摘要
目的 探讨磁共振弥散张量成像（DTI）在轻、重度足月窒息新生儿预后评估中的作用。方法 收集2013年1月至2015年12月在南通大学附属常州儿童医院新生儿科住院的25例窒息新生儿，其中轻度窒息组11例和重度窒息组14例；另将10例无脑损伤的足月儿设为对照组。所有患儿行颅脑常规磁共振和DTI检查，获取研究对象的7个感兴趣区（ROI）的表观弥散系数分数（ADC）值、各向异性（FA）值和体素量，以及白质纤维数量，分析不同程度窒息之间的差异，并对FA值与新生儿神经行为测定（NBNA）评分相关性进行分析。结果 1.丘脑FA值在对照组左、右两侧为0.54±0.08、0.56±0.15，在轻度窒息组为0.45±0.03、0.44±0.10，在重度窒息组为0.21±0.11、0.25±0.13；内囊后肢FA值在对照组左、右两侧为0.49±0.09、0.48±0.08，在轻度窒息组为0.37±0.08、0.38±0.03，在重度窒息组为0.20±0.04、0.19±0.13；丘脑和内囊后肢FA值在3组间差异有统计学意义（F＝9.12、9.11、8.18、8.55，均P〈0.05）。上纵束体素量在对照组左、右两侧为1 094±112、1 123±113，在轻度窒息组为986±111、1 009±144，在重度窒息组为450±116、671±126；内囊前肢体素量在对照组左、右两侧为947±104、1 237±184，在轻度窒息组为854±118、799±114，在重度窒息组为324±110、311±126；内囊后肢体素量在对照组左、右两侧为2 047±129、2 137±238，在轻度窒息组为1 843±233、1 753±247，在重度窒息组为867±118、999±167；上纵束、内囊前肢和内囊后肢体素量在3组间差异有统计学意义（F＝10.11、9.45、7.33、8.45、12.65、11.23，均P〈0.05）。扣带回白质纤维数量在对照组左、右两侧为245±72、405±94，在轻度窒息组为225±52、365±114，在重度窒息组为145±62、185±84；上额枕束白质纤维数量在对照组左、右两侧为56±19、212±33，在轻度窒息组为49±22、197±33，在重度窒息组为33±12、156±39；内囊后肢白质纤维数量在对照组左、右两侧为284±112、988±233，在轻度窒息组为234±67、678±234，在重度窒息组为114±67、188±84；扣带回、上额枕束和内囊后肢白质纤维数量在3组间差异有统计学意义（F＝3.11、3.45、9.88、9.12、7.45、8.88，均P〈0.05）。2.FA值与NBNA评分相关性分析：内囊后肢FA值与NBNA评分的等级相关系数rs为0.666，高于其他部位，以NBNA评分≥35作为预后良好的标准，可得内囊后肢FA值评估预后的ROC曲线，曲线下面积为0.816，P＝0.005。当内囊后肢FA值≥0.375时，患儿预后良好，其敏感度为73.1%，特异度为77.8%。结论 部分ROI的FA值、体素量和白质纤维的数量能定量反映窒息新生儿的脑白质损伤情况，其中内囊后肢FA值与NBNA评分相关性最显著，具有更加重要的意义，能为窒息患儿提供较为准确和客观的预后评估。
Objective To discuss the prognostic evaluation of magnetic resonance diffusion tensor imaging （DTI）in term neonates with mild and severe asphyxia.Methods Eleven neonates with mild asphyxia, 14 neonates with severe asphyxia and 10 control neonates were studied.All the neonates were examined by conventional magnetic resonance imaging（MRI） and DTI.Fraction anisotropy （FA） values, apparent diffusion coefficient （ADC） values, voxel numbers and fiber numbers were calculated in seven regions of interest（ROI） and compared among the 3 groups.The correlation between FA values and neonatal behavioral neurological assessment（NBNA）scores were analyzed.Results （1） FA values in the left and the right thalamus were 0.54±0.08 and 0.56±0.15 in control group, 0.45±0.03 and 0.44±0.10 in mild group, and 0.21±0.11 and 0.25±0.13, respectively in severe group .FA values in posterior limbs of internal capsule were 0.49±0.09 and 0.48±0.08 in control group, 0.37±0.08 and 0.38±0.03 in mild group, and 0.20±0.04, 0.19±0.13 in severe group; FA values in thalamus and posterior limbs of internal capsule had statistical differences among the 3 groups（F=9.12, 9.11, 8.18, 8.55, all P〈0.05）. Voxel numbers in the left and the right superior longitudinal fasciculus were 1 094±112 and 1 123±113 in control group, 986±111 and 1 009±144 in mild group, 450±116 and 671±126 in severe group.Voxel numbers in anterior limbs of internal capsule were 947±104 and 1 237±184 in control group, 854±118 and 799±114 in mild group, 324±110 and 311±126 in severe group.Voxel numbers in posterior limbs of internal capsule were 2 047±129 and 2 137±238 in control group, 1 843±233 and 1 753±247 in mild group, 867±118 and 999±167 in severe group.Voxel numbers in superior longitudinal fasciculus, anterior and posterior limbs of internal capsule had statistical differences among the 3 groups（F=10.11, 9.45, 7.33, 8.45, 12.65, 11.23, all P〈0.05）; Fiber numbers in the left and the right cingulate gyrus were 245±72 and 405±94 in control group, 225±52 and 365±114 in mild group, 145±62 and 185±84 in severe group.Fiber numbers in inferior front-occipital fasciculus were 56±19 and 212±33 in control group, 49±22 and 197±33 in mild group , 33±12 and 156±39 in severe group.Fiber numbers in posterior limbs of internal capsule were 284±112 and 988±233 in control group, 234±67 and 678±234 in mild group, 114±67 and 188±84 in severe group.Fiber numbers in cingulate gyrus, inferior front-occipital fasciculus and posterior limbs of internal capsule had statistical differences among the 3 groups （F=3.11, 3.45, 9.88, 9.12, 7.45, 8.88, all P〈0.05）. （2）The correlation between FA value and NBNA scores was analyzed： the correlation coefficient in posterior limbs of internal capsule was 0.666 which was higher than those of the other areas.The area under the ROC curve of FA values in anterior limbs of internal capsule was 0.816 （P=0.005）, used NBNA scores≥35 as a good outcome.FA values （≥0.375） in the posterior limbs of the internal capsules predicted a good outcome and the corresponding sensitivity and specificity was 73.1% and 77.8%, respectively.Conclusion In some ROIs, FA values, voxel numbers, and fiber numbers can quantitatively reflect the degree of white matter injury in neonates with asphyxia.Furthermore, the FA values in the posterior limbs of the internal capsules are closely correlated with NBNA scores, so it has more important clinical significance, and can accurately and objectively assess the prognosis in neonates with asphyxia.
出处
《中华实用儿科临床杂志》
CSCD
北大核心
2017年第18期1406-1411,共6页
Chinese Journal of Applied Clinical Pediatrics
基金
江苏省妇幼健康科研项目（F201612）
常州市科技支撑计划（CE20165027）
常州市卫计委重大科技项目（ZD201515）
常州市高层次卫生人才培养工程资助
关键词
婴儿
新生
窒息
弥散张量成像
各向异性
白质纤维束成像
Infant, newborn
Asphyxia
Diffusion tensor imaging
Fraction anisotropy
White matter fiber tractography
