DWI对HIE合并黄疸患儿早期诊断价值的探讨

目的探讨磁共振弥散加权成像（DWI）的表观弥散系数（ADC）值在评价足月新生儿缺氧缺血性脑病（HIE）同时合并黄疸时的早期临床诊断价值。方法采用平面回波超高速成像方法对mE患儿进行DwI冠状位扫描，感兴趣区为左右两侧的豆状核、额叶深部白质及海马，后期处理为ADC值的测定，并对测定数据进行分析。结果①HIE组均为足月儿，共32例，轻、中、重度HIE患儿分别为12例、13例、7例。根据合并黄疸轻重程度再次分为无黄疸组8例，轻度黄疸5例，中度黄疸14例，重度黄疸5例；②无黄疸组与重度黄疸组的右侧豆状核ADC值比较差异有统计学意义（P=0．047〈0．05）；无黄疸组与重度黄疸组左侧豆状核ADC值比较差异有统计学意义（P=0．044〈0．05）；③在进行右侧海马的ADC值比较中，无黄疸组与轻度黄疸组比较差异有统计学意义（P=0．008〈0．05）；轻度黄疽与中度黄疸组比较差异有统计学意义（P=0．015〈0．05）；④在进行左侧海马ADC值比较中，无黄疸组与轻度黄疸组比较差异有统计学意义（P=0．002〈0．05）；轻度黄疸与中度黄疸比较差异有统计学意义（P=0．002〈0．05）；轻度黄疸与重度黄疸组比较差异有统计学意义（P=0．014〈0．05）；⑤各部位ADC值与黄疸之间无相关性（均P〉O．01），即随着黄疸程度的加重ADC值无明显的变化趋势。结论早期进行DwI扫描，黄疸对HIE患儿的DWI信号无影响，可用于早期鉴别缺氧缺血性脑病和胆红素脑病。

Discussion on early diagnosis value of DWI on HIE complicated with jaundice

Objective To discuss the early clinical diagnosis value of apparent diffusion coefficient （ADC） in MR diffusion weighted imaging （MR DWI） in assessing term neonatal hypoxic-ischemic encephalopathy （HIE） complicated with jaundice. Methods SE-EPI was used for DWI coronal scan for HIE neonates. Region of interest （ROI） included left and right lenticular nucleus, deep white matter of frontal lobe and hippocamp. ADG values were measured and analyzed. Results HIE group included 32 term neonates, which were divided into mild group （12 cases）, moderate group （13 cases） and severe group （7 cases）. They were also divided into non-jaundice group （8 cases）, mild jaundice group （5 cases）, moderate jaundice group （14 cases） and severe jaundice group （5 cases） according to the severity of complicated jaundice. ADC values in left and right lenticular nucleus in severe jaundice group were significantly different from those in non-jaundice group respectively （P =0.047 〈 0. 05 and P =0.044 〈0.05, respectively）. The differences in ADC values in fight hippocamp between non-jaundice group and mild jaundice group （ P = 0. 008 〈 0.05 ） and between mild jaundice group and moderate jaundice group （P = 0.015 〈 0.05 ） were statistically significant. The differences in ADC values in left hippocamp between non-jaundice group and mild group （ P = 0.002 〈 0.05 ）, mild jaundice group and moderate jaundice group （ P = 0.002 〈 0.05 ）, mild jaundice group and severe jaundice group （P = 0.014 〈 0.05） were also statistically significant. ADC value in each ROI was not correlated with jaundice （P 〉 0.01 ）. That was to say with the degree of severity of jaundice, there was no obvious change in ADC value. Conclusion When being scanned by DWI early, jaundice cannot affect DWI signal of HIE neonate. It can be used to discriminate HIE from bilirubin encephalopathy at early stage.