目的 探讨基于T1WI、T2WI、T2液体衰减反转恢复(fluid attenuated inversion recovery,FLAIR)、扩散加权成像(diffusion-weighted imaging,DWI)序列半定量分析探究妊娠期糖尿病婴儿(infant of gestational diabetic mothers,IDMs)脑发育异常改变的价值.材料与方法 回顾性纳入54例IDMs为观察组(IDMs组),同期无高危围产因素孕妇分娩的70例婴儿作为健康对照(healthy control,HC)组.根据出生胎龄是否小于37周,将IDMs组及HC组分别分为早产儿IDMs A组(27例)、HC A组(33例)和足月儿IDMs B组(27例)、HC B组(37例).行1.5 T MRI颅脑T1WI、T2WI、T2 FLAIR及 DWI序列扫描,选取小脑半球、杏仁核、海马、颞叶白质、豆状核、尾状核、丘脑腹外侧核、内囊后肢、胼胝体压部、额叶白质、枕叶白质、顶叶白质、半卵圆中心及咬肌的最大层面手动绘制设置感兴趣区(region of interest,ROI),测量各ROI的信号强度及表观扩散系数(apparent diffusion coefficient,ADC)值,计算出各个区域/咬肌的T1、T2平均信号强度比值(signal intensity ratio,SIR)(SIRT1、SIRT2、SIRT2 FLAIR).比较各比值及ADC值的组间差异,通过受试者工作特征(receiver operating characteristic,ROC)曲线评价诊断效能,采用DeLong检验比较各曲线下面积(area under the curve,AUC)的差异性.观察MR强度比值与母亲75 g口服葡萄糖耐量试验(Oral Glucose Tolerance Test,OGTT)的血糖水平之间的关联性.结果 与HC组相比,IDMs组枕叶、豆状核、尾状核、内囊后肢、丘脑腹外侧核、顶叶、额叶、半卵圆中心的SIRT1、所有区域SIRT2、除枕叶及内囊后肢其他区域的SIRT2 FLAIR、颞叶的ADC值均降低(P<0.05).分层分析后发现,IDMs A组小脑半球、内囊后肢、丘脑腹外侧核、半卵圆中心的SIRT1、所有区域的SIRT2、除枕叶及胼胝体压部外其他部位SIRT2 FLAIR均低于HC组;IDMs B组额叶、顶叶的SIRT1、所有区域SIRT2、小脑半球、颞叶的ADC值均低于HC B组(P<0.05).IDMs组与HC组的ROC曲线分析显示,所有部位SIRT2的AUC值最高,其中颞叶的SIRT2具有较好的诊断效能(AUC=0.702).DeLong检验显示小脑半球、海马、颞叶、枕叶、内囊后肢、顶叶在SIRT2 与SIRT1、SIRT2 FLAIR或ADC的AUC值差异存在统计学意义(P<0.05).IDMs组所有区域SIRT2 与OGTT 1 h血糖呈负相关(P<0.05).结论 MRI信号强度的半定量分析有助于识别IDMs的早期神经发育异常,其中SIRT2诊断效能更高.
A semi-quantitative MRI study on brain developmental abnormalities in infants of gestational diabetic mothers
Objective:To investigate the value of semi-quantitative analysis based on T1WI,T2WI,T2 fluid attenuated inversion recovery(FLAIR),and diffusion-weighted imaging(DWI)sequences in exploring abnormal brain development changes in infants of gestational diabetic mothers(IDMs).Materials and Methods:A total of 54 cases of DMs were retrospectively included as the observation group(IDMs group),while 70 infants born to mothers without high-risk perinatal factors during the same period served as the healthy control(HC)group.Based on whether the gestational age at birth was less than 37 weeks,the IDMs group and the HC group were further divided into preterm infants:27 in the IDMs A group and 33 in the HC A group,and term infants:27 in the IDMs B group and 37 in the HC B group.A 1.5 T MRI was performed using T1WI,T2WI,T2 FLAIR,and DWI sequences.Regions of interest(ROI)were manually drawn on the maximum slices of the cerebellar hemispheres,amygdala,hippocampus,temporal lobe white matter,globus pallidus,caudate nucleus,ventrolateral thalamic nucleus,posterior limb of the internal capsule,splenium of the corpus callosum,frontal white matter,occipital white matter,parietal white matter,centrum semiovale,and masseter muscles,measuring the signal intensity and apparent diffusion coefficient(ADC)values of each ROI.The mean signal intensity ratios(SIRT1,SIRT2,SIRT2 FLAIR)of each region/masseter muscle were calculated.Differences in these ratios and ADC values between groups were compared,and the diagnostic efficacy was evaluated using receiver operating characteristic(ROC)curves,with DeLong's test applied to compare the differences in the area under the curve(AUC).The relationship between MR intensity ratios and maternal 75 g oral glucose tolerance test(OGTT)blood glucose levels was also observed.Results:Compared with the HC group,the IDMs group showed reduced SIRT1 in the occipital lobe,globus pallidus,caudate nucleus,posterior limb of the internal capsule,ventrolateral thalamic nucleus,parietal lobe,frontal lobe,and centrum semiovale,as well as lower SIRT2 in all regions,and lower SIRT2 FLAIR in all regions except for the occipital lobe and posterior limb of the internal capsule.The ADC values in the temporal lobe were also lower(P<0.05).After stratified analysis,it was found that SIRT1 in the cerebellar hemisphere,posterior limb of the internal capsule,ventrolateral thalamic nucleus,and centrum semiovale,as well as SIRT2 in all regions,and SIRT2 FLAIR in all areas except for the occipital lobe and splenium of the corpus callosum in the IDMs A group were lower than in the control group.In the IDMs B group,SIRT1 in the frontal and parietal lobes,SIRT2 in all regions,and ADC values in the cerebellar hemisphere and temporal lobe were lower than those in the HC B group(P<0.05).ROC curve analysis showed that the AUC values for SIRT2 in all regions in the IDMs group were the highest,with SIRT2 in the temporal lobe demonstrating good diagnostic efficacy(AUC=0.702).DeLong's test indicated statistically significant differences in AUC values between SIRT2 and SIRT1,SIRT2 FLAIR,or ADC in the cerebellar hemisphere,hippocampus,temporal lobe,occipital lobe,posterior limb of the internal capsule,and parietal lobe(P<0.05).SIRT2 in all regions of the IDMs group was negatively correlated with 1-hour blood glucose levels from the OGTT(P<0.05).Conclusions:The relative signal intensity ratios of T1WI,T2WI,and T2 FLAIR,along with ADC values,are useful for the early detection of neurodevelopmental abnormalities in IDMs.Among these,SIRT2 demonstrates a higher diagnostic efficacy.
infant of gestational diabetic mothersbrain developmentmagnetic resonance imagingdiffusion-weighted imagingsignal intensity ratio
万方数据
维普
