磁共振扩散张量成像联合1H-MRS技术在HIE诊断及病情评估中的应用

Application of MRI diffusion tensor imaging combined with 1H⁃MRS technology in HIE diagnosis and disease assessment

目的探究磁共振扩散张量成像(DTI)联合氢质子磁共振波谱(1H-MRS)技术在新生儿缺氧缺血性脑病(HIE)诊断及病情评估中的应用。方法选取本院HIE患儿108例作为观察组,另选取同期高胆红素血症患儿54例作为对照组。比较两组、观察组不同病情程度患儿DTI、1H-MRS技术参数,并对比观察组不同病情程度患儿神经行为发育(NBNA)评分,分析DTI、1H-MRS技术参数与病情程度、NBNA评分相关性及对HIE诊断价值。结果内囊后肢、内囊前肢、胼胝体压部、胼胝体膝部、半卵圆中心、额叶白质、豆状核各向异分数(FA)值、基底节区、额叶区N-乙酰天门冬氨酸/肌酸(NAA/Cr)、NAA/胆碱复合物(NAA/Cho)与HIE患儿病情程度呈负相关,与NBNA评分呈正相关(P<0.05)。内囊后肢、胼胝体压部、额叶白质FA值、基底节区NAA/Cr、NAA/Cho联合诊断HIE的AUC为0.888。结论DTI联合IH-MRS技术可为新生儿HIE早期诊断、病情程度评估提供有效影像学信息。

Objective To explore the application of diffusion tensor imaging(DTI)combined with 1H⁃magnetic resonance spectroscopy(1H⁃MRS)in the diagnosis and assessment of neonatal hypoxic⁃ischemic encephalopathy(HIE).Methods 108 children with HIE in our hospital were selected as the observation group,and 54 children with hyperbilirubinemia in the same period were selected as the control group.The DTI and 1H⁃MRS technical parameters of children with different disease levels in the two groups and the observation group were compared.The neonatal behavioral neurological assessment(NBNA)scores of children with different disease levels in the observation group were compared,and the correlation between DTI and 1H⁃MRS technical parameters and disease severity,NBNA scores and the diagnostic value of HIE were analyzed.Results The fractional anisotropy(FA)value of the posterior limb of internal capsule,anterior limb of internal capsule,splenium of corpus callosum,knee of corpus callosum,centrum semiovale,white matter of frontal lobe and lenticular nucleus,N⁃acetylaspartic acid/creatine(NAA/Cr)and NAA/choline complex(NAA/Cho)in basal ganglia and frontal lobe were negatively correlated with the severity of the disease in children with HIE,and positively correlated with the NBNA score(P<0.05).The AUC of the combined diagnosis of HIE by FA value of posterior limb of internal capsule,splenium of corpus callosum,white matter of frontal lobe,NAA/Cr and NAA/Cho in basal ganglia was 0.888.Conclusion DTI combined with 1H⁃MRS technology can provide effective imaging information for early diagnosis of neonatal HIE and assessment of disease severity.