摘要
目的探讨多回波采集增强T_2*加权血管成像(ESWAN)序列结合扩散张量成像(DTI)对新生儿缺氧缺血性脑病(HIE)的诊断价值。方法选取我院2012年1月—2015年1月间收治的40例HIE新生儿作为观察组,选取同期在我院生产的20例正常足月新生儿作为对照组,2组新生儿的检查时间和胎龄差异均无统计学意义(均P>0.05)。对2组新生儿均行常规MRI(T_1WI、T_2WI)、ESWAN和DTI扫描,统计观察组出血灶数目,并采用t检验比较观察组病灶和对照组中与观察组病灶对应部位的R2*值、相位值和各向异性分数(FA)值的差异。结果 ESWAN和常规MRI(T_1WI、T_2WI)显示出血部位主要位于脑干、额叶、枕叶、颞叶、室管膜下、脑室、小脑和蛛网膜下腔8个区域,出血表现为:(1)脑实质和室管膜下出血点在常规MRI上表现为短线状、稍低或等T1、稍高或低T_2信号影;17例ESWAN显示的出血灶数目多于常规MRI,显示出血灶面积也大于常规MRI,且边界更为清楚;3例MRI上未能显示出血灶,而ESWAN显示出微小的出血灶。(2)脑室出血在MRI上表现为类圆形的T1等或稍高信号、T_2等或稍低信号,ESWAN显示为团状或点状低信号影,轮廓清晰。(3)蛛网膜下腔出血位于颞叶或枕叶,常规MRI上表现为T1线状稍高信号,T_2显示欠清晰,而ESWAN表现为线状低信号影。观察组40例患儿中,ESWAN共检出病灶173个,其中出血灶107个(61.8%),其余为脑白质损伤和弥漫性脑白质水肿病灶。常规MRI也检出病灶173个,其中出血灶仅75个(43.4%)。观察组新生儿病灶部位的R2*值显著高于对照组对应部位(P<0.05),而相位值和FA值低于对照组(均P<0.05)。结论 ESWAN检测HIE患儿出血病灶敏感、准确,而DTI检测脑白质损伤敏感性良好,两者结合应用能够准确评估HIE的脑损伤。
Objective To explore value of the combined application of enhanced T2 star weighted angiography （ESWAN） and diffusion tensor imaging in diagnosis of hypoxic-ischemic encephalopathy（HIE）. Methods Forty infants with HIE in our hospitial during January 2012 to January 2015 were chosen as the observation group, and 20 cases of normal full-term newborns admitted in the same period were chosen as control group. There was no significant difference in examination time and gestational age between the two groups （P〉0.05）. They underwent conventional T1WI, T2WI, ESWAN, and DTI scans, the number of hemorrhage foci was measured and the differences in R2＊value, phase value, and anisotropy fraction （FA） between the two groups were compared with t-test. Results ESWAN and MRI showed that the main sites of hemor-rhage were brain stem, frontal lobe, occipital lobe, temporal lobe, subependymal space, ventricle, cerebellum, and subarach-noid space. The manifestations of hemorrhage included, 1） the parenchymal and subependymal hemorrhage on the conven-tional MRI showed striped, mild hypointensity or isointensity on T1WI, and mild hyperintensity or hypointensity on T2WI. In the 17 cases with hemorrhage, the ESWAN could detect more hemorrhage foci and larger volume than the conventional MRI. The boundary of the hemorrhage was more clear on the ESWAN than on conventional MRI. Small hemorrhage could be de-tected on the ESWAN, but not on conventional MRI in 3 cases. 2） The ventricular hemorrhage on the conventional MRI showed round shape, and iso-or mild hyperintensity on T1WI, and ios-or mild hyporintensity on T2WI. While, the hemor-rhage showed patchy or spotted hypointensity with demarked border on the ESWAN. 3） The subarachnoid hemorrhage in the temporal or occipital areas showed striped mild hyperintensity on T1WI and blurry on T2WI on the conventional MRI, but showed linear low signal shadow on the ESWAN. In the observation group of 40 children, a total of 173 lesions were detected by ESWAN, including 107 hemorrhagic lesions （61.8％） and extensive white matter damage or edema. And 173 lesions were detected by conventional MRI, including 75 hemorrhagic lesions （43.4％）with the lesions. The R2＊value in observation group was significantly higher （P〈0.05）, but phase and FA values were significantly lower than that in the control group （P〈0.05）. Conclusion ESWAN is sensitive and accurate in detecting hemorrhage in HIE patients, while DTI is sensitive in detecting white matter injury. The combination of the two technologies can accurately assess HIE brain injury.
出处
《国际医学放射学杂志》
北大核心
2018年第1期22-26,共5页
International Journal of Medical Radiology
关键词
新生儿
缺氧缺血性脑病
磁共振成像
增强T2＊加权血管成像
扩散张量成像
Newborn
Hypoxic-ischemic encephalopathy
Magnetic resonance imaging
Enhanced T2 star weighted angiography
Diffusion tensor imaging
