60 newborn with HIE were selected from May 2014 to July 2017 in our Hospital,60 healthy newborns were selected at the same time,all newborns were given MRI,^ 1 H MRS detection. Results：Compared with the healthy newborns,the HIE newborns features of the MRI,white matter and cortex,basal ganglia region T1 WI,high signal on screen brain edema mean higher/leaf number,subarachnoid and diffuse brain hemorrhage,the features of the ^ 1 h MRS,see the pancreatic phthalein compounds-a（CLx-a）,a peak n-acetyl aspartate（NAA）,choline（Cho）,creatine（Cr）,lactic acid（Lac）but low NAA or some cases NAA peak lower than Cr peak,NAA/Cr,NAA/Cho levels of HIE newborns were significantly lower than those of healthy newborn,CLx-a/Cr,Lac/Cr levels of HIE newborns were significantly higher than those of healthy newborn,the difference was statistically significant（P 0.05）. In the accuracy,sensitivity,specific degrees of HIE diagnosis,MRI were 83.33%,80.00%,81.67%,^ 1 H MRS were 86.67%,83.33%,85.00%,^ 1 H MRS joint MRI were 96.67%,95.00%,95.83%,^ 1 H MRS joint MRI were significantly higher than those of MRI,^ 1 h MRS,the difference was statistically significant（P 0.05）.Conclusions：Compared with the healthy newborn,HIE newborns MRI,^ 1 h MRS obvious have anomaly characteristics,both the diagnosis of HIE has good value,and the joint has higher diagnostic value,it′s worth for further clinical promotion.