MR弥散张量成像对缺氧缺血性脑病的Meta分析报告
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摘要
目的采用Meta分析综合定量评价MR弥散张量成像对缺氧缺血性脑病的诊断价值。方法检索美国医学索引Medline、Ovid、Springer、Elsevier、LippincottWilliams&Wilkins(Lww)数据库及中国期刊网国内文献库(CNKI)1997年1月至2016年12月公开发表的中英文文献,分析软件为RevMan5.3,合并效应量为加权均数差(weightedmean difference,WMD)。结果纳入研究DTI诊断HIE的文献共13篇。结果显示:(1)轻、中、重度HIE组新生儿内囊后肢、胼胝体膝部、压部各向异性分数(fractional anisotropy,FA)值比对照组新生儿低,其中内囊后肢WMD及95%CI为-0.04(-0.06,-0.02)、-0.07(-0.10,-0.03)、-0.07(-0.10,-0.03);胼胝体压部WMD及95%CI为-0.09(-0.10,-0.07)、-0.09(-0.12,-0.06)、-0.19(-0.33,-0.05);胼胝体膝部WMD及95%CI为-0.06(-009,-0.03)、-0.07(-0.10,-0.05)、-0.13(-0.21,-0.06)。(2)轻度HIE组新生儿在顶叶白质、额叶白质区FA值与对照组新生儿相比无统计学意义;中重度组FA值比对照组新生儿低。(3)豆状核、丘脑、尾状核及放射冠区FA值与对照组新生儿相比无统计学意义。结论内囊后肢、胼胝体压部及膝部是HIE受累最明显的部位;其FA值降低可为HIE的早期诊断提供影像学依据。
Objective To evaluate the value of MR diffusion tensor imaging in the diagnosis of hypoxic-ischemic-cephalopathy by Meta-analysis.Methods Searching the related literatures in Medline,Ovid,Springer,Elsevier,Lippincott Williams&Wilkins(Lww)and the Chinese Journal Net(CNKI)from January 1997 to December 2016,analysis software for the RevMan 5.3,the combined effect was the weighted average difference(WMD).Results A total of 13 articles were included in the study of DTI diagnosis of HIE.The results showed that:(1)The FA value of the posterior limb of internal capsule,the plenium and genu of corpus callosum in the neonates with mild,moderate and severe HIE were lower than that in the control group of which the value of WMD and 95%CI in the posterior limb of Internal capsule were-0.04(-0.06,-0.02),-0.07(-0.10,-0.03),-0.07(-0.10,-0.03),of which the value of WMD and 95%CI in the Splenium of corpus callosum were-0.09(-0.10,-0.07),-0.09(-0.12,-0.06),-0.19(-0.33,-0.05);of which the value of WMD and 95%CI in the Genu of corpus callosum were-0.06(-009,-0.03),-0.07(-0.10,-0.05),-0.13(-0.21,-0.06).(2)There was no significant difference in the FA value of the Parietal white matter,frontal white matter in neonates with mild HIE group compared with the control group.The FA value of moderate to severe group was lower than that of control group.(3)There were no statistically significant in comparing the FA value of lentiform nucleus,thalamus,caudate nucleus and radiation crown with neonatal control group.Conclusion The posterior limb of internal capsule,the splenium and genu of corpus callosum were the most obvious parts of HIE involvement.The decrease of FA value can provide imaging basis for the early diagnosis of HIE.
