磁共振弥散张量成像在新生儿胆红素血症所致神经功能障碍中的应用

Application of magnetic resonance diffusion tensor imaging in bilirubin-induced neurological dysfunction in neonates

摘要:

目的 探讨磁共振弥散张量成像（DTI）感兴趣区（ROI）各向异性分数（FA）值在新生儿高胆红素血症所致神经功能障碍（BIND）中的价值。方法 收集2017年1月至2018年1月住院的高胆红素血症新生儿91例，根据血清总胆素峰值分为轻-中度增高组（n=45）、重度增高组（n=35）、极重度增高组（n=11）。根据是否存在异常神经系统表现分为神经功能障碍组（n=20）、非神经功能障碍组（n=71）。选择同期正常健康足月儿10例为对照组。所有新生儿完成头部DTI检查，测量并比较双侧苍白球、内囊前肢、内囊后肢、小脑齿状核的FA值。结果 极重度增高组苍白球FA值低于对照组、轻-中度增高组及重度增高组（P < 0.05），重度增高组苍白球FA值低于对照组（P < 0.05）。极重度增高组内囊后肢FA值低于对照组、轻-中度增高组及重度增高组（P < 0.05）。神经功能障碍组苍白球、内囊后肢FA值低于非神经功能障碍组（P < 0.05）。结论 血清胆红素水平结合DTI在苍白球区、内囊后肢FA值的变化，推测BIND患儿可能同时存在神经核团及脑白质纤维损伤。

Abstract:

Objective To study the value of fractional anisotropy (FA) of regions of interest (ROI) on magnetic resonance diffusion tensor imaging (DTI) in bilirubin-induced neurological dysfunction in neonates. Methods A total of 91 neonates with hyperbilirubinemia who were hospitalized from January 2017 to January 2018 were enrolled. According to the peak level of total serum bilirubin, they were divided into three groups:mild/moderate increase (n=45), severe increase (n=35), and extremely severe increase (n=11). According to the presence or absence of abnormal neurological manifestations, they were divided into two groups:neurological dysfunction (n=20) and non-neurological dysfunction (n=71). Ten healthy full-term infants were enrolled as the control group. Head DTI was performed for all neonates to measure the FA values of the bilateral globus pallidus, the anterior limb of the internal capsule, the posterior limb of the internal capsule, and the cerebellar dentate nucleus. Results The extremely severe increase group had significantly lower FA values of the globus pallidus than the control, mild/moderate increase, and severe increase groups (P < 0.05). The severe increase group had significantly lower FA values of the globus pallidus than the control group (P < 0.05). The extremely severe increase group had significantly lower FA values of the posterior limb of the internal capsule than the control, mild/moderate increase, and severe increase groups (P < 0.05). The neurological dysfunction group had significantly lower FA values of the globus pallidus and the posterior limb of the internal capsule than the non-neurological dysfunction group (P < 0.05). Conclusions Serum bilirubin level combined with the changes in the DTI FA values of the globus pallidus and the posterior limb of the internal capsule can be used to predict the injury of cerebral nuclei and white matter fibers.