Comparison of Predictive Values of Magnetic Resonance Biomarkers Based on Scan Timing in Neonatal Encephalopathy Following Therapeutic Hypothermia
Comparison of Predictive Values of Magnetic Resonance Biomarkers Based on Scan Timing in Neonatal Encephalopathy Following Therapeutic Hypothermia
复制标题
基于扫描定时的磁共振生物标志物对低温治疗后新生儿脑病的预测价值比较
DOI：
10.1016/j.jpeds.2021.08.011
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发表时间：
2021
期刊：
影响因子：
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通讯作者：
Aida Noriko
中科院分区：
文献类型：
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作者：
Shibasaki Jun;Niwa Tetsu;Piedvache Aurelie;Tomiyasu Moyoko;Morisaki Naho;Fujii Yuta;Toyoshima Katsuaki;Aida Noriko
目的根据扫描时机确定新生儿亚低温治疗后脑病的最佳定量磁共振（MR）生物标志物。（35-41周妊娠）患有新生儿脑病，接受了低温治疗;分别在出生后24-96小时（n = 56）和7-14天（n = 92）进行扩散加权成像和质子MR波谱，以估计表观扩散系数（ADC）值，深灰质中N-乙酰天冬氨酸和N-乙酰谷氨酸（tNAA）、乳酸和胆碱浓度以及乳酸/tNAA、tNAA/胆碱比值。不良结局包括18-22月龄时的死亡或神经发育障碍。我们使用接收器操作特征曲线来检查每个MR生物标志物的预后准确性。ResultsDeep graymatter tNAA浓度显示出最好的预后值，曲线下面积（AUC）分别为0.97和1.00在24-96小时和7-14天出生后，分别。在24-96小时龄时，ADC值、乳酸浓度和乳酸/tNAA比值显示出预后价值，AUC分别为0.90、0.95和0.97。在7-14天的年龄，AUC的ADC值，乳酸，乳酸/tNAA的比率分别为0.61，0.67和0.80，这些都低于那些在24-96小时的年龄。尽管ADC值、乳酸水平和乳酸/tNAA比值在出生后24-96小时内也显示出较高的预后价值，但只有tNAA在出生后第二周内仍具有较高的预后价值。
ObjectiveTo determine the optimal quantitative magnetic resonance (MR) biomarker in neonatal encephalopathy following therapeutic hypothermia based on scan timing.Study designThis retrospective study included 98 neonates (35-41 weeks of gestation) with neonatal encephalopathy, who underwent therapeutic hypothermia; diffusion-weighted imaging and proton MR spectroscopy were performed at 24-96 hours (n = 56) and 7-14 days (n = 92) after birth, respectively, to estimate apparent diffusion coefficient (ADC) values,N-acetylaspartate and N-acetylaspartylglutamate (tNAA), lactate, and choline concentrations, and lactate/tNAA, tNAA/choline ratios in the deep gray matter. Adverse outcomes included death or neurodevelopmental impairment at 18-22 months of age. We used receiver operating characteristic curves to examine the prognostic accuracy of each MR biomarker.ResultsDeep gray matter tNAA concentrations showed the best prognostic value, with an area under the curve (AUC) of 0.97 and 1.00 at 24-96 hours and 7-14 days after birth, respectively. At 24-96 hours of age, ADC values, lactate concentrations, and lactate/tNAA ratios showed prognostic value with AUCs of 0.90, 0.95, and 0.97, respectively. At 7-14 days of age, the AUCs of ADC values, lactate, and lactate/tNAA ratios were 0.61, 0.67, and 0.80, respectively; these were lower than those at 24-96 hours of age.ConclusionsDuring the first 2 weeks of life, the deep gray matter tNAA concentration was the most accurate quantitative MR biomarker. Although ADC values, lactate levels, and lactate/tNAA ratios also showed high prognostic value during 24-96 hours of life, only tNAA retained high prognostic value in the second week of life.