新生儿缺氧缺血性脑病磁共振影像学评分与临床分度的相关性研究

Correlation between magnetic resonance imaging score and clinical grading in neonatal hypoxic-ischemic encephalopathy

摘要:

目的 探讨新生儿缺氧缺血性脑病（HIE）磁共振成像（MRI）影像学评分与临床分度的相关性。方法 依据HIE临床分度标准对61例HIE患儿进行分度，应用改良的MRI评分系统进行不同MRI序列的损伤评分，分析HIE影像学评分与临床严重程度之间的关系。结果 中度HIE的MRI影像学评分低于重度HIE，差异有统计学意义（P < 0.01）；0~7 d新生儿的MRI弥散加权成像（DWI）评分与MRI综合评分的相关系数最高（r > 0.9）；>7 d新生儿的MRI T1加权成像评分与MRI综合评分的相关系数最高（r=0.963）；重度HIE脑损伤的头部MRI表现主要以基底节/丘脑+脑干和全脑型损伤为主，而中度HIE以分水岭损伤为主、脑干很少受累，差异有统计学意义（P < 0.01）。结论 MRI影像学评分系统与HIE临床分度之间有较好的相关性，可协助HIE临床诊断及分度。

Abstract:

Objective To investigate the correlation between magnetic resonance imaging (MRI) score and clinical grading in neonatal hypoxic-ischemic encephalopathy (HIE).Methods Clinical grading was performed for 61 neonates with HIE according to the HIE clinical grading standard. The modified MRI scoring system was used to determine the injury scores on different MRI sequences. The correlation between HIE imaging score and clinical severity was analyzed.Results The MRI score in neonates with moderate HIE was significantly lower than that in those with severe HIE (P < 0.01). Neonates aged 0-7 days had the highest correlation coefficient between diffusion weighted imaging (DWI) score and total MRI score (r > 0.9), and neonates aged >7 days had the highest correlation coefficient between T1-weighted imaging score and total MRI score (r=0.963). Brain MRI showed injuries in the basal ganglia/thalamus+brainstem and even the whole brain in neonates with severe HIE, while the neonates with moderate HIE had injuries in the cerebral watershed, with little involvement of the brainstem (P < 0.01).Conclusions There is a good correlation between the MRI scoring system and clinical grading in neonatal HIE, suggesting the system can help with the clinical diagnosis and grading of HIE.