摘要
目的探讨超声剪切波弹性成像(SWE)对新生儿缺氧缺血性脑损伤(HII)的诊断价值。方法64例新生儿作为研究对象,应用超声SWE技术对其颅脑内感兴趣区(ROI)进行弹性测量,ROI分别为左右侧脑室及基底节区脑实质,弹性成像的剪切波速度转化为杨氏模量表示组织硬度。分析新生儿基本信息;比较正常儿新生儿与HII患儿双侧侧脑室及基底节弹性值;分析新生儿双侧侧脑室及基底节弹性诊断效能。结果64例新生儿中正常新生儿30例,HII患儿34例。HII患儿左右侧侧脑室以及基底节区的均值(mean)、最大值(max)、最小值(min)、标准差(sd)均小于正常新生儿,差有显著统计学意义(P<0.05)。基于弹性均值,右侧侧脑室的曲线下面积(AUC)[95%置信区间(95%CI)]、阈值、敏感度、特异度分别为1.00(1.00,1.00)、5.34 kPa、100.00%、100.00%;左侧侧脑室的AUC(95%CI)、阈值、敏感度、特异度分别为0.99(0.98,1.00)、5.20 kPa、97.06%、96.67%;基底节的AUC(95%CI)、阈值、敏感度、特异度分别为0.92(0.85,0.99)、6.32 kPa、88.24%、86,67%。基于弹性最大值,右侧侧脑室的AUC(95%CI)、阈值、敏感度、特异度分别为1.00(0.99,1.00)、11.37 kPa、97.06%、100.00%;左侧侧脑室的AUC(95%CI)、阈值、敏感度、特异度分别为0.98(0.95,1.00)、8.98kPa、94.12%、100.00%;基底节的AUC(95%CI)、阈值、敏感度、特异度分别为0.69(0.55,0.83)、13.10 kPa、58.82%、96.67%。基于弹性最小值,右侧侧脑室的AUC(95%CI)、阈值、敏感度、特异度分别为0.91(0.82,0.99)、3.22 kPa、100.00%、76.67%;左侧侧脑室的AUC(95%CI)、阈值、敏感度、特异度分别为0.73(0.60,0.86)、3.12 kPa、82.35%、66.67%;基底节的AUC(95%CI)、阈值、敏感度、特异度分别为0.76(0.63,0.88)、2.32 kPa、79.41%、76.67%。基于弹性标准差,右侧侧脑室的AUC(95%CI)、阈值、敏感度、特异度分别为0.98(0.96,1.00)、1.62 kPa、91.18%、96.67%;左侧侧脑室的AUC(95%CI)、阈值、敏感度、特异度分别为0.97(0.93,1.00)、1.62 kPa、94.12%、93.33%;基底节的AUC(95%CI)、阈值、敏感度、特异度分别为0.70(0.57,0.83)、2.19 kPa、58.82%、86.67%。左右侧侧脑室比基底节区的诊断效能好且与最小值和标准差相比,均值和最大值的诊断效能更高。结论超声SWE测量脑实质弹性能很好地区分HII和正常新生儿,最佳位置为左右侧侧脑室旁脑实质,最佳弹性参数为均值和最大值,值得临床推广。
Objective To explore the diagnostic value of ultrasonic shear wave elastography(SWE)in neonatal hypoxic ischemic injury(HII).Methods 64 neonates were used as study subjects,and the ultrasound SWE technique was applied to measure the elasticity of their intracranial regions of interest(ROIs),which were the right and left lateral ventricles and the brain parenchyma in the basal ganglia region,respectively,and the shear-wave velocity of elastography was converted into Young's modulus to indicate the stiffness of the tissues.The basic information of the neonates was analyzed;the elasticity of bilateral ventricles and basal ganglia were compared between normal neonates and HII neonates;the diagnostic efficacy of HII for elasticity of bilateral ventricle and basal ganglia in neonates was analyzed.Results There were 30 cases of normal neonates and 34 cases of HII neonates among the 64 neonates.The mean,maximum(max),minimum(min),and standard deviation(sd)of the right and left lateral ventricles as well as the basal ganglia region of HII neonates were smaller than those of the normal neonates,and the difference was statistically significant(P<0.05).Based on the mean elasticity,the area under the curve(AUC)[confidence interval(95%CI)],threshold,sensitivity and specificity of the right lateral ventricle were 1.00(1.00,1.00),5.34 kPa,100.00%and 100.00%,those of left lateral ventricle were 0.99(0.98,1.00),5.20 kPa,97.06%,and 96.67%,and those of basal ganglia were 0.92(0.85,0.99),6.32 kPa,88.24%,and 86,67%.Based on the maximum elasticity,the AUC(95%CI),threshold,sensitivity and specificity of the right lateral ventricle were 1.00(0.99,1.00),11.37 kPa,97.06%,and 100.000%,those of left lateral ventricle were 0.98(0.95,1.00),8.98 kPa,94.12%,and 100.00%,and those of basal ganglia were 0.69(0.55,0.83),13.10 kPa,58.82%,and 96.67%.Based on the minimum elasticity,the AUC(95%CI),threshold,sensitivity and specificity of the right lateral ventricle were 0.91(0.82,0.99),3.22 kPa,100.00%,and 76.67%,those of left lateral ventricle were 0.73(0.60,0.86),3.12 kPa,82.35%,and 66.67%,and those of basal ganglia were 0.76(0.63,0.88),2.32 kPa,79.41%,and 76.67%.Based on the standard deviation of elasticity,the AUC(95%CI),threshold,sensitivity and specificity of the right lateral ventricle were 0.98(0.96,1.00),1.62 kPa,91.18%and 96.67%,those of left lateral ventricle were 0.97(0.93,1.00),1.62 kPa,94.12%and 93.33%,and those of basal ganglia were 0.70(0.57,0.83),2.19 kPa,58.82%and 86.67%.The diagnostic efficacy of the left and right lateral ventricles was better than that of the basal ganglia,and the diagnostic efficacy of the mean and maximum values was higher than that of the minimum and standard deviation.Conclusion Ultrasonic SWE measurement of brain parenchymal elasticity can well distinguish HII and normal neonates,with the best location being the left and right lateral ventricle of the brain parenchyma,the best elastic parameters being the mean and maximum values,which is worthy of clinical promotion.
作者
施杨
任海悦
徐金锋
孙秀荣
陈玲玲
SHI Yang;REN Hai-yue;XU Jin-feng(Department of Ultrasound,Shenzhen People's Hospital,Shenzhen 518000,China)
出处
《中国实用医药》
2024年第9期17-21,共5页
China Practical Medicine
基金
广东省医学科学技术研究基金项目(项目编号:C2022116粤卫科教函[2022]17号)。
关键词
剪切波弹性成像
超声
缺氧缺血性脑损伤
诊断
Shear wave elastography
Ultrasound
Hypoxic ischemic injury
Diagnosis
