From the Department of Academic Neonatology, EGA Institute for Women's Health (G.S.K., A.H.C., N.M., N.J.R.), and Centre for Medical Image Computing (A.M., S.O.), University College London, Medical School Building, 74 Huntley St, London WC1E 6AU, England; Department of Health Sciences, University of Leicester, Leicester, England (S.J.); Department of Medical Physics & Bioengineering, University College Hospital NHS Foundation Trust, London, England (D.P., A.B., E.B.C.); and Department of Neuroradiology, Great Ormond Street Hospital for Children NHS Trust, London, England (R.G.).
Radiology. 2014 Apr;271(1):230-8. doi: 10.1148/radiol.13122679. Epub 2013 Nov 21.
To determine (a) whether diffuse white matter injury of prematurity is associated with an increased choline (Cho)-to-creatine (Cr) ratio and a reduced N-acetylaspartate (NAA)-to-Cho ratio and whether these measures can be used as biomarkers of outcome and (b) if changes in peak area metabolite ratios at magnetic resonance (MR) spectroscopy are associated with changes in T2 and fractional anisotropy (FA) at MR imaging.
The local ethics committee approved this study, and informed parental consent was obtained for each infant. At term-equivalent age, 43 infants born at less than 32 weeks gestation underwent conventional and quantitative diffusion-tensor and T2-weighted MR imaging. Single-voxel point-resolved proton (hydrogen 1) MR spectroscopy was performed from a 2-cm(3) voxel centered in the posterior periventricular white matter. Outcome was evaluated by using Bayley scales at a corrected age of 1 year. Associations were investigated with Pearson product moment or Spearman rank order correlation. Differences in ratios in infants with and infants without impairment were tested by using t tests.
NAA/Cho and Cho/Cr ratios correlated with the scaled gross motor score and the composite motor score, independent of gestational age (P < .05). FA at diffusion-tensor MR imaging and T2 at MR imaging correlated with the NAA/Cho ratio (P < .05 for both) but not with the Cho/Cr ratio. Infants with motor scores of less than 85 (impaired) had an increased Cho/Cr ratio (P < .03) and a reduced NAA/Cho ratio (P < .01) compared to those without impairment. A combination of increased Cho/Cr ratio and decreased NAA/Cho ratio predicted impaired motor outcome at a corrected age of 1 year with a sensitivity of 0.80 (95% confidence interval [CI]: 0.57, 0.94) and a specificity of 0.80 (95% CI: 0.66, 0.88).
The combination of Cho/Cr and NAA/Cho ratios measured in the posterior periventricular white matter at term-equivalent age is predictive of motor outcome at 1 year in infants born at less than 32 weeks gestation.
确定（a）早产儿弥漫性脑白质损伤是否与胆碱（Cho）与肌酸（Cr）比值增加和 N-乙酰天门冬氨酸（NAA）与 Cho 比值降低有关，以及这些指标是否可用作结局的生物标志物；（b）磁共振（MR）波谱峰值面积代谢物比值的变化是否与 MR 成像 T2 和各向异性分数（FA）的变化有关。
当地伦理委员会批准了这项研究，并获得了每位婴儿父母的知情同意。在胎龄相等时，43 名胎龄小于 32 周的早产儿进行了常规和定量弥散张量和 T2 加权 MR 成像。单体素点分辨质子（氢 1）MR 波谱在以侧脑室后角为中心的 2cm3 体素内进行。通过校正年龄为 1 岁时的贝利量表进行预后评估。用 Pearson 积矩或 Spearman 秩相关分析来研究相关性。用 t 检验比较有和无损伤的婴儿的比值差异。
NAA/Cho 和 Cho/Cr 比值与 scaled gross motor score 和 composite motor score 相关，与胎龄无关（P <.05）。弥散张量 MR 成像的 FA 和 MR 成像的 T2 与 NAA/Cho 比值相关（P <.05），但与 Cho/Cr 比值无关。运动评分低于 85（受损）的婴儿 Cho/Cr 比值增加（P <.03），NAA/Cho 比值降低（P <.01），与无损伤者相比。Cho/Cr 比值增加和 NAA/Cho 比值降低的组合可预测校正年龄为 1 岁时的运动结局，其敏感性为 0.80（95%置信区间[CI]：0.57，0.94），特异性为 0.80（95% CI：0.66，0.88）。
胎龄相等时在侧脑室后角测量的 Cho/Cr 和 NAA/Cho 比值的组合可预测胎龄小于 32 周的早产儿在 1 岁时的运动结局。
