摘要
目的探讨表观扩散系数(ADC)直方图在量化中重度新生儿缺氧缺血性脑病(HIE)中的诊断价值。方法回顾性分析2015年7月至2018年9月南京医科大学附属儿童医院中重度HIE患儿49例及同期就诊的无神经系统症状体征的足月新生儿为对照组31例的头颅磁共振成像(MRI)资料。采用ImgJ软件勾画丘脑/基底节层面全脑区域作为感兴趣区,用MRIcron软件获得ADC直方图及参数。比较HIE组和对照组之间各ADC直方图参数的差异。分析HIE组ADC直方图参数与新生儿神经行为(NBNA)评分的相关性。采用ROC曲线评价各参数的诊断效能。结果HIE组的ADC平均值、ADC最小值、ADC最大值、众数值(mode-value)、方差、异质性、10%~90%百分比ADC值分别为634±65、310±36、1683±18、711±87、66928±921、5907±204、477±50、513±53、542±56、568±59、591±61、625±92、661±97、709±105、811±119,均高于对照组(均P<0.05),HIE组模态密度(mode-count)小于对照组(272±22比395±83,t=2.996,P<0.05)。差异有统计学意义的参数(平均ADC值、ADC最小值、ADC最大值、mode-count、mode-value、方差、异质性、10%~90%百分比ADC值)均与NBNA评分有相关性,其中mode-count与NBNA评分呈负相关(r=-0.369,P<0.05),其余呈正相关(均P<0.05)。方差的曲线下面积(AUC)最大(0.881),诊断效能其次为90%ADC值和ADC最大值。结论ADC直方图有助于诊断HIE,能够客观且量化反映脑组织的弥散信息,可评价HIE的严重程度。
Objective To investigate the diagnostic value of apparent diffusion coefficient(ADC)histogram in quantifying moderate to severe neonatal hypoxic-ischemic encephalopathy(HIE).Methods A total of 49 children with moderate to severe HIE admitted to the Children′s Hospital Affiliated to Nanjing Medical University from July 2015 to September 2018 were retrospectively analyzed.Cranial magnetic resonance imaging(MRI)data of 31 full-term neonates without neurological symptoms and signs who visited the hospital during the same period were recruited as the control group.ImgJ software was used to delineate the whole brain area at the thalamus/basal ganglia level as the area of interest,and MRIcron software was used to obtain ADC histogram parameters.The differences of ADC histogram parameters between HIE group and control group were compared.The correlation between ADC histogram parameters and neonatal neurobehavioral neurological assessment(NBNA)in HIE group was analyzed.Receiver operating characteristic(ROC)curve was used to evaluate the diagnostic efficiency of each parameter.Results The mean value,minimum value,maximum value,mode-value,variance,heterogeneity and 10%-90%ADC values of HIE group were all greater than those of the control group(634±65,310±36,1683±18,711±87,66928±921,5907±204,477±50,513±53,542±56,568±59,591±61,625±92,661±97,709±105,811±119),the differences were statistically significant(all P<0.05),while mode-count of HIE group was smaller than that of the control group(272±22 to 395±83),and the difference was statistically significant(t=2.996,P<0.05).All the above parameters with statistical differences were correlated with NBNA score,among which mode-count was negatively correlated with NBNA score(r=-0.369,P<0.05),and the rest were positively correlated(all P<0.05).The area under the ROC curve(AUC)of variance had the highest diagnostic efficiency(0.881),followed by 90%ADC value and ADC maximum value.Conclusion ADC histogram is helpful for the diagnosis of HIE,objectively and quantitatively reflecting the diffusion information of brain,and assessing the severity of HIE.
作者
王瑞珠
席艳丽
杨明
朱美娇
杨凤
Wang Ruizhu;Xi Yanli;Yang Ming;Zhu Meijiao;Yang Feng(Department of Radiology,Children′s Hospital Affiliated to Nanjing Medical University,Nanjing 210008,China)
出处
《中华医学杂志》
CAS
CSCD
北大核心
2021年第9期624-629,共6页
National Medical Journal of China
基金
南京市科技发展基金(YKK14117)
江苏省六大高峰人才项目(WSN-192)
江苏省卫生健康委项目(LGY2019009)。
关键词
缺氧缺血
脑
新生儿学
表观扩散系数
神经行为测定
Hypoxia-ischemia,brain
Neonatology
Apparent diffusion coefficient
Neonatal behavioral neurological assessment
