3D-ASL联合DWI对足月新生儿缺血缺氧性脑病的临床诊断价值

Diagnostic Value of 3D-ASL Combined with DWI in Neonatal Hypoxic-ischemic Encephalopathy

目的探讨三维动脉自旋标记成像(3D-ASL)联合弥散加权成像(DWI)对新生儿缺氧缺血性脑病(HIE)的诊断价值。方法以临床诊断结果作为诊断"金标准",对临床诊断为HIE的23例足月新生儿(HIE组)及23例无HIE病史的足月新生儿(对照组)行常规MRI(T_(1)WI、T_(2)WI、T_(2)FLAIR)、3D-ASL和DWI扫描。对3D-ASL图像进行后处理获得伪彩图,并在此图上选择双侧基底节、丘脑、额顶叶白质区、双侧小脑半球及小脑蚓部为ROI,测量两组r CBF值并分析;对3D-ASL及DWI均为阳性的病变范围进行测量并统计两者之间的一致性。结果HIE组中除双侧顶叶白质外,双侧基底节区、丘脑、额叶白质、小脑半球及小脑蚓部的r CBF较对照组差异均有统计学意义(P<0.05);HIE组中常规MRI、DWI及3D-ASL图像均呈阳性表现的11例,其中DWI与3D-ASL均显示阳性并可对应的病变有40个,且均为小灶性,3D-ASL与DWI病变的面积大小差异无统计学意义;HIE组中常规MRI或DWI图像为阳性,而3D-ASL图像为阴性的8例;常规MRI及DWI图像为阴性,而3D-ASL图像为阳性表现的1例;常规MRI、DWI及3D-ASL图像均呈阴性表现的3例。结论3D-ASL不仅可以反映足月新生儿HIE患者脑血流灌注的改变,更重要的是联合DWI及常规MRI大大减低了HIE的漏诊,并更精确地判断临床疗效及预后情况。

Objective to explore the diagnostic value of three dimensional arterial spin labeling(3D-ASL)perfusion weighted imaging combined with diffusion weighted imaging(DWI)in neonatal hypoxic ischemic encephalopathy(HIE).Methods the clinical diagnosis results were used as the gold standard.twenty-three full-term neonates(HIE group)with HIE and twenty-three full-term neonates(control group)without HIE were scanned with routine MRI(T_(1)WI,T_(2)WI,T_(2)FLAIR),3D-ASL and DWI.the 3D-ASL images can get pseudo-color maps after post-processing.On this map,the bilateral basal ganglia,thalamus,fronto-parietal white matter area,bilateral cerebellar hemisphere and cerebellar vermis were selected as ROI.the rCBF values of the two groups were measured and analyzed.the positive range of lesions in 3D-ASL and DWI were measured,and the two groups of consistency were calculated.Results Except for bilateral parietal white matter,the rCBF of bilateral basal ganglia,thalamus,frontal white matter,cerebellar hemisphere and cerebellar vermis in HIE group were significantly different from that in control group(P<0.05).there were 11 cases whose routine MRI,DWI and 3D-ASL images in HIE group all showed positive,which had 40 small lesions showed by both DWI and 3D-ASL.For small lesions,there was no significant difference in size between 3D-ASL and DWI.In HIE group,there were 8 cases whose routine MRI or DWI images were positive,while 3D-ASL images were negative;there was 1 case whose routine MRI and DWI images were negative,while 3D-ASL images were positive;there were 3 cases whose routine MRI,DWI and 3D-ASL images were negative.Conclusion 3D-ASL can not only reflect the changes of cerebral blood flow perfusion in full-term neonates with HIE,but also reduce the missed diagnosis of HIE by combining DWI and conventional MRI,and more accurately judge clinical therapeutic effect and prognosis.