A prospective, longitudinal diffusion tensor imaging study of brain injury in newborns
A prospective, longitudinal diffusion tensor imaging study of brain injury in newborns
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DOI：
10.1212/wnl.59.6.824
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发表时间：
2002-09-24
期刊：
影响因子：
9.9
通讯作者：
Neil, JJ
中科院分区：
文献类型：
--
作者：
McKinstry, RC;Miller, JH;Neil, JJ
目的：探讨新生儿脑损伤后水扩散系数（D-av）的变化规律。方法：从新生儿重症监护室招募10名围产期脑损伤高危新生儿。常规和扩散张量MRI进行了三次在第一周的生活。损伤后1周，通过评估常规MR图像（T1，T2，液体衰减反转恢复）确定损伤区域。对于所有三次扫描，确定这些区域的D-av值。结果如下：大多数婴儿在损伤后1天的D-av值降低，但10名婴儿中有4名的损伤不明显或被低估，尽管在1周时常规成像上存在损伤。到第三天，所有婴儿受伤部位的D-av值均下降，达到比正常值低约35%的最低点。到损伤后第7天，D-av值恢复正常（恢复正常化）。结论：在损伤后第一天获得的MR扩散图像（其对比度由D-av的变化确定）不一定显示新生儿最终损伤的全部范围。在出生后第二天至第四天之间获得的图像可靠地表明了损伤的程度。到第7天，弥散MR对围产期脑损伤的敏感性低于常规MR，因为D-av的短暂异常正常化。总体而言，弥散MR可能不适合作为新生儿损伤后第一天检测脑损伤的金标准。
Objective: To establish the magnitude and time course of the changes in water diffusion coefficient (D-av) following newborn infant brain injury. Methods: Ten newborn infants at high risk for perinatal brain injury were recruited from the neonatal intensive care unit. Conventional and diffusion tensor MRI was performed on three occasions during the first week of life. Regions of injury were determined by evaluating conventional MR images (T1, T2, fluid-attenuated inversion recovery) at 1 week after injury. D-av values were determined for these regions for all three scans. Results: D-av values were decreased in most infants 1 day after injury, but injury was not evident or underestimated in 4 of 10 infants despite the presence of injury on conventional imaging at 1 week. By the third day, D-av values were decreased in injured areas in all infants, reaching a nadir of approximately 35% less than normal values. By the seventh day after injury, D-av values were returning to normal (pseudonormalization). Conclusions: MR diffusion images (for which contrast is determined by changes in D-av) obtained on the first day after injury do not necessarily show the full extent of ultimate injury in newborn infants. Images obtained between the second and fourth days of life reliably indicate the extent of injury. By the seventh day, diffusion MR is less sensitive to perinatal brain injury than conventional MR because of transient pseudonormalization of D-av. Overall, diffusion MR may not be suitable as a gold standard for detection of brain injury during the first day after injury in newborn infants.