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目的探讨MR快速评估新生儿缺氧缺血性脑病(HIE)的最优序列组合及其应用价值。方法足月新生儿在出生后10天内由于围产期窒息行MRI,根据日龄分为出生4天以内(Ⅰ组或早期组)和出生4~10天(Ⅱ组或晚期组)两个亚组。两名评估者共同回顾性评估T_1WI、T_2WI、液体衰减反转恢复(FLAIR)、扩散加权成像(DWI)和矢状位T_1WI及不同序列组合对HIE的分度,并计算与参考标准一致性(Kappa值),确定MRI对HIE快速评价的最优序列组合。结果与参考标准比较,对新生儿HIE的分度评价,DWI在早期组评价的K值为最高(K=0.783),T_1WI在晚期组评价的K值为最高(K=0.704)。横轴位T_1WI、T_2WI和DWI联合序列评价与参考标准具有高度一致性(K=0.865),依次增加FLAIR和矢状位T_1WI序列到T_1WI、T_2WI和DWI联合其K值不变。结论MRI横轴位T_1WI、T_2W和DWI联合是快速评估新生儿HIE的最佳序列组合。
Objective To investigate the optimal sequence combination and its application value of MR for rapid assessment of neonatal hypoxic-ischemic encephalopathy (HIE). Methods Full-term newborns were divided into two groups: born within 4 days (group Ⅰ or early group) and born 4 to 10 days (group Ⅱ or group Ⅱ) due to perinatal asphyxia within 10 days after birth. group. Two assessors reviewed retrospectively T-WI, T2WI, FLAIR, DWI, and T_1WI and their association with different sequences for HIE classification, and calculated the agreement with the reference standard ( Kappa value) to determine the optimal sequence of MRI for rapid evaluation of HIE. Results Compared with the reference standard, the K value of DWI in the early group was the highest (K = 0.783). The K value of the T_1WI in the late group was the highest (K = 0.704). The T 1WI, T 2WI and DWI images of transverse axis were highly consistent with the reference standard (K = 0.865), and the FLAIR and sagittal T 1WI sequences were increased to T 1WI, while T 2WI and DWI were unchanged. Conclusion The combination of transverse axial T_1WI, T_2W and DWI is the best sequence for rapid assessment of neonatal HIE.