目的:探讨3.0 T磁共振头颅磁敏感加权成像(SWI)和波谱成像(MRS)影像分度在新生儿缺氧缺血性脑病(HIE)脑损伤程度评估中的应用价值及HIE早期诊断相关预测因素。方法:选取我院在新生儿科诊断为HIE的患儿60例。比较头颅SWI 与MRS序列检查对颅内出血灶的检出率、损伤脑叶数、临床分度和SWI分度、MRS分度之间相关以及HIE早期诊断相关预测因素。结果:60例HIE患儿的影像检查结果中,SWI的检出率为91.4%,MRS的检出率为100%,不同病情程度的HIE患儿的一般资料比较,差异具有统计学意义(P＜0.05)；临床分度和SWI分度、MRS分度之间显著相关(P＜0.05),但两种影像学方法对于检测临床分度无差异(P＞0.05)；对于损伤脑叶数的检测,临床分度为轻度时,SWI优于MRS(P＜0.05)；多因素Logistic回归分析表明羊水粪染、脐带绕颈、Apgar值为HIE独立预测因素(P<0.05)。结论:3.0 T磁共振SWI及MRS作为近年来磁共振新开发的成像技术,对新生儿颅内出血具有高度敏感性。3.0 T磁共振SWI及MRS可无创分析脑内具体生物化学成分水平的变化,从统计学的定量角度反映出更多的生化指标,从而判断出新生儿脑损伤的严重程度。

Objective: To evaluate the value of 3.0T magnetic resonance imaging (MR) SWI and MRS in evaluating the degree of brain injury in neonates with HIE and the predictive factors of early diagnosis of HIE. Methods:60 cases of neonatal hypoxic ischemic encephalopathy diagnosed in our hospital from October 2014 to March 2016 were analyzed statistically. To compare the correlation between SWI and MRS in detecting intracranial hemorrhage foci, the number of injured lobes, clinical grading, SWI grading, MRS grading, and the predictors of early diagnosis of HIE. Results:Among the 60 cases of HIE, the detection rate of SWI and MRS was 91.4% and 100%, respectively. The general data of HIE patients with different degrees of illness were statistically different (P<0.05), and there was a significant correlation between clinical grading, SWI grading and MRS grading (P<0.05). There was no significant difference in severity (P>0.05); SWI was superior to MRS when the clinical grade was mild (P<0.05), and there was no difference in the rest (P>0.05); Multivariate logistic regression analysis showed that amniotic fluid stool staining, umbilical cord around neck and Apgar value were independent predictors of HIE (P<0.05). Conclusion: 3.0T MR SWI and MRS, as newly developed MRI imaging techniques in recent years, are highly sensitive to intracranial hemorrhage in neonates. 3.0T MR SWI and MRS can noninvasively analyze the changes of specific biochemical components in the brain, and reflect more biochemical indicators from the quantitative perspective of statistics, so as to judge the severity of brain injury in newborns.

R445.2;R722.1

重庆市基础与前沿研究计划项目合同(Y2016010037)