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目的评价3.0 T MR扩散张量成像(DTI)在足月新生儿缺氧缺血性脑病(HIE)中的应用价值。方法以19名无窒息史的正常足月新生儿做为对照,对24例HIE患儿(轻度19例、中重度5例)进行常规MRI及DTI检查。选取双侧大脑脚、豆状核、内囊后肢前后部、丘脑、半卵圆中心层面额叶前后部、顶叶以及胼胝体膝部、压部为感兴趣区(ROI),分别测得分数各向异性(FA)、平均扩散系数(MD)、轴向扩散张量(λ//)、垂直扩散张量(λ⊥)。采用ANOVA分析三组间不同部位各参数的变化。结果轻度组胼胝体压部FA值及左侧大脑脚MD、λ//值较对照组降低(P<0.05)。中重度组皮质脊髓束走行区、胼胝体膝部及压部的FA、λ//较对照组明显降低(P<0.001)。另外,中重度组左侧大脑脚λ⊥较对照组降低,而左侧内囊后肢前部、双侧内囊后肢后部λ⊥较对照组升高(P<0.01)。结论 DTI更能反映不同程度HIE损伤后脑组织轴索、髓鞘细微结构的改变。
Objective To evaluate the value of 3.0 T MR diffusion tensor imaging (DTI) in term neonates with hypoxic-ischemic encephalopathy (HIE). Methods Totally 19 normal full-term newborns without history of asphyxia were used as controls. Twenty-four HIE children (19 mild, 5 moderate and severe) underwent routine MRI and DTI. The bilateral cerebral peduncle, putamen, anterior and posterior hind limbs of the internal capsule, frontal and posterior frontal and parietal lobes of the thalamus and semiovales, parietal lobe and corpus callosum were selected as the ROI. The scores of each (FA), average diffusion coefficient (MD), axial diffusion tensor (λ //) and vertical diffusion tensor (λ⊥). ANOVA analysis of changes in the various parts of the three groups of parameters. Results Compared with the control group, the FA value of the corpus callosum and the MD, λ // values of the left brainstem in the mild group were significantly decreased (P <0.05). The moderate and severe corticospinal tract walking area, corpus callosum knee and pressure of the FA, λ / / compared with the control group was significantly lower (P <0.001). In addition, λ ⊥ of the left brainstem in the moderate and severe groups was lower than that in the control group, while λ⊥ in the anterior and posterior hind limbs of the left internal capsule was higher than that in the control group (P <0.01). Conclusion DTI can better reflect the changes of the axonal and myelin microstructure after HIE injury.