Near-infrared spectroscopy versus magnetic resonance imaging to study brain perfusion in newborns with hypoxic-ischemic encephalopathy treated with hypothermia
Near-infrared spectroscopy versus magnetic resonance imaging to study brain perfusion in newborns with hypoxic-ischemic encephalopathy treated with hypothermia
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DOI：
10.1016/j.neuroimage.2013.04.072
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发表时间：
2014-01-15
期刊：
影响因子：
5.7
通讯作者：
Soul, J. S.
中科院分区：
文献类型：
--
作者：
Wintermark, P.;Hansen, A.;Soul, J. S.
背景资料：脑血流灌注测定可为新生儿缺氧缺血性脑病（HIE）的评估和治疗提供有价值的信息。虽然动脉自旋标记灌注（ASL）磁共振成像（MRI）提供了局部脑血流量（CBF）值的无创和直接测量，但在逻辑上难以获得。近红外光谱（NIRS）可能是一种替代方法，因为它允许无创和连续监测脑血流动力学和氧合bedside.Objective：本研究的目的是确定脑灌注测量之间的相关性NIRS和Mitt在足月新生儿缺氧缺血性脑病治疗与低温.设计/方法：在这项前瞻性队列研究中，在低温期间进行的ASL-MRI和NIRS被用来评估这些新生儿的脑灌注。将每例患者1-2次MRI扫描测量的局部脑血流量（CBF）值与每次MRI前后NIBS记录的混合静脉饱和度值（SctO（2））进行比较。分析包括分组为中度与重度缺氧缺血性脑病的基础上，他们的初始背景模式的振幅整合electroencephalogram.Results：12个伴随录音获得7个新生儿。重度HIE窒息新生儿SctO（2）与CBF有较强的相关性（r = 0.88; p值= 0.0085）。重度HIE新生儿脑血流明显降低（可能较低的氧气供应）和提取较少的氧气当比较SctO（2）和CBF与中度HIE患者时，NIBS是监测和了解足月窒息新生儿脑灌注变化的有效床边工具，结合特定时间通过MRI获得的CBF精确测量，可能有助于调整HIE足月新生儿的神经保护策略。(C)2013 Elsevier Inc. All rights reserved.
Background: The measurement of brain perfusion may provide valuable information for assessment and treatment of newborns with hypoxic-ischemic encephalopathy (HIE). While arterial spin labeled perfusion (ASL) magnetic resonance imaging (MRI) provides noninvasive and direct measurements of regional cerebral blood flow (CBF) values, it is logistically challenging to obtain. Near-infrared spectroscopy (NIRS) might be an alternative, as it permits noninvasive and continuous monitoring of cerebral hemodynamics and oxygenation at the bedside.Objective: The purpose of this study is to determine the correlation between measurements of brain perfusion by NIRS and by Mitt in term newborns with HIE treated with hypothermia.Design/methods: In this prospective cohort study, ASL-MRI and NIRS performed during hypothermia were used to assess brain perfusion in these newborns. Regional cerebral blood flow (CBF) values, measured from 1-2 MRI scans for each patient, were compared to mixed venous saturation values (SctO(2)) recorded by NIBS just before and after each MRI. Analysis included groupings into moderate versus severe HIE based on their initial background pattern of amplitude-integrated electroencephalogram.Results: Twelve concomitant recordings were obtained of seven neonates. Strong correlation was found between SctO(2) and CBF in asphyxiated newborns with severe HIE (r = 0.88; p value = 0.0085). Moreover, newborns with severe HIE had lower CBF (likely lower oxygen supply) and extracted less oxygen (likely lower oxygen demand or utilization) when comparing SctO(2) and CBF to those with moderate HIE.Conclusions: NIBS is an effective bedside tool to monitor and understand brain perfusion changes in term asphyxiated newborns, which in conjunction with precise measurements of CBF obtained by MRI at particular times, may help tailor neuroprotective strategies in term newborns with HIE. (C) 2013 Elsevier Inc. All rights reserved.