磁共振平扫联合弥散张量成像对新生儿脑损伤诊断价值研究

Study on the diagnosis value of MRI combined with diffusion tensor imaging of neonatal brain injury

目的探讨磁共振平扫联合弥散张量成像(diffusion tensor imaging,DTI)在新生儿脑损伤的诊断价值。方法回顾性分析新生儿科疑诊脑损伤行脑部磁共振成像(MRI)(T1WI、T2WI、T2 FLAIR、DWI及DTI)检查的45例图像,将其分为脑损伤组(A组)、有窒息史未见脑损伤组(B组)、正常组(C组),每组各15例,重点分析其DWI、各向异性分数(fractional anisotropy,FA)值、白质纤维束变化情况,归纳分析其特征及差异。FA值兴趣区选侧脑室旁、内囊后支、胼胝体膝部及压部、大脑脚区域。结果45例中,A组双侧脑室旁局部见T1WI高信号,T2WI低信号,T2FLAIR高信号或等信号,DWI见扩散受限信号,ADC值减低、兴趣区FA值减低,白质纤维束稀疏、毛糙,模糊;B组T1WI、T2WI、T2FLAIR、DWI未见异常信号,兴趣区FA值稍减低,内囊后肢FA值减低,白质纤维束稍毛糙,稀疏;C组无窒息史,磁共振平扫及DTI未见明显异常。并进行统计学两两比较,A组患儿较B组患儿FA值减低,B组患儿FA值较C组患儿降低,内囊后肢FA值减低较明显;A组患儿FA值较C组患儿降低,差异均具有统计学意义(P<0.05)。结论DTI在发现新生儿窒息后早期脑损伤较磁共振平扫敏感,通过FA值的测量,白质纤维束追踪可对损伤程度进行定量评估,指导临床医生进行早期干预治疗。

Objective To explore the diagnosis value of MRI combined with diffusion tensor imaging of neonatal brain injury.Methods Retrospective analysis of 45 cases neonatal brain injury MRI(T1WI、T2WI、T2FLAIR、DWI、DTI)in suspected diagnosis,They were divided into the brain injury group(A),without brain injury with history of asphyxia group(B),and the normal group(C),in each group 15 cases,analyzed DWI and fractional anisotropy(FA)value,and changes of white matter fiber tracts,and their characteristics and differences were induced.the ROI of FA values were selected as paraventricular,posterior branch of internal capsule,genu and pressing part of corpus callosum and cerebellar region.Results Forty-five cases of neonatal brain injury,in group A,T1WI high signal,T2WI low signal,T2FLAIR high signal or other signals were observed in bilateral paraventravular areas,diffusion restricted in DWI,ADC value decreased,FA value of decreased,and white matter fiber bundle was sparse,coarse and fuzzy.In group B,there were no abnormal signals on T1WI,T2WI,T2 FLAIR and DWI,the FA value of the interest area was slightly reduced,the FA value of the posterior limb of the inner capsule was reduced,and the white matter fiber tracts were slightly coarse and sparse.In group C,There was no history of asphyxiationand and no obvious abnormality was found in MRI and DTI.A pairwise comparison was conducted,and the FA value of children in group A was reduced compared with that in group B,the FA value of children in group B was lower than that in group C,the decrease of FA in posterior limb of internal capsule was obvious,the FA value of children in group A was lower than that in group C,and the difference was statistically significant(P<0.05).Conclusion DTI find that the early brain injury after neonatal asphyxia is more sensitive than MRI plain scan.By measuring the FA value,the white matter fiber bundle tracking could quantitatively assess the degree of injury and guide clinicians to conduct early intervention treatment.