首页|磁共振弥散张力成像在早产儿脑白质损伤及神经发育预后评估中的应用

磁共振弥散张力成像在早产儿脑白质损伤及神经发育预后评估中的应用

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目的 探讨磁共振(MRI)弥散张力成像(DTI)在早产儿脑白质损伤(WMI)及神经发育预后评估中的应用价值。方法 选择早产儿149例，均行头部MRI+DTI检查，记录感兴趣区(ROI)各向异性分数(FA)、表观弥散系数(ADC)值，根据检查结果将早产儿分为WMI组40例、nWMI组109例，并按检查时纠正胎龄分为33～34周、35～36周、≥37周，比较WMI组与nWMI组各胎龄FA值、ADC值。39例早产儿在纠正月龄约6个月时用格塞尔(Gesell)发育量表评估发育情况，其中适应性行为发育落后18例、个人-社会行为发育落后16例、大运动行为发育落后21例、精细运动行为发育落后25例、语言行为发育落后19例，Spearman相关法分析FA值、ADC值与Gesell发育量表评分的相关性。结果 nWMI组不同纠正胎龄阶段各ROI的FA值均高于WMI组(P均<0。05)。纠正胎龄33～34周，WMI组侧室旁白质、胼胝体膝部白质的ADC值高于nWMI组(P均<0。05);纠正胎龄35～36周，WMI组胼胝体膝部、内囊后肢ADC值高于nWMI组(P均<0。05);纠正胎龄≥37周，WMI组半卵圆中心白质、脑室旁白质、胼胝体膝部及内囊后肢白质ADC值高于nWMI组(P均<0。05)。大运动发育落后早产儿脑室旁白质的ADC值与Gesell发育量表评分呈负相关(r=-0。594，P<0。05)，认知行为发育落后早产儿内囊前肢的ADC值与Gesell发育量表评分呈负相关(r=-0。524，P<0。05)。结论 DTI检查的内囊前肢、后肢及脑室旁白质FA值可反映早产儿WMI情况，脑室旁白质ADC值可反映其大运动发育情况。
Application of diffusion tension imaging in the evaluation of white matter injury and neurodevelopmental prognosis in preterm infants
Objective To investigate the application of magnetic resonance imaging(MRI)diffusion tensor imaging(DTI)in the assessment of white matter injury(WMI)and neurodevelopmental prognosis of preterm infants.Methods A total of 149 preterm infants were included,all of whom underwent head MRI+DTI examination,and the values of fractional anisotropy(FA)and apparent diffusion coefficient(ADC)were collected.According to the examination results,preterm in-fants were divided into the WMI group(40 cases)and nWMI group(109 cases).For further analysis,the WMI and nWMI groups were classified based on postmenstrual age(PMA)during MRI+DTI examination(33-34 weeks group,35-36 weeks group,and≥37 weeks group).We compared FA and ADC values between WMI and nWMI groups.The Gesell Develop-mental Scale was used to evaluate the development of 39 preterm infants at 6 months of corrected age.Among them,there were 18 cases of adaptive behavioral development retardation,16 cases of individual-social behavior developmental retarda-tion,21 cases of gross motor performance developmental retardation,25 cases of fine motor behavior developmental retarda-tion and 19 cases of speech behavior developmental retardation.Spearman correlation was used to analyze the correlations between the FA and ADC values and the Gesell Developmental Scale.Results The FA values of each ROI in the nWMI group were higher than those of the WMI group at different corrected age(all P<0.05).ADC values of periventricular white matter and genu of corpus callosum in the WMI group at the corrected age of 33-34 weeks were higher than those of the nW-MI group(all P<0.05).At the corrected age of 35-36 weeks,ADC values in genu of corpus callosum and posterior limbs of internal capsule in the WMI group were higher than those in the nWMI group(all P<0.05).At the corrected age of≥37 weeks,ADC values in semiovale center,periventricular white matter,genu of corpus callosum and posterior limbs of internal capsule in the WMI group were higher than those in the nWMI group(all P<0.05).There was a negative correlation between the ADC value of periventricular white matter and Gesell Developmental Scale score in premature infants with gross motor de-velopment delay(r=-0.594,P<0.05).The ADC value of the forelimb of the internal capsule was negatively correlated with the Gesell Developmental Scale score in preterm infants with cognitive behavior developmental retardation(r=-0.524,P<0.05).Conclusions FA values in anterior and posterior limbs of internal capsule and paraventricular white matter can re-veal WMI in preterm infants.ADC value of the periventricular white matter can reflect the development of gross motor.

white matter injurydiffusion tensor imagingneurodevelopmentfractional anisotropyapparent dif-fusion coefficientGesell Developmental Scalepremature infants

刘玲、陈阳、黄炳龙、林少珠、敖当、蔡娜莉

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广东医科大学附属医院儿科,广东湛江 524000

深圳市盐田区人民医院儿科

脑白质损伤 弥散张力成像 神经发育 各向异性分数 表观弥散系数 格塞尔发育量表 早产儿

广东医科大学附属医院临床研究项目湛江市科技计划项目

LCYJ2019B0092021A05078

2024

10.3969/j.issn.1002-266X.2024.04.002

山东医药
山东卫生报刊社

山东医药

CSTPCD
影响因子：1.225
ISSN：1002-266X
年,卷(期)：2024.64(4)
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