不同时间窗内新生儿缺氧缺血性脑病分度的扩散加权成像研究

目的 探讨扩散加权成像(DWI)在不同时间窗内对足月新生儿缺氧缺血性脑病(HIE)分度的可行性和应用价值.方法 回顾性分析77例临床确诊为HIE的常规MRI、DWI图像,根据日龄分为2组,其中早期病例组(≤7 d)38例、中晚期病例组(8~28 d)39例.对两组病例进行T1WI、DWI分度并与临床分度比较.结果 与临床分度结果 相比较,早期病例中:DWI对轻度、中度和重度HIE的诊断符合率分别为56.25%(9/16)、100%(14/14)和100%(8/8);T1WI对轻度、中度和重度HIE的诊断符合率分别为25%(4/16)、71.43%(10/14)和25%(2/8).DWI分度与T1WI分度无统计学差异(U=-1.899,P=0.058).中晚期病例中:DWI对轻度、中度和重度HIE的诊断符合率分别为8.33%(1/12)、28.57%(6/21)和66.67%(4/6);T1WI对轻度、中度和重度HIE的诊断符合率分别为75%(9/12)、95.24%(20/21)和100%(6/6).DWI分度与T1WI分度比较具有统计学差异(U=-3.778,P=0.000).结论 不同时间窗DWI和T1WI对HIE分度评价不同.DWI对早期HIE进行分度可行,并与临床分度具有较高的符合率,但与T1WI分度无统计学差异;而对中晚期HIE DWI分度明显不及T1WI分度.

Diffusion weighted imaging in the grading of hypoxic-ischemic encephalopathy at different time windows

Objective To evaluate the clinical efficacy of diffusion weighted imaging（DWI） in the grading of hypoxic-ischemic encephalopathy（HIE） instituted at different time window. Methods The MRI and DWI of 77 patients with HIE clinical proven were collected and analyzed retrospectively. All the patients were divided into I （ ≤7 days） and Ⅱ （8-28 days） groups which included 38 and 39 cases respectively according to their age. The coincident diagnosing rate with clinical results were compared among the grading of DWI and T1WL Results Compared to the results of clinical grading, I group ： the coincidence of DWI in diagnosing mild, moderate, serious HIE was 56. 25% （9/16） , 100% （ 14/14 ） , and 100% （ 8/8 ） , respectively. The coincidence of T1WI in diagnosing mild, moderate, serious HIE was 25% （ 4/16 ）, 71.43% （ 10/14 ）, and 25% （ 2/8 ）, respectively. There were no significant statistical difference between T1WI and DWI （ U = - 1. 899, P = 0. 058 ）. 11 group： the coincidence of DWI in diagnosing mild, moderate, serious HIE was 8.33% （1/12） ,28.57% （6/21）, and 66. 67% （4/6）, respectively. The coincidence of T1WI in diagnosing mild, moderate, serious HIE Was 75% （9/12）,95.24% （20/21） , and 100% （6/6） , respectively. There were significant statistical difference between TI WI and DWI （ U = - 3.778,P = 0. 000）. Conclusions There was different grading between DWI and TI WI at the different time window of HIE. DWI is of important value in assessing the grading of HIE accurately in its early phase, however, there are no statistical differences between DWI and T1WI, but DWI is less than T1WI to evaluate HIE in its later phase.