DWI对新生儿缺氧缺血性脑病的诊断价值

Diagnostic value of DWI in neonatal hypoxic-ischemic encephalopathy

目的:探讨DWI对新生儿缺氧缺血性脑病(HIE)的早期诊断价值,以及不同区域脑组织对于缺氧缺血性改变的敏感度差异。方法:选取临床诊断为HIE的足月患儿46例为实验组,选取56例同期出生无脑损伤的足月新生儿作为对照组,均于出生后7 d内行MRI检查。分别测量2组额叶白质、顶叶白质、颞叶白质、枕叶白质、半卵圆中心、豆状核、丘脑、内囊后肢、小脑齿状核、脑干及胼胝体11个区域的ADC值,比较2组不同区域脑组织ADC值的差异,并利用ROC曲线分析ADC值对HIE的诊断效能。结果:实验组额叶白质、顶叶白质、半卵圆中心、豆状核、丘脑、内囊后肢及胼胝体的ADC值均低于对照组,差异均有统计学意义(均P<0.05)。ROC曲线示,内囊后肢的AUC最大(0.837),以ADC值1.09×10^(-3) mm^(2)/s为临界值鉴别HIE患儿与健康新生儿时,诊断效能最佳。结论:DWI可早期诊断新生儿HIE;内囊后肢对于缺氧缺血导致的脑损伤较其他部位更为敏感。

Objective:To explore the early diagnosis value of DWI for neonatal hypoxic-ischemic encephalopathy(HIE),and the sensitivity of different brain regions to hypoxic-ischemic changes.Methods:46 cases of neonatal HIE were selected as the experimental group,and 56 cases of full-term newborns without brain injury were selected as the control group.All of them were examined by MRI within 7 d after birth.The ADC values were measured and compared respectively in eleven brain regions of two groups,including white matter of frontal lobe,parietal lobe,temporal lobe and occipital lobe,centrum semiovale,lenticular nucleus,thalamus,posterior limb of internal capsule,cerebellar hemisphere,brainstem and corpus callosum.ROC curve was applied to analyze the diagnostic performance of the ADC values to HIE.Results:The ADC values of the frontal white matter,parietal white matter,centrum semiovale,lenticular nucleus,thalamus,posterior limb of internal capsule and corpus callosum in the experimental group were lower than those in the control group,and the differences were statistically significant(all P<0.05).ROC curve showed that AUC of posterior limb of internal capsule was the largest(0.837).Taking ADC value of 1.09×10^(-3) mm^(2)/s as the critical value to distinguish neonatal HIE from healthy neonates,the diagnostic efficiency was optimum.Conclusions:DWI can be used for early diagnosis of neonatal HIE.The posterior limb of the internal capsule is more sensitive than other regions to brain hypoxic ischemic damage.