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目的探讨磁共振弥散加权成像(DWI)的表观弥散系数值(ADC)和氢质子磁共振频谱(1H-MRS)在评价足月新生儿缺氧缺血性脑病(HIE)中的临床价值。方法32例足月HIE患儿和同期10例健康足月新生儿生后10d内行DWI和1H-MRS扫描,记录代谢产物1H-MRS波峰下面积和ADC值,并进行比较。结果(1)HIE组右侧基底节和额叶的乳酸/肌酸比值(Lac/Cr)较对照组升高,N乙酰天门冬氨酸/肌酸比值(NAA/Cr)、胆碱/肌酸比值(Cho/Cr)较对照组降低,差异有统计学意义(P均<0.05);轻度、中度、重度HIE组右侧基底节和额叶的Lac/Cr比值逐渐升高,均高于对照组(P均<0.05),右侧基底节NAA/Cr、Cho/Cr比值逐渐降低,均低于对照组(P均<0.05)。HIE的临床分度与右侧基底节和额叶的Lac/Cr呈正相关,与右侧基底节的NAA/Cr、Cho/Cr呈负相关。(2)HIE组左右两侧豆状核及右侧额叶深部白质ADC值较对照组降低,差异有统计学意义(P<0.05);HIE临床分度与左右两侧豆状核及右侧额叶深部白质的ADC值为负相关。(3)右侧基底节NAA/Cr与左右两侧豆状核ADC值呈正相关。结论DWI和1H-MRS对新生儿HIE的临床诊断有重要临床意义,将两者结合可更好地评价脑损伤的严重程度,为临床诊疗提供有力依据,值得深入研究及推广。
Objective To investigate the clinical value of apparent diffusion coefficient (ADC) and hydrogen proton magnetic resonance spectroscopy (1H-MRS) in diffusion-weighted magnetic resonance imaging (DWI) in assessing neonatal hypoxic-ischemic encephalopathy (HIE) Methods DWI and 1H-MRS were performed in 32 infants with full-term HIE and 10 healthy full-term infants at the same time. The area under the 1H-MRS peak and the ADC value were recorded and compared. Results (1) The ratio of Lac / Cr to basal ganglia and frontal lobe in HIE group was higher than that in control group, and N acetyl aspartate / creatine ratio (NAA / Cr) (P <0.05). The ratio of Lac / Cr in basal ganglia and frontal lobe in mild, moderate and severe HIE groups gradually increased, both of which were significantly lower than those in control group (P <0.05). The ratios of NAA / Cr and Cho / Cr in the right basal ganglia were lower than those in the control group (all P <0.05). The clinical grade of HIE was positively correlated with Lac / Cr of the right and left basal ganglia and negatively correlated with NAA / Cr and Cho / Cr of the right basal ganglia. (2) The ADC value of lentiform nucleus in left and right sides of the HIE group and the deep white matter in the right frontal lobe were significantly lower than those in the control group (P <0.05). The clinical scores of HIE group were significantly lower than those in the right and left lentiform nucleus The frontal lobe deep white matter ADC values were negatively correlated. (3) The right basal ganglia NAA / Cr was positively correlated with left and right nucleus pulposus ADC values. Conclusion DWI and 1H-MRS have important clinical significance in the diagnosis of neonatal HIE. Combining the two can better assess the severity of brain injury and provide a strong basis for clinical diagnosis and treatment, which deserves further study and promotion.