磁共振T_(1)WI及波谱成像在新生儿急性胆红素脑病的临床应用价值

Clinical Value of Magnetic Resonance T_(1)WI and Magnetic Resonance Spectroscopy in Neonatal Acute Bilirubin Encephalopathy

目的 研究磁共振T_(1)WI信号比值及波谱成像在新生儿急性胆红素脑病的临床应用及其价值。方法 回顾性收集临床诊断为.急性高胆红素脑病的新生儿40例,男22例,女18例,年龄2-29天,平均(11.63±5.36)天。根据新生儿神经行为评分评定(neonata l behavioral neu ro logica l ass ess m ent,NBNA),NBNA≥35分的患儿作为轻症组21例,NBNA<35分作为重症组19例;同期选取18例健康或生理性黄疸的新生儿为对照组。所有新生儿均已进行M R平扫及波谱扫描,获得苍白球(globus pallidus)与壳核(putamen)T_(1)WI信号比值(G/P)及苍白球区波谱序列中肌酸(Cr)、天门冬氨酸(NAA)、胆碱(Cho)、谷氨酰胺(Glx)、肌醇(ml)等代谢产物峰值图,并以Cr作为基准参照物,与各代谢产物作相对定量计算比值。采用单因素方差分析(oneway ANOVA)比较3组间G/P值以及NAA/Cr、Cho/Cr、Glx/Cr、 ml/Cr比值。采用受试者操作特征曲线(ROC)分析各项指标的诊断效能。结果 轻症、重症及对照三组间患儿年龄和性别的差异均无统计学意义(均P>0.05),NAA/Cr、Cho/Cr、 Glx/Cr、ml/Cr及G/P差异存在统计学意义(P<0.05);在轻症组与重症组之间,Glx/Cr、ml/Cr及G/P的差异存在统计学意义(P<0.05),其诊断效能AUC值分别为0.724,0.754,0.708,当三者联合诊断时,AUC值达到0.917。结论 常规磁共振T_(1)WI信号比值结合波谱成像在诊断新生儿急性胆红素脑病严重程度方面具有重要的价值。

Objective To study the clinical application and value of magnetic resonance T_(1)WI signal ratio and spectral imaging in neonatal acute bilirubin encephalopathy.Methods Retrospectively collected 40 neonates with clinical diagnosis of acute hyperbilirubin encephalopathy,22 males and 18 females,aged 2-29 days,average(11.63±5.36)days.According to the neonatal behavioral neurological assessment(NBNA),21 children with NBNA≥35 were classified as mild symptoms,while 19 children with NBNA<35 were classified as severe symptoms;During the same period,18 healthy or physiological jaundice newborns were selected as the control group.All newborns have undergone MR plain and spectral scans to obtain whole brain T_(1)WI signal values and creatine(Cr),aspartic acid(NAA),choline(Cho),glutamine(Glx),myo-inositol(mI)and other metabolite peak graphs,and using Cr as the benchmark reference,the relative quantitative calculation ratio of each metabolite is made.One-way ANOVA was used to compare the T_(1)WI signal ratio(G/P)of globus pallidus and putamen,as well as NAA/Cr,Cho/Cr,Glx/Cr,mI/Cr ratio.Receiver operating characteristic(ROC)curve was used to analyze the diagnostic performance of each index.Results There were no significant differences in age and gender between the mild,severe and control groups(all P>0.05),but there were differences in NAA/Cr,Cho/Cr,Glx/Cr,mI/Cr and G/P There was statistical significance(P<0.05);between the mild group and the severe group,the differences in Glx/Cr,mI/Cr and G/P were statistically significant(P<0.05),and the diagnostic efficacy AUC values were 0.724,0.754,0.708,when the three were jointly diagnosed,the AUC value reached 0.917.Conclusion Conventional magnetic resonance T_(1)WI signal ratio combined with spectral imaging has important value in diagnosing the severity of neonatal acute bilirubin encephalopathy.