弥散加权成像与振幅整合脑电图在评估脑白质损伤早产儿神经发育预后的研究

Application of DWI and aEEG in assessing the neurodevelopmental prognosis of premature infants with WMD

目的:探讨磁共振成像(MRI)弥散加权成像(DWI)与振幅整合脑电图(aEEG)在评估脑白质损伤(WMD)早产儿神经发育预后的应用价值。方法:选取医院诊治的107例早产儿的临床资料,根据早产儿有无WMD将其分为WMD组(35例)和非WMD组(72例),均予以DWI与aEEG检查。对比两组早产儿额叶、基底叶、背侧丘脑、内囊后肢、放射冠等部位的表观弥散系数(ADC)值和各向异性分数(FA)值;观察两组早产儿aEEG各参数评分,包括连续性、睡眠-觉醒周期、下边界振幅、波谱带宽度与下边界振幅变化及总分;评估ADC值、FA值及aEEG评分诊断WMD早产儿神经发育情况的受试者工作特征(ROC)曲线下面积(AUC)值、灵敏度和特异度。结果:WMD组早产儿额叶、基底叶、背侧丘脑、内囊后肢、放射冠等部位的ADC值均高于非WMD组,差异有统计学意义(t=4.320,t=6.788,t=3.786,t=2.953,t=5.339;P<0.05),而WMD组额叶、基底叶、背侧丘脑、内囊后肢以及放射冠等部位的FA值均低于非WMD组,差异有统计学意义(t=4.738,t=4.005,t=5.038,t=3.746,t=8.707;P<0.05)。WMD组早产儿aEEG各参数的连续性、睡眠-觉醒周期、下边界振幅、波谱带宽度与下边界振幅变化及总分均低于非WMD组,差异有统计学意义(t=3.746,t=3.197,t=4.602,t=4.054,t=4.350;P<0.05)。ROC曲线分析显示,ADC值、FA值及aEEG评估WMD早产儿神经发育情况的AUC值分别为0.764、0.912和0.628,灵敏度分别为65.70%、91.70%和50.00%,特异度分别为86.10%、88.60%和100.00%。结论:DWI与aEEG在评估WMD早产儿神经发育预后状况中具有重要价值,尤其是DWI具有较高的灵敏度和特异度。

Objective:To explore the application value of MR diffusion-weighted imaging(DWI)and amplitudeintegrated electroencephalogram(aEEG)in assessing the prognosis of neurodevelopment of premature infants with white matter damage(WMD).Methods:The clinical data of 107 premature infants who admitted to hospital were selected.They were divided into WMD group(n=35)and non-WMD group(n=72)according to whether there was WMD,and all of them were examined by DWI and aEEG.The apparent diffusion coefficient(ADC)value and fractional anisotropy(FA)value in the frontal lobe,basal lobe,dorsal thalamus,posterior limb of internal capsule and corona radiation were compared between the two groups.The scores of various parameters of aEEG that included continuity,sleep-wake cycle,lower boundary amplitude,band width of spectrum,the change of lower boundary amplitude and total score between two groups were observed.The area under curve(AUC)value of receiver operating characteristics(ROC),sensitivity and specificity of ADC value,FA value and aEEG score in diagnosing neurodevelopmental status of premature infants with WMD were assessed.Results:The ADC values of the frontal lobe,basal lobe,dorsal thalamus,posterior limb of internal capsule,and corona radiation of WMD group were significantly higher than those of non-WMD group(t=4.320,t=6.788,t=3.786,t=2.953,t=5.339,P<0.05),while the FA values of frontal lobe,basal lobe,dorsal thalamus,posterior limb of internal capsule,and corona radiation of WMD group were significantly lower than those of non-WMD group(t=4.738,t=4.005,t=5.038,t=3.746,t=8.707,P<0.05),respectively.The continuity,sleep-wake cycle,lower boundary amplitude,band width of spectrum,the change of lower boundary amplitude and total score of WMD group were significantly lower than those of non-WMD group(t=3.746,t=3.197,t=4.602,t=4.054,t=4.350,P<0.05),respectively.ROC curve analysis showed that the AUC values of ADC value,FA value and aEEG value were respectively 0.764,0.912 and 0.628 in assessing the neurodevelopmental status of premature infant with WMD.The sensitivities of them were respectively 65.70%,91.70%and 50.00%,and the specificities of them were respectively 86.10%,88.60%and 100.00%.Conclusion:DWI and aEEG have great value in assessing the neurodevelopmental prognosis of premature infants with WMD,especially DWI,which has higher sensitivity and specificity.