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目的探讨DWI结合常规MRI诊断不同日龄足月新生儿缺氧缺血性脑病(HIE)的价值。方法回顾性分析中、重度HIE新生儿147例(病例组),其中79例患儿日龄<7天(病例组1),68例日龄7~28天(病例组2);选择同期正常新生儿分别作为对照组1(26名)和对照组2(17名)。所有患者均行常规MRI及DWI,选择脑内8个不同ROI观察其信号特点并测量ADC值。结果全部受试者外周白质ADC值均高于中央白质,以额顶叶深部白质最高,内囊后肢最低;对照组2额叶、顶叶、侧脑室旁白质和丘脑腹外侧核ADC值均低于对照组1(t=5.87、4.30、2.62、3.10,P均<0.05)。病例组1中,中度HIE患儿额顶叶深部白质、胼胝体压部及内囊后肢低于对照组1(P<0.05),重度HIE患儿侧脑室旁白质和丘脑腹外侧核也低于对照组1(P<0.05);病例组2中,中、重度HIE患儿内囊后肢及胼胝体压部ADC值均低于对照组2(P<0.05)。结论 DWI能较常规MRI早期、客观地检出足月儿HIE。
Objective To explore the value of DWI combined with conventional MRI in diagnosis of neonatal hypoxic-ischemic encephalopathy (HIE) of different ages. Methods A total of 147 newborns with moderate and severe HIE were enrolled in this study. Among them, 79 (79%) patients (day 1) and 68 days (day 7 to 28) Newborns served as control group 1 (26) and control group 2 (17). All patients underwent routine MRI and DWI, 8 different ROIs were selected to observe the signal characteristics of the brain and measure the ADC value. Results All subjects had higher peripheral white matter ADC values than those of central white matter, with the highest in the frontal lobe and the lowest in the posterior limb of the internal capsule. The ADC values in the frontal lobes, parietal lobe, lateral ventricle, and ventrolateral thalamus of control group 2 were all low In control group 1 (t = 5.87,4.30,2.62,3.10, P <0.05). In case group 1, the amount of the parietal lobe deep white matter, the corpus callosum, and the posterior limb of the internal capsule in the moderate HIE group were lower than those in the control group 1 (P <0.05), and those in the severe HIE children were also lower than those in the paraventricular nucleus Control group 1 (P <0.05). The ADC values of hindlimb and corpus callosum in the moderate and severe HIE children in case group 2 were lower than those in control group 2 (P <0.05). Conclusion DWI can detect full-term infants with HIE objectively and earlier than conventional MRI.