近红外光谱与磁共振成像在研究接受低温治疗的新生儿缺氧缺血性脑病的脑灌注中的应用比较。
Near-infrared spectroscopy versus magnetic resonance imaging to study brain perfusion in newborns with hypoxic-ischemic encephalopathy treated with hypothermia.
机构信息
Division of Newborn Medicine, Department of Pediatrics, Montreal Children's Hospital, McGill University, 2300 Tupper Street, Montreal, QC H3H 1P3, Canada; Division of Newborn Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; Computational Radiology Laboratory, Department of Radiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA.
出版信息
Neuroimage. 2014 Jan 15;85 Pt 1(0 1):287-93. doi: 10.1016/j.neuroimage.2013.04.072. Epub 2013 Apr 28.
BACKGROUND
The measurement of brain perfusion may provide valuable information for assessment and treatment of newborns with hypoxic-ischemic encephalopathy (HIE). While arterial spin labeled perfusion (ASL) magnetic resonance imaging (MRI) provides noninvasive and direct measurements of regional cerebral blood flow (CBF) values, it is logistically challenging to obtain. Near-infrared spectroscopy (NIRS) might be an alternative, as it permits noninvasive and continuous monitoring of cerebral hemodynamics and oxygenation at the bedside.
OBJECTIVE
The purpose of this study is to determine the correlation between measurements of brain perfusion by NIRS and by MRI in term newborns with HIE treated with hypothermia.
DESIGN/METHODS: In this prospective cohort study, ASL-MRI and NIRS performed during hypothermia were used to assess brain perfusion in these newborns. Regional cerebral blood flow (CBF) values, measured from 1-2 MRI scans for each patient, were compared to mixed venous saturation values (SctO2) recorded by NIRS just before and after each MRI. Analysis included groupings into moderate versus severe HIE based on their initial background pattern of amplitude-integrated electroencephalogram.
RESULTS
Twelve concomitant recordings were obtained of seven neonates. Strong correlation was found between SctO2 and CBF in asphyxiated newborns with severe HIE (r=0.88; p value=0.0085). Moreover, newborns with severe HIE had lower CBF (likely lower oxygen supply) and extracted less oxygen (likely lower oxygen demand or utilization) when comparing SctO2 and CBF to those with moderate HIE.
CONCLUSIONS
NIRS is an effective bedside tool to monitor and understand brain perfusion changes in term asphyxiated newborns, which in conjunction with precise measurements of CBF obtained by MRI at particular times, may help tailor neuroprotective strategies in term newborns with HIE.
背景
脑灌注测量可为缺氧缺血性脑病（HIE）新生儿的评估和治疗提供有价值的信息。动脉自旋标记灌注（ASL）磁共振成像（MRI）提供了区域脑血流（CBF）值的无创和直接测量，但在操作上具有挑战性。近红外光谱（NIRS）可能是一种替代方法，因为它可以在床边进行无创和连续监测脑血流动力学和氧合。
目的
本研究旨在确定接受低温治疗的 HIE 足月新生儿中，NIRS 和 MRI 测量的脑灌注之间的相关性。
设计/方法：在这项前瞻性队列研究中，使用 ASL-MRI 和低温期间进行的 NIRS 来评估这些新生儿的脑灌注。从每位患者的 1-2 次 MRI 扫描中测量的局部脑血流（CBF）值与 NIRS 记录的每次 MRI 前后混合静脉血氧饱和度值（SctO2）进行比较。分析包括根据初始振幅整合脑电图的背景模式将患者分为中度与重度 HIE 组。
结果
共获得了 7 名新生儿的 12 次同步记录。在重度 HIE 的窒息新生儿中，SctO2 与 CBF 之间存在很强的相关性（r=0.88；p 值=0.0085）。此外，与中度 HIE 相比，重度 HIE 的新生儿 CBF 较低（可能供氧较低），从 SctO2 和 CBF 中提取的氧气较少（可能氧需求或利用率较低）。
结论
NIRS 是一种有效的床边工具，可以监测和了解足月窒息新生儿的脑灌注变化，与特定时间通过 MRI 获得的 CBF 的精确测量相结合，可能有助于为 HIE 足月新生儿量身定制神经保护策略。
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