CAJ | 학술논문

目的探讨孕中晚期胎儿不同部位脑实质的ADC值与胎龄之间的关系.方法 2009年3月至2010年9月,在温州医学院附属第二医院70例超声怀疑异常而MRI检查正常的胎儿(产后临床随访均发育正常)行MRI DWI扫描,均为单胎,胎龄为孕24 ～ 38周,平均胎龄32.4周.利用ADC=1n(S600/S0)／(B0-B600)公式计算胎儿顶叶、额叶、颞叶、枕叶、脑干、小脑、基底节区及丘脑的ADC值,用线性回归分析来分析胎龄与ADC值之间的关系.结果胎儿顶叶白质、枕叶白质、丘脑、基底节区、小脑、脑干、额叶白质、颞叶白质的平均ADC值分别为(1.77±0.32) mm2/s、(1.71±0.32)mm2/s、(1.31±0.18) mm2/s、(1.34 ±0.15)mm2/s、(1.41 ±0.18)mm2/s、(1.17±0.16)mm2/s、(1.87±0.18)mm2/s、(1.74±0.19)mm2/s.顶叶、枕叶、丘脑、基底节、脑干及小脑ADC值与胎龄均呈负相关(均P＜0.05)；额叶及颞叶ADC值与胎龄间无线性相关(P＞0.05),但两者的ADC值随着胎龄的增长有下降的趋势.各部位ADC值与胎龄的线性相关系数(r)及回归系数(b)分别为:枕叶r=0.470,b=-0.052；顶叶r=0.420,b=-0.045；小脑r=0.370,b=-0.027；脑干r=0.027,b=-0.020;丘脑r=0.320,b=-0.027及基底节区r=0.300,b=-0.021.孕中晚期胎儿额叶白质的平均ADC值最高,脑干区最低.各脑叶白质的平均ADC值较深部灰质核团及小脑、脑干的ADC值高.ADC值随胎儿发育成熟下降速率最快的部位为顶叶和枕叶脑白质,小脑、丘脑及基底节区次之.结论胎儿脑实质不同区域ADC值及其随胎龄的改变可以不同程度地反映脑的发育情况.
목적 탐토잉중만기태인불동부위뇌실질적ADC치여태령지간적관계.방법 2009년3월지2010년9월,재온주의학원부속제이의원70례초성부의이상이MRI검사정상적태인(산후림상수방균발육정상)행MRI DWI소묘,균위단태,태령위잉24 ～ 38주,평균태령32.4주.이용ADC=1n(S600/S0)／(B0-B600)공식계산태인정협、액협、섭협、침협、뇌간、소뇌、기저절구급구뇌적ADC치,용선성회귀분석래분석태령여ADC치지간적관계.결과 태인정협백질、침협백질、구뇌、기저절구、소뇌、뇌간、액협백질、섭협백질적평균ADC치분별위(1.77±0.32) mm2/s、(1.71±0.32)mm2/s、(1.31±0.18) mm2/s、(1.34 ±0.15)mm2/s、(1.41 ±0.18)mm2/s、(1.17±0.16)mm2/s、(1.87±0.18)mm2/s、(1.74±0.19)mm2/s.정협、침협、구뇌、기저절、뇌간급소뇌ADC치여태령균정부상관(균P＜0.05)；액협급섭협ADC치여태령간무선성상관(P＞0.05),단량자적ADC치수착태령적증장유하강적추세.각부위ADC치여태령적선성상관계수(r)급회귀계수(b)분별위:침협r=0.470,b=-0.052；정협r=0.420,b=-0.045；소뇌r=0.370,b=-0.027；뇌간r=0.027,b=-0.020;구뇌r=0.320,b=-0.027급기저절구r=0.300,b=-0.021.잉중만기태인액협백질적평균ADC치최고,뇌간구최저.각뇌협백질적평균ADC치교심부회질핵단급소뇌、뇌간적ADC치고.ADC치수태인발육성숙하강속솔최쾌적부위위정협화침협뇌백질,소뇌、구뇌급기저절구차지.결론 태인뇌실질불동구역ADC치급기수태령적개변가이불동정도지반영뇌적발육정황.
Objective To analyze the relationship between gestational age and apparent diffusion coefficient (ADC) values in different regions of fetal brain from middle to late trimester.Methods DW images performed in 70 singleton non-sedated fetuses with questionably abnormal results on sonography and normal fetal MR imaging results were retrospectively reviewed.The median gestational age was 32.4 weeks (range,24-38).With the formula of ADC =In (S600/S0)/(B0-B600),the mean ADC values were obtained for fetal parietal white matter (WM),frontal WM,temporal WM,occipital WM,pons,cerebellum,basal ganglia and thalamus.The relationship of mean ADC values in different regions with gestational age was analyzed with linear regression.Results The mean ADC values were 1.77 ± 0.32 mm2/s (SD) in fetal parietal white matter (WM),1.71 ±0.32 mm2/s in occipital WM,1.31 ±0.18 mm2/s in thalamus,1.34 ±0.15 mm2/s in basal ganglia.And the mean ADC values in eerebellum,pons,frontal WM and temporal WM were 1.17 ± 0.16,1.41 ± 0.18,1.87 ± 0.18 and 1.74 ± 0.19 mm2/s respectively.A significant negative correlation between ADC values and gestational age was found for parietal WM,occipital WM,pons,cerebellum,basal ganglia and thalamus (P ＜ 0.05).Frontal WM ADC (P ＞ 0.05) and temporal WM ADC (P =0.05) did not significantly change with gestational age whereas only a downward trend was present.The correlation coefficient (r) and coefficient of regression (b) were 0.420 and-0.045 in parietal WM ; 0.470 and-0.052 in occipital WM ; 0.370 and-0.027 in cerebellum ; 0.027 and-0.020 in pons ; 0.320 and-0.027 in thalamus; 0.300 and-0.021 in basal ganglia.The mean ADC values peaked in frontal WM and lowest in pons.The mean ADC values in white matter were higher than those in deep gray nuclei,cerebellum and pons.With the development of fetal brain,ADC values declined the fastest in cerebellum and occipital WM,followed by basal ganglia and thalamus.Conclusion Regional differences in non-sedated fetal brain ADC values and their evolutions with gestational age are likely to reflect variations in brain maturation.lowest in pons.The mean ADC values in white matter were higher than those in deep gray nuclei,cerebellum and pons.With the development of fetal brain,ADC values declined the fastest in cerebellum and occipital WM,followed by basal ganglia and thalamus.Conclusion Regional differences in non-sedated fetal brain ADC values and their evolutions with gestational age are likely to reflect variations in brain maturation.