| 常规MRI信号改变与定量磁敏感加权图像评估高胆红素血症的足月新生儿潜在脑损伤 |
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| 作者姓名： | 罗纯 刘建萍 张丽丽 张仙海 梁栋梁 吴耀忠 高明勇 |
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| 作者单位： | 佛山市第一人民医院影像科，广东 佛山 528000 |
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| 基金项目： | 佛山市卫生健康局医学科研课题20200368广东省卫生健康委员会面上项目B2021393 |
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| 摘 要： | 目的 探究常规MRI信号改变及定量磁敏感加权图像（QSM）定量评估足月新生儿高胆红素血症患儿潜在脑损伤的价值。 方法 回顾性分析2019年1月~2020年12月我院收治的临床综合诊断为高胆红素血症的足月新生儿50例（Ⅰ组），另选48例胆红素不高的无脑相关疾病的足月新生儿作为对照组（Ⅱ组）。再根据血清总胆红素水平将Ⅰ组分为轻中度升高组和重度及极重度升高组。所有患儿均行治疗前MR平扫、扩散加权成像扫描，其中38例患儿行QSM检查，对比不同组别患儿MR信号强度之间差异及其与血清总胆红素水平的相关性；比较胆红素升高患儿与对照组患儿不同核团磁化率之间的差异，及其与血清总胆红素水平之间的相关性。 结果 胆红素升高患儿更容易出现苍白球（GP）T1WI高信号表现（36/12 vs 13/37，P < 0.001）；3组之间GP的T1WI信号强度（SI1）/T2WI信号强度（SI2）比值的差异有统计学意义（P=0.034），但SI1GP、SI2GP、SI1P、SI2P、SI1FWM、SI2FWM、SI1FGM、SI2FGM、SI1GP/SI1P、SI1GP/SI1FWM、SI1GP/SI1FGM、△SI1（GP-P）、△SI1（GP-FGM）、△SI1（GP-P）/SI1GP、△SI1（GP-P）/△SI1（GP-FGM）、△SI1（GP-P）/△SI1（GP-FWM）的差异均无统计学意义（P > 0.05）；SI1 GP/SI2GP与血清总胆红素水平呈极弱相关关系（r=0.261，P=0.009），当日龄与出生体质量控制时，SI1 GP/SI2GP、△SI1（GP-P）/△SI1（GP-FGM）与血清总胆红素仍呈极弱相关（r=0.230，P=0.014；r=-0.184，P=0.014）。胆红素升高组与对照组之间苍白球、壳核、丘脑底核及脑干的磁化率之间的差异均有统计学意义（P < 0.05）；且壳核及丘脑底核与血清总胆红素水平呈轻度相关（r=-0.419，P= 0.011；r=-0.391，P=0.018），而苍白球及脑干与血清胆红素呈中度相关（r=-0.620，P < 0.001；r=-0.630，P < 0.001）。 结论 高胆红素血症新生儿单纯评价苍白球T1WI高信号有一定的诊断意义，但是常规MR信号强度与血清胆红素是否升高没有明确相关性；而苍白球、壳核、丘脑底核及脑干QSM测定的磁化率可能可以更早的发现高胆红素血症新生儿潜在脑损伤。
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| 关 键 词： | 新生儿 高胆红素血症 常规MR信号强度 定量磁敏感加权图像 磁化率 |
| 收稿时间： | 2022-06-20 |
Conventional MRI signal changes and quantitative susceptibility mapping to assess potential brain damage in neonates with hyperbilirubinemia |
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| Authors: | LUO Chun LIU Jianping ZHANG Lili ZHANG Xianhai LIANG Dongliang WU Yaozhong GAO Mingyong |
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| Affiliation: | Department of Radiology, The First People's Hospital of Foshan, Foshan 528000, China |
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| Abstract: | Objective To explore the value of conventional MRI signal changes and quantitative susceptibility mapping (QSM) in quantitative assessment of potential brain injury in neonates with hyperbilirubinemia. Methods Fifty neonates (group Ⅰ) who were clinically diagnosed with neonatal hyperbilirubinemia in our hospital were retrospectively analyzed from January 2019 to December 2020. Forty-eight neonates without hyperbilirubinemia and brain-related diseases were the control group (group Ⅱ). All children underwent MR plain scan and diffusion weighted imaging scan before treatment, and 38 children underwent QSM examination. The differences between the MR signal intensities of children in different groups and their correlation with serum total bilirubin levels were compared. The differences between the magnetic susceptibility of different nuclei in children with elevated bilirubin and the control group were compared, and their correlation with serum total bilirubin levels were analyzed. Results Children with hyperbilirubinemia were more inclined to have high signal intensity of the globus pallidus on T1WI (36/12 vs 13/37, P < 0.001). The difference of SI1GP/SI2GP was statistically significant (P=0.034), while the difference of other indicators were not statistically significant (P > 0.05). There was a very weak correlation between the SI1GP/SI2GP with serum total bilirubin level (r=0.261, P=0.009).When the age and birth weight were controlled, the SI1 GP/SI2GP, ΔSI1(GP-P)/ΔSI1(GP-FGM) was a very weak correlated(r=0.230, P=0.014; r=-0.184, P=0.014). There were statistically significant differences in the magnetic susceptibility of the globus pallidus, putamen, subthalamic nucleus and brainstem between the elevated bilirubin group and the control group(P < 0.05).The magnetic susceptibility of putamen and subthalamic nucleus were slightly correlated with serum total bilirubin levels (r=-0.419, P=0.011; r=-0.391, P=0.018), while there was a moderate correlation between the magnetic susceptibility of globus pallidus and brainstem and serum bilirubin levels (r=-0.620, P < 0.001; r=-0.630, P < 0.001). Conclusion The evaluating signal intensity of the globus pallidus on T1WI is helpful for thediagnosis of neonates with hyperbilirubinemia. There is no clear correlation between the signal intensity of conventional MR and the increase of serum bilirubin. The magnetic susceptibility measured by QSM in the globus pallidus, putamen, subthalamic nucleus and brainste may earlier indicate the potential brain damage in neonates with hyperbilirubinemia. |
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