Objective To evaluate the value of MR diffusion tensor imaging in the diagnosis of hypoxic-ischemic-cephalopathy by Meta-analysis.Methods Searching the related literatures in Medline,Ovid,Springer,Elsevier,Lippincott Williams&Wilkins(Lww)and the Chinese Journal Net(CNKI)from January 1997 to December 2016,analysis software for the RevMan 5.3,the combined effect was the weighted average difference(WMD).Results A total of 13 articles were included in the study of DTI diagnosis of HIE.The results showed that:(1)The FA value of the posterior limb of internal capsule,the plenium and genu of corpus callosum in the neonates with mild,moderate and severe HIE were lower than that in the control group of which the value of WMD and 95%CI in the posterior limb of Internal capsule were-0.04(-0.06,-0.02),-0.07(-0.10,-0.03),-0.07(-0.10,-0.03),of which the value of WMD and 95%CI in the Splenium of corpus callosum were-0.09(-0.10,-0.07),-0.09(-0.12,-0.06),-0.19(-0.33,-0.05);of which the value of WMD and 95%CI in the Genu of corpus callosum were-0.06(-009,-0.03),-0.07(-0.10,-0.05),-0.13(-0.21,-0.06).(2)There was no significant difference in the FA value of the Parietal white matter,frontal white matter in neonates with mild HIE group compared with the control group.The FA value of moderate to severe group was lower than that of control group.(3)There were no statistically significant in comparing the FA value of lentiform nucleus,thalamus,caudate nucleus and radiation crown with neonatal control group.Conclusion The posterior limb of internal capsule,the splenium and genu of corpus callosum were the most obvious parts of HIE involvement.The decrease of FA value can provide imaging basis for the early diagnosis of HIE.
引文
[1]李艳,杜奕,陈志强,等.缺氧缺血性脑病患儿表观扩散系数与行为神经测定评分的相关性研究[J].中华放射学杂志,2015,49(2):133-137.
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[3]李红新,屠文娟,董选,等.磁共振弥散张量成像在新生儿缺氧缺血性脑病亚急性期的应用研究[Z].中国浙江湖州:20152.
[4]李清勇,吉红月,吉吉喆,等.弥散张量成像对新生儿缺氧缺血性脑病的临床分析[J].医疗装备,2015,(10):42-43.
[5]向葵,干芸根,王宏伟,等.扩散张量成像各向异性分数在足月新生儿缺氧缺血性脑病中的应用[J].中国医学影像学杂志,2016,24(4):248-252.
[6]朱志军,曹满瑞,张碧娟,等.扩散张量成像在足月新生儿缺氧缺血性脑病诊断的应用价值[J].临床放射学杂志,2014,33(5):761-764.
[7]柏天军,于龙,王涛,等.3.0T磁共振扩散张量成像FA值在新生儿HIE早期诊断中的研究[J].医学影像学杂志,2012,22(4):514-518.
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[9]徐运军,刘斯润.常规MRI正常的新生儿缺氧缺血性脑病弥散张量成像初探[J].立体定向和功能性神经外科杂志,2005,18(3):158-162.
[10]贾林燚.弥散张量成像对新生儿缺氧缺血性脑病的诊断价值[J].河北医药,2013,35(2):236-237.
[11]Ancora G,Testa C,Grandi S,et al.Prognostic value of brain proton MR spectroscopy and diffusion tensor imaging in newborns with hypoxic-ischemic encephalopathy treated by brain cooling[J].Neuroradiology,2013,55(8):1017-1025.
[12]李静,索凌云,任转琴,等.ESWAN结合FA值对新生儿缺氧缺血性脑病的诊断价值研究[J].医学影像学杂志,2013,23(8):1165-1169.
[13]Zhang F,Liu C,Qian L,et al.Diffusion Tensor Imaging of White Matter Injury Caused by Prematurity-Induced HypoxicIschemic Brain Damage[J].Med Sci Monit,2016,22:2167-2174.
[14]胡玉莲.DTI在足月新生儿窒息后脑损伤中的应用效果观察[J].中国卫生产业,2015,(24):105-107.
[15]邢可舟.新生儿缺氧缺血性脑病的磁共振弥散张量成像及动脉自旋标记成像的诊断价值研究[D].山东大学,2016.
[16]Brissaud O,Amirault M,Villega F,et al.Efficiency of fractional anisotropy and apparent diffusion coefficient on diffusion tensor imaging in prognosis of neonates with hypoxic-ischemic encephalopathy:a methodologic prospective pilot study[J].AJNR Am JNeuroradiol,2010,31(2):282-287.
[17]Ward P,Counsell S,Allsop J,et al.Reduced fractional anisotropy on diffusion tensor magnetic resonance imaging after hypoxicischemic encephalopathy[J].Pediat rics,2006,117(4):e619-e630.
[18]昌爱武.弥散张量白质纤维示踪术研究分析足月新生儿缺氧缺血性脑病[J].中国CT和MRI杂志,2015,13(1):30-31.
