头颅MRI T1WI信号强度比值在足月新生儿高胆红素血症中的应用

doi:10.12117/jccmi.2020.08.008

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摘要目的：探讨苍白球T1WI信号强度（Signal intensity in globus pallidus，SIgp）和苍白球/壳核信号比值（The ratio of T1WI signal intensity in globus pallidus to putamen，G/P）与新生儿高胆红素血症（Neonatal hyperbilirubinemia，NHB）分度的相关性及其诊断NHB脑损伤的价值。方法：收集2017年1月—2019年11月224例NHB患儿的临床及MRI资料，按照血清总胆红素峰值水平分为6组，即正常对照组（B0组）、轻度NHB组（B1组）、中度NHB组（B2组）、重度NHB组（B3组）、极重度NHB组（B4组）、危险性NHB组（B5组），分别测定双侧SIgp和壳核T1WI信号强度（Signal intensity in putamen，SIp），同时计算G/P值。采用One-way ANOVA分析不同组别SIgp和G/P间的差异，组内多重比较使用LSD法。采用Spearman分析SIgp和G/P与NHB分度之间的相关性。采用ROC分析SIgp和G/P诊断NHB分度的效能。结果：不同NHB分度之间的SIgp和G/P差异有统计学意义（P＜0.05）。B0和B2、B3、B4、B5组间，B1和B4、B5组间的SIgp差异有统计学意义（P＜0.05）；B0和B2、B3、B4、B5组间，B1和B2、B3、B4、B5组间，B2和B3、B4、B5组间，B3和B5组间，B4和B5组间的G/P差异有统计学意义（P＜0.01）。SIgp与NHB分度呈弱正相关（rs=0.281，P＜0.001），G/P与NHB分度呈强正相关（rs=0.714，P＜0.001）。各组G/P的AUC均大于SIgp，各组ROC间的差异均有统计学意义（Z＞1.96，P＜0.05）。结论：G/P能为NHB脑损伤分度提供客观的影像学证据，诊断效能较SIgp好，当G/P值≥1.160时需警惕发生急性胆红素脑病（Acute bilirubin encephalopathy，ABE）。

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	赖伟1
	徐凤丹1
	梁润球1
	范淼2
	黎倩仪1
	刘丽珍1
	李登辉1
	李宁1
	刘建新1

关键词 ：高胆红素血症, 婴儿, 新生, 磁共振成像

Abstract：Objective: To investigate the correlation between the signal intensity in globus pallidus(SIgp), the ratio of T1WI signal intensity in globus pallidus to putamen(G/P) and the grades of neonatal hyperbilirubinemia(NHB) and the value in diagnosing NHB brain injury. Methods: The clinical and MRI data of 224 cases of NHB hospitalized from January 2017 to November 2019 were collected, and divided into 6 groups according to the peak level of serum total bilirubin, ranging from B0 to B5. The SIgp and SIp were measured respectively, and the G/P ratio was calculated. The differences between SIgp and G/P in different groups were analyzed by One-way ANOVA. The correlation between SIgp, G/P and serum bilirubin level were analyzed by Spearman. The efficacy of SIgp and G/P in the diagnosis of bilirubin brain injury were analyzed by ROC. Results: There were significant differences in SIgp and G/P between different NHB grades(P<0.05). The differences of SIgp between B0 and B2, B3, B4, B5 groups, B1 and B4, B5 groups were statistically significant respectively(P<0.05). The differences of G/P between B0 and B2, B3, B4, B5 groups, B1 and B2, B3, B4, B5 groups, B2 and B3, B4, B5 groups, B3 and B5 groups, B4 and B5 groups were statistically significant respectively(P<0.01). There was a weak positive correlation between SIgp and NHB grades(rs=0.281, P<0.001), and a strong positive correlation between G/P and NHB grades(rs=0.714, P<0.001). The AUC of G/P in each group was significantly higher than that of SIgp, and the difference of ROC in each group was statistically significant(Z>1.96, P<0.05). Conclusion: G/P ratio can provide objective imaging evidence for the grades of NHB brain injury, and it’s diagnostic efficiency is better than SIgp. It is necessary to be alert to the occurrence of acute bilirubin encephalopathy(ABE) when the G/P ratio is ≥1.160.

Key words： Hyperbilirubinemia Infant, newborn Magnetic resonance imaging

收稿日期: 2020-01-06

PACS:	Ｒ722.17
	Ｒ445.2

基金资助:广东省东莞市社会科技发展（一般）项目（201950715028857）；广东医科大学科研基金：自然科学，面上培育项目（M2017022）。

通讯作者: 刘建新，广东医科大学附属东莞儿童医院（东莞市第八人民医院）放射科，523325。E-mail：373066547@qq.com

作者简介: 赖伟（1982-），男，广东人，主任医师。E-mail：dreamfimmu66@tom.com

引用本文:

赖伟1，徐凤丹1，梁润球1，范淼2，黎倩仪1，刘丽珍1，李登辉1，李宁1，刘建新1. 头颅MRI T1WI信号强度比值在足月新生儿高胆红素血症中的应用[J]. 中国临床医学影像杂志, 2020, 31(8): 558-562.
LAI Wei1, XU Feng-dan1, LIANG Run-qiu1, FAN Miao2, LI Qian-yi1, LIU Li-zhen1, LI Deng-hui1, LI Ning1, LIU Jian-xin1. The application of T1WI signal intensity ratio of cranial MRI in term neonatal hyperbilirubinemia. JOURNAL OF CHINA MEDICAL IMAGING, 2020, 31(8): 558-562.

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http://www.jccmi.com.cn/CN/10.12117/jccmi.2020.08.008 或 http://www.jccmi.com.cn/CN/Y2020/V31/I8/558

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