MR Imaging and Outcome of Term Neonates with Perinatal Asphyxia: Value of Diffusion-weighted MR Imaging and 1H MR Spectroscopy
MR Imaging and Outcome of Term Neonates with Perinatal Asphyxia: Value of Diffusion-weighted MR Imaging and 1H MR Spectroscopy
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DOI：
10.1148/radiol.11110213
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发表时间：
2011-10-01
期刊：
影响因子：
19.7
通讯作者：
Groenendaal, Floris
中科院分区：
文献类型：
--
作者：
Alderliesten, Thomas;de Vries, Linda S.;Groenendaal, Floris
目的：比较围产期窒息后新生儿缺氧缺血性脑病的神经发育结果与（a）弥散加权（DW）磁共振（MR）成像中丘脑和基底节的表观弥散系数（ADC）和（B）基底节氢1（H-1）MR波谱测量之间的相关性。材料和方法：这项回顾性研究得到了当地伦理委员会的批准，并且免除了获得知情同意书的要求。81例围产期窒息的足月新生儿接受了常规和DW头颅MR成像（中位年龄，4天;年龄范围，1-14天）; 51例新生儿还接受了H-1 MR波谱检查。从18到46个月评估神经发育。对有利和不利结局的患者进行比较。对所有患者进行受试者操作特征分析，并对44例出生7天内检查的患者进行单因素和多因素logistic回归分析，使用MR成像评分，基底节和丘脑中的ADC，以及基底节中的H-1 MR波谱测量。所有81名新生儿中有28名出现不良结局（20名死亡，7名发展为脑瘫，1名患有严重精神发育迟滞），44名新生儿中有22名在出生后7天内接受ADC和H-1 MR波谱检查。不良预后与（a）出生7天内检查的新生儿基底神经节（P <0.001）和丘脑（P = 0.001）中ADC较低以及（B）基底神经节中乳酸（Lac）-N-乙酰天冬氨酸（NAA）比率较高（P <0.001）相关。多因素分析显示，MR成像评分结合出生后第1周内基底节Lac/NAA比值或ADC值与预后的相关性优于单独MR成像（P = 0.006，Lac/NAA比率的受试者工作特征曲线下面积[AUC] = 0.85; P <0.0001，基底神经节中ADC的AUC = 0.93）。结合MR成像评分和基底神经节ADC值或Lac/NAA比值与窒息足月新生儿预后的相关性优于单独使用MR成像。(C)RSNA，2011年
Purpose: To compare the association between neurodevelopmental outcome in neonates with hypoxic-ischemic encephalopathy following perinatal asphyxia and (a) apparent diffusion coefficients (ADCs) in the thalamus and basal ganglia at diffusion-weighted (DW) magnetic resonance (MR) imaging and (b) hydrogen 1 (H-1) MR spectroscopic measurements in the basal ganglia.Materials and Methods: This retrospective study was approved by the local ethics committee, and the requirement to obtain informed consent was waived. Eighty-one term neonates with perinatal asphyxia underwent conventional and DW cranial MR imaging (median age, 4 days; age range, 1-14 days); 51 neonates also underwent H-1 MR spectroscopy. Neurodevelopment was assessed from 18 to 46 months. Patients with favorable and adverse outcomes were compared. Receiver operating characteristics analysis was performed in all patients, and uni- and multivariate logistic regression analyses were performed in 44 patients examined within 7 days of birth by using MR imaging scores, ADCs in the basal ganglia and thalamus, and H-1 MR spectroscopic measurements in the basal ganglia.Results: An adverse outcome was seen in 28 of all 81 neonates (20 died, seven developed cerebral palsy, and one had severe mental retardation) and 22 of the 44 neonates examined within 7 days of birth with both ADC and H-1 MR spectroscopy. Poor outcome was associated with (a) lower ADCs in the basal ganglia (P < .001) and thalamus (P = .001) of neonates examined within 7 days of birth and (b) a higher lactate (Lac)-N-acetylaspartate (NAA) ratio in the basal ganglia (P < .001). Multivariate analysis showed that MR imaging score combined with Lac/NAA ratios or ADCs in the basal ganglia within the 1st week of life had a better association with outcome than did MR imaging alone (P = .006, area under the receiver operating characteristic curve [AUC] = 0.85 with Lac/NAA ratio; P < .0001, AUC = 0.93 with ADCs in basal ganglia).Conclusion: The combination of MR imaging score with ADCs or Lac/NAA ratios in the basal ganglia has a better association with outcome of asphyxiated term neonates than does MR imaging alone. (C) RSNA, 2011