[19]周旭峰,张丽雅,高志祥,等.早产儿缺氧缺血性脑病的MRI诊断[J].中国CT和MRI杂志,2014,12(3):8-10,48.
[20]Massaro AN,Evangelou I,Fatemi A,et al.White matter tract integrity and developmental outcome in newborn infants with hypoxicischemic encephalopathy treated with hypothermia[J].Dev Med Child Neurol,2015,57(5):441-448.
[2]蔡清,薛辛东,富建华.新生儿缺氧缺血性脑病磁共振的研究进展[J].中华儿科杂志,2010,48(3):227-231.
[3]李红新,屠文娟,董选,等.磁共振弥散张量成像在新生儿缺氧缺血性脑病亚急性期的应用研究[Z].中国浙江湖州:20152.
[4]李清勇,吉红月,吉吉喆,等.弥散张量成像对新生儿缺氧缺血性脑病的临床分析[J].医疗装备,2015,(10):42-43.
[5]向葵,干芸根,王宏伟,等.扩散张量成像各向异性分数在足月新生儿缺氧缺血性脑病中的应用[J].中国医学影像学杂志,2016,24(4):248-252.
[6]朱志军,曹满瑞,张碧娟,等.扩散张量成像在足月新生儿缺氧缺血性脑病诊断的应用价值[J].临床放射学杂志,2014,33(5):761-764.
[7]柏天军,于龙,王涛,等.3.0T磁共振扩散张量成像FA值在新生儿HIE早期诊断中的研究[J].医学影像学杂志,2012,22(4):514-518.
[8]沈全力,冯晓源,钱镔.FA值在新生儿缺氧缺血性脑病随访中的应用[J].中国医学计算机成像杂志,2009,15(2):158-163.
[9]徐运军,刘斯润.常规MRI正常的新生儿缺氧缺血性脑病弥散张量成像初探[J].立体定向和功能性神经外科杂志,2005,18(3):158-162.
[10]贾林燚.弥散张量成像对新生儿缺氧缺血性脑病的诊断价值[J].河北医药,2013,35(2):236-237.
[11]Ancora G,Testa C,Grandi S,et al.Prognostic value of brain proton MR spectroscopy and diffusion tensor imaging in newborns with hypoxic-ischemic encephalopathy treated by brain cooling[J].Neuroradiology,2013,55(8):1017-1025.
[12]李静,索凌云,任转琴,等.ESWAN结合FA值对新生儿缺氧缺血性脑病的诊断价值研究[J].医学影像学杂志,2013,23(8):1165-1169.
[13]Zhang F,Liu C,Qian L,et al.Diffusion Tensor Imaging of White Matter Injury Caused by Prematurity-Induced HypoxicIschemic Brain Damage[J].Med Sci Monit,2016,22:2167-2174.
[14]胡玉莲.DTI在足月新生儿窒息后脑损伤中的应用效果观察[J].中国卫生产业,2015,(24):105-107.
[15]邢可舟.新生儿缺氧缺血性脑病的磁共振弥散张量成像及动脉自旋标记成像的诊断价值研究[D].山东大学,2016.
[16]Brissaud O,Amirault M,Villega F,et al.Efficiency of fractional anisotropy and apparent diffusion coefficient on diffusion tensor imaging in prognosis of neonates with hypoxic-ischemic encephalopathy:a methodologic prospective pilot study[J].AJNR Am JNeuroradiol,2010,31(2):282-287.
[17]Ward P,Counsell S,Allsop J,et al.Reduced fractional anisotropy on diffusion tensor magnetic resonance imaging after hypoxicischemic encephalopathy[J].Pediat rics,2006,117(4):e619-e630.
[18]昌爱武.弥散张量白质纤维示踪术研究分析足月新生儿缺氧缺血性脑病[J].中国CT和MRI杂志,2015,13(1):30-31.
[19]周旭峰,张丽雅,高志祥,等.早产儿缺氧缺血性脑病的MRI诊断[J].中国CT和MRI杂志,2014,12(3):8-10,48.
[20]Massaro AN,Evangelou I,Fatemi A,et al.White matter tract integrity and developmental outcome in newborn infants with hypoxicischemic encephalopathy treated with hypothermia[J].Dev Med Child Neurol,2015,57(5):441-448.