Cerebral Magnetic Resonance Biomarkers in Neonatal Encephalopathy: A Meta-analysis
Cerebral Magnetic Resonance Biomarkers in Neonatal Encephalopathy: A Meta-analysis
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DOI：
10.1542/peds.2009-1046
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发表时间：
2010-02-01
期刊：
影响因子：
8
通讯作者：
Robertson, Nicola J.
中科院分区：
文献类型：
--
作者：
Thayyil, Sudhin;Chandrasekaran, Manigandan;Robertson, Nicola J.
目的：准确预测新生儿脑病（NE）的神经发育结局对于临床管理和评估神经保护疗法非常重要。我们对脑磁共振（MR）生物标志物在新生儿脑病婴儿中的预后准确性进行了荟萃分析。方法：我们回顾了所有将新生儿期进行的 MR 生物标志物与 >= 1 岁时的神经发育结果进行比较的研究。我们遵循 Cochrane 诊断准确性方法组推荐的标准方法，并使用随机效应模型进行荟萃分析。计算了每个 MR 生物标志物的汇总受试者工作特征曲线和森林图。 chi (2) 检验检查了异质性。结果：荟萃分析中纳入了 32 项研究（860 名患有 NE 的婴儿）。为了预测不良结果，新生儿期（第 1-30 天）的常规 MRI 的汇总敏感性为 91%（95% 置信区间 [CI]：87%-94%），特异性为 51%（95% CI：45%-58%）。与早期 MRI（第 1-7 天）相比，晚期 MRI（第 8-30 天）的敏感性较高，但特异性较低。质子磁共振波谱深部灰质乳酸/N-乙酰天冬氨酸 (Lac/NAA) 峰面积比（第 1-30 天）的总体汇总灵敏度为 82%（95% CI：74%-89%），特异性为 95%（95% CI：88%-99%）。根据一般研究分析，在新生儿期任何时间，Lac/NAA 都比传统 MRI 具有更好的诊断准确性。内囊后肢征和脑水表观扩散系数的辨别力较差。结论：深部灰质Lac/NAA是新生儿期预测NE后神经发育结局最准确的定量MR生物标志物。 Lac/NAA 可能有助于早期临床管理决策和为父母提供咨询，并可作为评估新型神经保护疗法的临床试验的替代终点。儿科 2010；125：e382-e395
OBJECTIVE: Accurate prediction of neurodevelopmental outcome in neonatal encephalopathy (NE) is important for clinical management and to evaluate neuroprotective therapies. We undertook a metaanalysis of the prognostic accuracy of cerebral magnetic resonance (MR) biomarkers in infants with neonatal encephalopathy.METHODS: We reviewed all studies that compared an MR biomarker performed during the neonatal period with neurodevelopmental outcome at >= 1 year. We followed standard methods recommended by the Cochrane Diagnostic Accuracy Method group and used a random-effects model for meta-analysis. Summary receiver operating characteristic curves and forest plots of each MR biomarker were calculated. chi (2) tests examined heterogeneity.RESULTS: Thirty-two studies (860 infants with NE) were included in the meta-analysis. For predicting adverse outcome, conventional MRI during the neonatal period (days 1-30) had a pooled sensitivity of 91% (95% confidence interval [CI]: 87%-94%) and specificity of 51% (95% CI: 45%-58%). Late MRI (days 8-30) had higher sensitivity but lower specificity than early MRI (days 1-7). Proton MR spectroscopy deep gray matter lactate/N-acetyl aspartate (Lac/NAA) peak-area ratio (days 1-30) had 82% overall pooled sensitivity (95% CI: 74%-89%) and 95% specificity (95% CI: 88%-99%). On common study analysis, Lac/NAA had better diagnostic accuracy than conventional MRI performed at any time during neonatal period. The discriminatory powers of the posterior limb of internal capsule sign and brain-water apparent diffusion coefficient were poor.CONCLUSIONS: Deep gray matter Lac/NAA is the most accurate quantitative MR biomarker within the neonatal period for prediction of neurodevelopmental outcome after NE. Lac/NAA may be useful in early clinical management decisions and counseling parents and as a surrogate end point in clinical trials that evaluate novel neuroprotective therapies. Pediatrics 2010;125:e382-e395