CAJ | 학술논문

目的：探讨缺氧缺血性脑病（HIE）新生儿大脑ADC值与临床行为神经测定（NBNA）评分的相关性，从影像角度评价ADC值在HIE早期诊断中的价值。方法选取109例日龄在7 d内的HIE患儿行常规MRI和DWI检查，根据HIE分级标准分为轻度组43例、中度组38例、重度组28例；同期收集24例正常足月儿作为对照组。所有受试者均进行NBNA评分，并测量双侧额叶深部白质、顶叶深部白质、侧脑室旁白质、内囊后肢、丘脑腹外侧核、豆状核、胼胝体压部及脑干8个部位的ADC值。采用单因素方差分析比较各组间ADC值，采用Pearson相关分析各部位ADC值与NBNA评分的相关性。结果除豆状核和脑干外，额叶深部、顶叶深部、侧脑室旁白质和内囊后肢、丘脑腹外侧核及胼胝体压部的ADC值随脑损伤程度加重而依次减低。轻、中、重度组额叶深部白质ADC值分别为（1.82±0.33）×10-3、（1.77±0.34）×10-3、（1.62±0.31）×10-3 mm2/s，顶叶深部白质ADC值分别为（1.81±0.34）×10-3、（1.79±0.27）×10-3、（1.72±0.31）×10-3 mm2/s，侧脑室旁白质ADC值分别为（1.27±0.15）×10-3、（1.23±0.12）×10-3、（1.15±0.17）×10-3 mm2/s，内囊后肢ADC值分别为（1.08±0.09）×10-3、（0.97±0.07）×10-3、（0.84±0.06）×10-3 mm2/s，丘脑腹外侧核ADC值分别为（1.13±0.07）×10-3、（1.08±0.13）×10-3、（1.00±0.13）×10-3 mm2/s，胼胝体压部ADC值分别为（1.27±0.22）×10-3、（1.18±0.16）×10-3、（1.00±0.23）×10-3 mm2/s，3组间差异均有统计学意义（F值分别为61.27、16.27、23.26、72.70、26.73、66.09，P值均<0.05）。轻、中、重度组NBNA评分分别为（36.8±1.4）、（33.5±1.6）、（29.3±2.6）分。额叶深部白质、顶叶深部白质、侧脑室旁白质、内囊后肢、丘脑腹外侧核及胼胝体压部ADC值与NBNA评分均呈正相关（r值分别为0.60、0.49、0.54、0.67、0.56、0.65，P值均<0.05）。结论 HIE新生儿大脑相关ROI ADC值与NBNA评分具有相关性，二者结合能够更准确、客观地评价HIE脑损伤。目的：探討缺氧缺血性腦病（HIE）新生兒大腦ADC值與臨床行為神經測定（NBNA）評分的相關性，從影像角度評價ADC值在HIE早期診斷中的價值。方法選取109例日齡在7 d內的HIE患兒行常規MRI和DWI檢查，根據HIE分級標準分為輕度組43例、中度組38例、重度組28例；同期收集24例正常足月兒作為對照組。所有受試者均進行NBNA評分，併測量雙側額葉深部白質、頂葉深部白質、側腦室徬白質、內囊後肢、丘腦腹外側覈、豆狀覈、胼胝體壓部及腦榦8箇部位的ADC值。採用單因素方差分析比較各組間ADC值，採用Pearson相關分析各部位ADC值與NBNA評分的相關性。結果除豆狀覈和腦榦外，額葉深部、頂葉深部、側腦室徬白質和內囊後肢、丘腦腹外側覈及胼胝體壓部的ADC值隨腦損傷程度加重而依次減低。輕、中、重度組額葉深部白質ADC值分彆為（1.82±0.33）×10-3、（1.77±0.34）×10-3、（1.62±0.31）×10-3 mm2/s，頂葉深部白質ADC值分彆為（1.81±0.34）×10-3、（1.79±0.27）×10-3、（1.72±0.31）×10-3 mm2/s，側腦室徬白質ADC值分彆為（1.27±0.15）×10-3、（1.23±0.12）×10-3、（1.15±0.17）×10-3 mm2/s，內囊後肢ADC值分彆為（1.08±0.09）×10-3、（0.97±0.07）×10-3、（0.84±0.06）×10-3 mm2/s，丘腦腹外側覈ADC值分彆為（1.13±0.07）×10-3、（1.08±0.13）×10-3、（1.00±0.13）×10-3 mm2/s，胼胝體壓部ADC值分彆為（1.27±0.22）×10-3、（1.18±0.16）×10-3、（1.00±0.23）×10-3 mm2/s，3組間差異均有統計學意義（F值分彆為61.27、16.27、23.26、72.70、26.73、66.09，P值均<0.05）。輕、中、重度組NBNA評分分彆為（36.8±1.4）、（33.5±1.6）、（29.3±2.6）分。額葉深部白質、頂葉深部白質、側腦室徬白質、內囊後肢、丘腦腹外側覈及胼胝體壓部ADC值與NBNA評分均呈正相關（r值分彆為0.60、0.49、0.54、0.67、0.56、0.65，P值均<0.05）。結論 HIE新生兒大腦相關ROI ADC值與NBNA評分具有相關性，二者結閤能夠更準確、客觀地評價HIE腦損傷。
목적：탐토결양결혈성뇌병（HIE）신생인대뇌ADC치여림상행위신경측정（NBNA）평분적상관성，종영상각도평개ADC치재HIE조기진단중적개치。방법선취109례일령재7 d내적HIE환인행상규MRI화DWI검사，근거HIE분급표준분위경도조43례、중도조38례、중도조28례；동기수집24례정상족월인작위대조조。소유수시자균진행NBNA평분，병측량쌍측액협심부백질、정협심부백질、측뇌실방백질、내낭후지、구뇌복외측핵、두상핵、변지체압부급뇌간8개부위적ADC치。채용단인소방차분석비교각조간ADC치，채용Pearson상관분석각부위ADC치여NBNA평분적상관성。결과제두상핵화뇌간외，액협심부、정협심부、측뇌실방백질화내낭후지、구뇌복외측핵급변지체압부적ADC치수뇌손상정도가중이의차감저。경、중、중도조액협심부백질ADC치분별위（1.82±0.33）×10-3、（1.77±0.34）×10-3、（1.62±0.31）×10-3 mm2/s，정협심부백질ADC치분별위（1.81±0.34）×10-3、（1.79±0.27）×10-3、（1.72±0.31）×10-3 mm2/s，측뇌실방백질ADC치분별위（1.27±0.15）×10-3、（1.23±0.12）×10-3、（1.15±0.17）×10-3 mm2/s，내낭후지ADC치분별위（1.08±0.09）×10-3、（0.97±0.07）×10-3、（0.84±0.06）×10-3 mm2/s，구뇌복외측핵ADC치분별위（1.13±0.07）×10-3、（1.08±0.13）×10-3、（1.00±0.13）×10-3 mm2/s，변지체압부ADC치분별위（1.27±0.22）×10-3、（1.18±0.16）×10-3、（1.00±0.23）×10-3 mm2/s，3조간차이균유통계학의의（F치분별위61.27、16.27、23.26、72.70、26.73、66.09，P치균<0.05）。경、중、중도조NBNA평분분별위（36.8±1.4）、（33.5±1.6）、（29.3±2.6）분。액협심부백질、정협심부백질、측뇌실방백질、내낭후지、구뇌복외측핵급변지체압부ADC치여NBNA평분균정정상관（r치분별위0.60、0.49、0.54、0.67、0.56、0.65，P치균<0.05）。결론 HIE신생인대뇌상관ROI ADC치여NBNA평분구유상관성，이자결합능구경준학、객관지평개HIE뇌손상。
