苍白球T_(1)WI信号强度在新生儿高胆红素血症评估中的价值分析

Application of T_(1) signal intensity of globus pallidus in neonatal hyperbilirubinemia

目的探讨苍白球T1WI信号强度与新生儿高胆红素血症(NHB)程度的相关性。方法回顾性分析228例新生儿常规磁共振图像和临床实验室资料,按血清总胆红素峰值将患儿分为对照组(B0)、轻度NHB组(B1)、中度NHB组(B2)、重度NHB组(B3)和极重度-危险性NHB组(B4)。采用One-way ANOVA分析不同组别苍白球T1WI信号强度(T1G)、苍白球/壳核T1WI信号强度比值(G/P)、苍白球/脑白质T1WI信号强度比值(G/W)、苍白球/脑皮质T1WI信号强度比值(G/Gr)以及苍白球T1WI信号强度增加值(G-W)的差异,组内多重比较使用LSD法。将NHB组患儿的T1G、G/P、G/W、G/Gr和G-W分别与治疗前血清总胆红素峰值及暴露时间进行Pearson相关性分析。结果本研究共纳入B0组44例,B1组13例,B2组24例,B3组115例,B4组32例,各组T1G值为1175.09±314.60、1163.43±358.16、1134.50±323.65、1196.51±310.59、1176.37±260.44;G/P值为1.23±0.08、1.20±0.08、1.20±0.05、1.21±0.06、1.21±0.07;G/W值为1.59±0.13、1.57±0.13、1.54±0.10、1.57±0.11、1.57±0.12;G/Gr值为1.23±0.09、1.26±0.12、1.29±0.10、1.31±0.85、1.29±0.08;G-W值为434.19±135.19、422.19±153.25、399.77±143.35、434.37±132.13、421.78±112.48。5组间的G/Gr值差异有统计学意义(P<0.001),其中B0和B2、B3、B4组间差异有统计学意义(P=0.009、P<0.001、P=0.005),5组间的T1G、G/P值、G/W值及G-W值的差异均无统计学意义(P>0.05),NHB组苍白球T1WI信号强度相关值与胆红素峰值及暴露时间相关性分析结果显示仅G/P、G/W及G/Gr值与暴露时间呈负相关(r=-0.197,P=0.008;r=-0.206,P=0.006;r=-0.151,P=0.044),将日龄作为控制变量进行偏相关分析,G/P、G/W及G/Gr值与暴露时间之间也无显著相关性(r=-0.063,P=0.401;r=-0.101,P=0.179;r=-0.044,P=0.557)。结论中度以上高胆红素血症患儿G/Gr值会增高,但苍白球T1WI信号强度并不能反映胆红素血症的程度。

Objective To analyze the correlation between the signal intensity of globus pallidus(GP)on T1-weighted MRI and neonatal hyperbilirubinemia.Methods 228 neonates with hyperbilirubinemia were divided into 5 groups of B0(control,44),B1(mild,13),B2(moderate,24),B3(severe,115)to B4(extreme,32)according to the peak levels of serum total bilirubin.The brain MRI was retrospectively analyzed to compare the signal intensity of globus pallidus(T1G),G/P(GP to lentiform nucleus ratio),G/W(GP to white matter ratio),G/Gr(GP to gray matter ratio)and G-W(enhancement of GP signal intensity)in different groups using one-way ANOVA.Pearson correlation analysis was applied to investigate the correlation between GP,G/P,G/W,G/Gr,G-W,and serum total bilirubin peak value before treatment and the duration of exposure.Results There were significant differences(P<0.001)in the G/Gr(1.23±0.09,1.26±0.12,1.29±0.10,1.31±0.85,1.29±0.08)among the 5 groups.The differences of G/Gr between B0,B2,B3,B4 groups were statistically significant(P=0.009,P<0.001,P=0.005).There were no significant differences in T1G(1175.09±314.60,1163.43±358.16,1134.50±323.65,1196.51±310.59,1176.37±260.44),G/P(1.23±0.08,1.20±0.08,1.20±0.05,1.21±0.06,1.21±0.07),G/W(1.59±0.13,1.57±0.13,1.54±0.10,1.57±0.11,1.57±0.12),G-W(434.19±135.19,422.19±153.25,399.77±143.35,434.37±132.13,421.78±112.48)among different groups(P>0.05).Pearson correlation analysis showed that G/P(r=-0.063,P=0.401),G/W(r=-0.101,P=0.179),and G/Gr(r=-0.044,P=0.557)were negatively correlated with the duration of exposure.The T1G,G/P,G/W,G/Gr,and G-W were not correlated with serum total bilirubin peak value before treatment.Partial correlation analysis using age as correction factor also showed no correlation of all five values with bilirubin or the duration of exposure.Conclusion The G/Gr is increased in neonates with moderate,severe or extreme hyperbilirubinemia.However,T1G cannot reflect the degree of hyperbilirubinemia.