表观弥散系数在新生儿缺血缺氧性脑病诊断及预后评估中的临床价值研究

Clinical Value Research of Apparent Diffusion Coefficient in Diagnosis and Prognosis Evaluation of Neonatal Hypoxic Ischemic Encephalopathy

目的研究表观扩散系数信号特征及其值在新生儿缺血缺氧性脑病(hypoxic-ischemic encephalopathy,HIE)诊断及预后评估中的价值。方法回顾性分析2021年1月—2023年1月在本院就诊且确诊为HIE的60例患儿的临床资料,并同时选取20例健康新生儿设为对照组,比较病变信号特征及不同序列病灶检出情况、不同病情程度与相应的表观弥散系数(apparent diffusion coefficient,ADC)。结果脑干及幕下、皮层及皮层下区、基底节核团区、丘脑区、深部白质区及内囊前、后肢病变扩散加权成像(diffusion weighted imaging,DWI)序列均表现为信号增高,即扩散受限;60例HIE患儿共检出136个病灶,DWI序列病灶检出率优于T1WI、T2WI及T1WI联合T2WI扫描,差异有统计学意义(χ^(2)=20.042,P<0.001);DWI序列阳性检出率优于其他序列,差异有统计学意义(χ^(2)=5.065,P=0.024)。以对照组作为参照,皮层及皮层下、丘脑区、深部白质区及内囊前、后肢ADC值与不同病情程度具有较高一致性,且具有统计学意义。结论DWI可以有效识别HIE且优于常规磁共振成像(MRI)序列,ADC值对HIE损伤的指标检测具有临床价值,可以为临床治疗过程提供一种无创、无潜在放射损伤的影像检查技术手段。

Objective To explore apparent diffusion coefficient signal characteristics and quantitative indicators of ADC values,observe their value in diagnosis and prognosis evaluation of neonatal ischemic hypoxic encephalopathy.Methods The paper reviewed and analyzed 60 pediatric patients with HIE diagnosis from January 2021 to January 2023,and collected 20 healthy newborns as control group.Signal characteristics of lesions,detection of lesions in different sequences,comparison of different disease severity and corresponding ADC were observed.Results DWI sequences of brainstem and subcortical regions,cortical and subcortical regions,basal ganglia nuclei,thalamic regions,deep white matter regions and anterior and posterior limb lesions of internal capsule showed increased signal and limited diffusion.136 lesions were detected among 60 HIE patients,and detection of lesions in DWI sequence was better than T1WI,T2WI,and T1WI combined with T2WI scanning,with statistically significant difference(chi square 2=20.042,P<0.001).Positive detection rate of DWI sequence was better than other sequences,with statistically significant difference(chi square 2=5.065,P=0.024).Compared with control group,ADC values of cortex,subcortical,thalamic area,deep white matter area and anterior and posterior limbs of internal capsule were highly consistent and statistically significant with different disease severity groups.Conclusion DWI functional imaging can identify HIE effectively,which is better than routine MR sequences.Apparent diffusion coefficient ADC value has clinical value in monitoring indicators of HIE injury,and can provide non-invasive and potential radiation free imaging technique in clinical treatment.