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目的:运用弥散张量成像(DTI)技术中表观弥散系数与各向异性分数定量分析不同程度新生儿缺氧缺血性脑病患者的脑损伤变化特点。方法:选择2013年5月~2015年5月临床诊断的新生儿缺氧缺血性脑病(hypoxic ischemic encephalopathy,HIE)患者45名,依据患者病情程度分为轻度(HIE)组20例与中重度(HIE)组25例,另取同期正常足月出生,无窒息史新生儿20例,3组患儿均行DTI检查。分析其表面弥散系数(ADC)图及各向异性分数(FA)图的变化特点,并对各组相同部位的额叶脑灰白质区、顶叶脑白质及灰质区、放射冠脑白质区、基底节层面尾状核、豆状核、内囊前后肢、丘脑等脑灰质区进行ADC值及FA值定量分析,比较各组患者相同部位弥散系数和各向异性差异。结果:DTI可清晰显示新生儿脑内白质纤维的走形及方向。同一患儿不同解剖部位,其ADC、FA值差异有统计学有意义(P<0.05)。随着病情程度加重,患儿脑灰白质区ADC值逐渐下降,FA值也逐渐下降,不同病情程度的新生儿缺氧缺血性脑病患儿相同解剖部位脑灰、白质区ADC值及FA值的差异有统计学意义(P<0.05)。结论:ADC、FA值能准确定量分析不同病情程度的新生儿缺氧缺血性脑病患者脑灰、白质部位的各向异性特点。利用弥散张量成像可以量化分析新生儿缺氧缺血性脑病的病情程度。
OBJECTIVE: To quantitatively analyze the changes of brain injury in neonates with hypoxic-ischemic encephalopathy (HIE) by diffusion tensor imaging (DTI) technique with apparent diffusion coefficient and anisotropy fraction. Methods: Forty-five neonates with hypoxic ischemic encephalopathy (HIE) diagnosed in our hospital from May 2013 to May 2015 were divided into mild HIE group Twenty-five patients with severe HIE and 20 normal newborns with full-term full-term asphyxia were enrolled in this study. DTI was performed in all three groups. The changes of surface diffusion coefficient (ADC) and anisotropy fraction (FA) were analyzed. The changes of frontal lobe gray matter area, parietal white matter and gray matter area, corneal white matter area, Basal ganglia, caudate nucleus, putamen, foregut and thalamus of brain were quantified by ADC and FA values. Differences of diffusivity and anisotropy in the same part of the patients were compared. Results: DTI can clearly show the shape and orientation of white matter in newborn brain. The same children with different anatomical sites, ADC, FA values were statistically significant (P <0.05). With the severity of the disease, the ADC value of gray matter in children gradually decreased and the FA value decreased gradually. The ADC value and FA value of brain gray matter and white matter in the same anatomical part of neonates with different severity of illness The difference was statistically significant (P <0.05). Conclusion: The ADC and FA values can accurately and quantitatively analyze the anisotropy of brain gray matter and white matter in neonates with hypoxic-ischemic encephalopathy of different severity. The use of diffusion tensor imaging can quantify the severity of neonatal hypoxic-ischemic encephalopathy.