Objective To explore the correlation between apparent diffusion coefficient(ADC)and neonatal behavioral neurological assessment(NBNA) of newborns with hypoxic ischemic encephalopathy (HIE),and to evaluate ADC in the early diagnosis of HIE from the imaging perspective. Method One hundred and nine neonates aged 0—7 days with HIE underwent conventional MRI and DWI. According to HIE grading standards, there were 43 neonates in the mild group, 38 in the moderate group, 28 in the severe group, and meanwhile 24 normal neonates with the same ages were selected as the control group. All cases were assessed with NBNA, and ADC values of bilateral frontal white matter, parietal white matter, periventricular white matter, posterior limb of the internal capsule(PLIC), ventral lateral nucleus of thalamus, lenticular nucleus, splenium of the corpus callosum, brainstem were measured. ADC values of different groups were compared by analysis of variance, and the correlations between ADC values of all ROIs and NBNA were analyzed by Pearson correlation. Results Except lenticular nucleus and the brainstem, ADC values of frontal white matter, parietal white matter, periventricular white matter and PLIC, ventral lateral nucleus of thalamus, splenium of the corpus callosum were decreased in the mild, moderate, severe group. In the mild, moderate, and severe group, the ADC values of frontal deep white matter were(1.82± 0.33)× 10-3,(1.77 ± 0.34)× 10-3 and(1.62 ± 0.31)× 10-3 mm2/s,while they were(1.81 ± 0.34)× 10-3,(1.79 ± 0.27)× 10-3 and(1.72 ± 0.31)× 10-3 mm2/s for the parietal deep white matter,(1.27 ± 0.15)× 10-3,(1.23 ± 0.12)× 10-3 and(1.15 ± 0.17)× 10-3 mm2/s for the periventricular white matter,(1.08 ± 0.09)× 10-3,(0.97 ± 0.07)×10-3 and(0.84±0.06)×10-3 mm2/s for the PLIC,(1.13±0.07)×10-3 ,(1.08±0.13)×10-3 and(1.00± 0.13)× 10-3 mm2/s for the ventral lateral nucleus of thalamus,(1.27 ± 0.22)× 10-3,(1.18 ± 0.16)× 10-3 and (1.00 ± 0.23)× 10-3 mm2/s for the splenium of the corpus callosum. There were statistically significant differences between the 3 groups (F=61.27,16.27, 23.26, 72.70, 26.73, 66.09,all P<0.05). In the mild, modreate and severe group, NBNA were(36.8 ± 1.4) in the mild group,(33.5 ± 1.6) in the moderate,and (29.3 ± 2.6) in the severe group. There was positive correlation between ADC values of frontal white matter, parietal white matter, periventricular white matter and PLIC, ventral lateral nucleus of thalamus, splenium of the corpus callosum and NBNA scores(r=0.60,0.49,0.54,0.67,0.56,0.65,all P<0.05). Conclusions There are correlations between ADC values of the related ROIs of HIE and NBNA scores. Combining two aspects might diagnose the brain injury of HIE more accurately and objectively.