目的：探究MRI常规序列及扩散序列DWI定量参数ADC值在新生儿低血糖脑损伤中的诊断价值。方法：收集整理我院新生儿科2016年6月—2019年1月低血糖脑损伤患儿的临床、影像及检验资料共48例。分析其MRI表现，并根据新生儿低血糖程度分为3个组（a组血糖≤1.0 mmol/L，b组＞1.0~1.7 mmol/L，c组＞1.7~2.0 mmol/L，应用SPSS 23.0软件分析ADC值在不同分组间的差异及与血糖的相关性。结果：①统计结果：a组17例，b组17例，c组14例；其中28例（58%）在DWI中病灶显示明显优于常规序列（T1WI、T2WI）；②不同低血糖严重程度分组（a，b，c）间的ADC值不同，随着低血糖严重程度增加，ADC值呈减低趋势，差异具有统计学意义（P<0.01）；③ADC值与低血糖严重程度呈中等程度相关，相关系数r为0.761。结论：①DWI较MRI常规序列能更敏感地发现低血糖脑损伤的部位、范围及损伤程度；②磁共振扩散成像定量参数ADC值在评估新生儿低血糖脑损伤的严重程度中有较好的诊断价值。
Abstract
Objective: To explore the diagnostic value of conventional MRI sequence and ADC value of DWI in neonatal hypoglycemic brain injury. Methods: A total of 48 cases of neonatal hypoglycemic brain injury were included with complete clinical, imaging and laboratory data from June 2016 to January 2019 in our hospital. The MRI findings were analyzed, and we divided the 48 cases into 3 groups according to the blood glucose level(group a: ≤1.0 mmol/L, group b: ＞1.0~1.7 mmol/L, group c: ＞1.7~2.2 mmol/L). We use SPSS 23.0 software to analyze the difference of ADC values among different groups and the correlation with blood glucose. Results: ①There were 17 patients in group a, 17 patients in group b, and 14 patients in group c. Among them, lesions of 28(58%) were more obviously showed in DWI than in conventional sequences(T1WI, T2WI). ②The ADC values were different among different groups(a, b, c). As the severity of hypoglycemia increased, the ADC value decreased, and the difference was statistically significant(P<0.01). ③The ADC value was strongly correlated with the severity of hypoglycemia, and the correlation coefficient r was 0.761. Conclusion: DWI is more sensitive in showing the location, extent and severity to hypoglycemic brain injury than MRI routine sequences. ADC value plays an important role in evaluating the severity of neonatal hypoglycemic brain injury.
关键词
脑损伤 /
低血糖症 /
婴儿 /
新生 /
磁共振成像
Key words
Brain injuries /
Hypoglycemia /
Infant, newborn /
Magnetic resonance imaging
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参考文献
[1]Sharma A, Davis A, Shekhawat PS. Hypoglycemia in the preterm neonate: etiopathogenesis, diagnosis, management and long-term outcomes[J]. Transl Pediatr, 2017, 6(4): 335-348.
[2]Cresto JC, Abdenur JP, Bergada I, et al. Long term follow up of persistent hyperinsulinaemic hypoglycaemia of infancy[J]. Arch Dis Child, 1998, 79(5): 440-444.
[3]Yang G, Zou LP, Wang J, et al. Neonatal hypoglycemic brain injury is a cause of infantile spasms[J]. Exp Ther Med, 2016, 11(5): 2066-2070.
[4]Su J, Wang L. Research advances in neonatal hypoglycemic brain injury[J]. Transl Pediatr, 2012, 1(2): 108-115.
[5]孙惠苗，关晓力，李真，等. 新生儿低血糖脑损伤的磁共振成像影像学诊断[J]. 中国药物与临床，2011，11（12）：1401-1402.
[6]宿军，王莉. 新生儿低血糖性脑损伤研究进展[J]. 中国当代儿科杂志，2011，13（5）：446-451.
[7]胡海燕，尹传高，王丽丽，等. 新生儿低血糖脑损伤临床与磁共振特征[J]. 安徽医学，2014，35（8）：1055-1057.
[8]杨雪莲，张莉，孙宏建. 足月新生儿低血糖脑损伤临床与磁共振特征分析[J]. 中国妇幼卫生杂志，2018，9（6）：48-51.
[9]徐友宁，王丽英，葛丽霞. 新生儿低血糖与脑损伤的关系[J]. 现代医药卫生，2010，26（10）：1454-1456.
[10]丁明明，周丛乐. 新生儿低血糖性脑损伤[J]. 中国新生儿科杂志，2011，26（1）：59-61.
[11]Burns CM, Rutherford MA, Boardman JP, et al. Patterns of cerebral injury and neurodevelopmental outcomes after symptomatic neonatal hypoglycemia[J]. Pediatrics, 2008, 122(1): 65-74.
[12]Yalnizoglu D, Haliloglu G, Turanli G, et al. Neurologic outcome in patients with MRI pattern of damage typical for neonatal hypoglycemia[J]. Brain Develop, 2007, 29(5): 285-292.
[13]Barkovich AJ, Ali FA, Rowley HA, et al. Imaging patterns of neonatal hypoglycemia[J]. AJNR, 1998, 19(3): 523-528.
[14]毛健，陈丽英，富建华，等. 新生儿低血糖脑损伤临床特征与磁共振成像动态变化[J]. 中国当代儿科杂志，2008，（2）：115-120.
[15]姚文君，郑穗生，王龙胜，等. 新生儿低血糖脑损伤的磁共振表现及弥散加权成像优势[J]. 安徽医科大学学报，2012，47（2）：161-163.
[16]陈红，王晓明，丁长伟，等. 新生儿低血糖脑损伤的MRI表现[J]. 中国医学影像技术，2013，29（7）：1086-1090.
[17]李晶，康军红，刘景哲，等. 新生儿低血糖脑损伤的MRI表现及鉴别诊断[J]. 新疆医学，2018，48（9）：964-966.
[18]向永华，金科，何四平，等. 新生儿低血糖脑损伤的MRI诊断及鉴别[J]. 放射学实践，2012，27（8）：914-916.
[19]李艳，杜奕，陈志强. 磁共振扩散加权成像在新生儿脑损伤的临床应用进展[J]. 中华临床医师杂志：电子版，2012，6（14）：4039-4041.
[20]Kim SY, Goo HW, Lim KH, et al. Neonatal hypoglycaemic encephalopathy: diffusion-weighted imaging and proton MR spectroscopy[J]. Pediatr Radiol, 2006, 36(2): 144-148.
[21]马海锋，欧宁锋，钟旭，等. DWI与1H-MRS在新生儿低血糖脑损伤中的应用价值[J]. 中国CT和MRI杂志，2014，12（2）：5-7.
