超声声脉冲辐射力成像技术评价缺氧缺血后新生儿早期脑损伤的初步研究

目的探讨超声声脉冲辐射力成像技术(ARFI)评价缺氧缺血后新生儿早期脑损伤的临床应用价值。方法选择2009年1月至2010年1月出生3天内入住我院新生儿重症监护病房的适于胎龄儿,足月HIE组、早产脑损伤组、足月对照组和早产对照组各40例。采用SiemensAcuson S2000超声诊断系统,生后4～7天常规行颅脑二维超声及彩色多普勒检查,于ARFI模式下启动声触诊组织量化(VTQ)功能测量颅脑双侧顶叶、丘脑及大脑镰的VTQ值,并对各组进行比较。结果 (1)足月HIE组及早产脑损伤组双侧顶叶及丘脑、大脑镰VTQ值均大于同胎龄对照组(P均<0.05)。(2)早产儿脑损伤组双侧顶叶及右侧丘脑VTQ值大于足月HIE组(P均<0.05)。(3)早产对照组双侧顶叶VTQ值大于足月对照组(P均<0.05)。(4)VTQ值随足月儿HIE病情加重呈增加趋势。结论 ARFI能实时、敏感探测新生儿脑部不同部位正常与病变时VTQ值,有望成为新生儿特别是早产儿脑损伤早期诊断手段之一。

Ultrasound acoustic radiation force impulse imaging evaluation of early brain injury in neonatal hypoxic-ischemic encephalopathy

Objective To explore the clinical application value of Acoustic Radiation Force Impulse Imaging technology(ARFI) in evaluation of neonates with Hypoxic Ischemic Encephalopathy(HIE).Methods Neonates appropriate for gestational age(AGA) admitted to our NICU from Jan.2009 to Jan.2010 were recruited.Each group of 40 patients was selected as follow: 1) AGA full-term HIE group,2) preterm brain injury group,3) full-term group and 4) preterm control group.Cerebral Two-Dimensional and Color Doppler Ultrasound tests were performed at 4-7 days of age.Under ARFI mode,using Virtual Touch Tissue Quantification(VTQ) to measure and to compare the VTQ values of bilateral parietal lobes,thalamus and cerebral falx among different groups.Results The VTQ values of bilateral parietal lobes,thalamus and cerebral falx in the full-term HIE and the preterm brain injury groups are greater than the VTQ values in their respective gestational age matched control groups(P<0.05).Similarly,the VTQ values of bilateral parietal lobes in preterm brain injury group is greater than the values in the full term HIE group(P<0.05);and the VTQ values of bilateral parietal lobes in premature birth control group is greater than the values in the full-term control group(P<0.05).Furthermore,VTQ values have tendency to increase with worsening of HIE in full-term infants.Conclusions ARFI technology detects the difference in VTQ values of normal and injured neonatal brain early and with good sensitivity.This technology may have potential as one of the early diagnostic tools in evaluating brain injury during neonatal period,especially in premature infants.