Brain volume and metabolism in fetuses with congenital heart disease: evaluation with quantitative magnetic resonance imaging and spectroscopy.
Brain volume and metabolism in fetuses with congenital heart disease: evaluation with quantitative magnetic resonance imaging and spectroscopy.
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DOI：
10.1161/circulationaha.109.865568
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发表时间：
2010-01-05
期刊：
影响因子：
37.8
通讯作者：
du Plessis AJ
中科院分区：
文献类型：
--
作者：
Limperopoulos C;Tworetzky W;McElhinney DB;Newburger JW;Brown DW;Robertson RL Jr;Guizard N;McGrath E;Geva J;Annese D;Dunbar-Masterson C;Trainor B;Laussen PC;du Plessis AJ
不良的神经发育结局是先天性心脏病（CHD）患儿发病率的重要来源。相当一部分患有复杂冠心病的新生儿有脑大小、结构和/或功能异常，这表明产前因素可能导致儿童神经发育疾病。采用三维体积磁共振成像（MRI）和磁共振波谱（1H-MRS）技术对55例冠心病胎儿和50例正常胎儿的脑容量和脑代谢进行前瞻性比较。人工分割胎儿颅内腔（ICV）、脑脊液（脑脊液）和脑总容量（TBV）。1H-MRS测定脑内n -乙酰天冬氨酸与胆碱比值（NAA:Cho），并鉴定脑内乳酸。完成胎儿超声心动图检查。MRI的胎龄（GA）范围为25 1/7 ~ 37 1/7周（中位30周）。在妊娠晚期，与对照组相比，CHD胎儿ga调整的TBV和ICV有显著的进行性下降。NAA：正常胎儿的Cho在妊娠晚期逐渐升高，但冠心病胎儿的上升速度明显较慢（p<0.001）。在调整GA和体重百分位数的多变量分析中，心脏诊断和通过主动脉瓣的联合心室输出量百分比与TBV独立相关。低NAA:Cho的独立预测因素包括诊断、无主动脉弓顺行血流和脑乳酸的证据（p<0.001）。与正常胎儿相比，患有某些形式冠心病的妊娠晚期胎儿GA和体重调整后的TBV更小，并且有证据表明神经轴突发育和代谢受损。血流动力学因素可能在这种异常发育中起重要作用。
Adverse neurodevelopmental outcome is an important source of morbidity in children with congenital heart disease (CHD). A significant proportion of newborns with complex CHD have abnormalities of brain size, structure, and/or function, suggesting that antenatal factors may contribute to childhood neurodevelopmental morbidity. Brain volume and metabolism were compared prospectively between 55 fetuses with CHD and 50 normal fetuses using 3-D volumetric magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (1H-MRS). Fetal intracranial cavity (ICV), cerebrospinal fluid, and total brain volumes (TBV) were measured by manual segmentation. 1H-MRS was used to measure the cerebral N-acetyl aspartate:choline ratio (NAA:Cho) and identify cerebral lactate. Complete fetal echocardiograms were performed. Gestational age (GA) at MRI ranged from 25 1/7 to 37 1/7 weeks (median 30 weeks). During the third trimester, there were progressive and significant declines in GA-adjusted TBV and ICV in CHD fetuses relative to controls. NAA:Cho increased progressively over the third trimester in normal fetuses, but the rate of rise was significantly slower (p<0.001) in CHD fetuses. On multivariable analysis adjusting for GA and weight percentile, cardiac diagnosis and percentage of combined ventricular output through the aortic valve were independently associated with TBV. Independent predictors of lower NAA:Cho included diagnosis, absence of antegrade aortic arch flow, and evidence of cerebral lactate (p<0.001). Third-trimester fetuses with some forms of CHD have smaller GA- and weight-adjusted TBV than normal fetuses, and evidence of impaired neuroaxonal development and metabolism. Hemodynamic factors may play an important role in this abnormal development.