亚急性期^(1)H-MRS及DTI对中重度缺氧缺血性脑病新生儿预后评估的价值

The Value of Subacutemagnetic Resonance Spectroscopy and Diffusion Tensor Imaging in Evaluating the Prognosis of Neonatal Hypoxicischemic Encephalopathy

目的利用氢质子磁共振波谱成像(^(1)H-MRS)和扩散张量成像(DTI)技术,探讨亚急性期^(1)H-MRS代谢物比值和部分各向异性分数(FA)值对中重度缺氧缺血性脑病(HIE)足月新生儿预后评估的价值。方法搜集37例亚急性期中重度足月HIE患儿,分别选用TE 135 ms和TE 35 ms行头颅^(1)H-MRS三维多体素扫描及DTI检查,根据其12~18个月Gesell量表发育商(DQ)分为预后良好组(n=21)和预后不良组(n=16),比较两组间豆状核区N-乙酰天门冬氨酸(NAA)/肌酐(Cr)、胆碱(Cho)/Cr、NAA/Cho、乳酸(Lac)/Cr、Lac/NAA、Lac/Cho比值及各深部白质FA值的差异,应用受试者工作特征曲线(ROC)分析各指标预测HIE预后的价值,并与DQ进行相关性分析。结果内囊后肢、胼胝体压部及大脑脚FA值在预后不良组和预后良好组间存在显著性差异(P<0.05),且内囊后肢FA值预测HIE预后的效能最高;TE 135 ms NAA/Cho和TE 35 ms Lac/NAA在两组间存在统计学差异(P<0.05),但其预测效能均低于内囊后肢及胼胝体压部FA值。部分能区DQ与内囊后肢FA值呈正相关,而与TE 35 ms Lac/NAA呈负相关,但两者相关度不高。结论亚急性期DTI及^(1)H-MRS能有效预测中重度足月HIE患儿1岁时神经发育结局,内囊后肢FA值在预后评估的价值较高。

Objective Magnetic resonance spectroscopy(~^(1)H-MRS)and diffusion tensor imaging(DTI)were used to investigate the value of~^(1)H-MRS metabolite ratio and fractional anisotropy(FA)value in predicting the prognosis of full-term newborns with moderate severe hypoxic ischemic encephalopathy(HIE)in subacute stage.Methods 37 full-term newborns with subacute moderate and severe HIE were collected,TE=135 ms and TE=35 ms were used to perform 3 D multi-voxel~^(1)H-MRS scanning and DTI examination of the head.They were divided into good prognostic group(n=21)and bad prognostic group(n=16)according to the development quotient(DQ)of Gesell scale at 12-18 month.The differences of NAA/Cr,Cho/Cr,NAA/Cho,Lac/Cr,Lac/NAA,Lac/Cho of lenticular nucleus and FA values of deep white matter between the two groups were compared.Receiver operating characteristic curve(ROC)was used to analyze the prognostic value of each indicator in HIE,and the correlation analysis with developmental quotient(DQ)was conducted.Results There were significant differences in FA values of the posterior limb of the internal capsule,splenium of the corpus callosum and cerebral peduncle between the poor prognosis group and the good prognosis group(P<0.05),and the FA value of the posterior limb of internal capsule had the greatest efficacy in predicting the prognosis of HIE.TE=135 ms NAA/Cho and TE=35 ms Lac/NAA were statistically different between the two groups(P<0.05),but their predictive efficacy was lower than the FA values of posterior limb of internal capsule and splenium of the corpus callosum.DQ of some energy regions was positively correlated with the FA value of posterior limb of internal capsule,but negatively correlated with TE=35 ms Lac/NAA,but the correlation was not high.Conclusion Subacute stage DTI and^(1)H-MRS can effectively predict the neurological development outcome at the age of one year of full-term newborns with moderate severe HIE,and the FA value of posterior limb of internal capsule has a high value in the prognostic evaluation.