低温治疗后新生儿MRI显示无或轻度脑损伤的预测价值。
Predictive value of neonatal MRI showing no or minor degrees of brain injury after hypothermia.
作者信息
Rollins Nancy, Booth Timothy, Morriss Michael C, Sanchez Pablo, Heyne Roy, Chalak Lina
机构信息
Department of Radiology, Children's Medical Center and the University of Texas Southwestern Medical Center, Dallas, Texas; Department of Pediatrics, Children's Medical Center and the University of Texas Southwestern Medical Center, Dallas, Texas.
Department of Radiology, Children's Medical Center and the University of Texas Southwestern Medical Center, Dallas, Texas.
出版信息
Pediatr Neurol. 2014 May;50(5):447-51. doi: 10.1016/j.pediatrneurol.2014.01.013. Epub 2014 Jan 7.
BACKGROUND
Magnetic resonance imaging is a surrogate biomarker for major neurodevelopmental disabilities in survivors of perinatal hypoxic-ischemic encephalopathy because injury to the basal ganglia/thalami is highly predictive of major neuromotor and cognitive problems. Major disabilities and the appearance of neonatal magnetic resonance imaging are improved with therapeutic hypothermia. We evaluated neurodevelopmental outcomes when conventional magnetic resonance imaging showed minimal or no brain injury.
METHODS
Institutional review board-approved series of 62 infants (≥36 weeks; ≥1800 g; 34 boys/28 girls) cooled for hypoxic-ischemic encephalopathy between 2005 and 2011 who underwent neonatal magnetic resonance imaging and Bayley Scales of Infant and Toddler Development-III at 22 ± 7 months of age. Magnetic resonance imaging at 5-14 (mean 8) days was scored as normal (score = 0), showing focal gray or white matter injury only (score = 1), or basal ganglia/thalamic and/or watershed lesions with or without more extensive hemispheric injury (score = 2). Sensitivity, specificity, and positive and negative predictive values for magnetic resonance scores 0 and 1 and statistical interaction between magnetic resonance imaging score and age at magnetic resonance imaging were determined.
RESULTS
Magnetic resonance score = 0 was seen in 35/62 patients; 26/35 (74%) were typically developing, seven (20%) had moderate and two (6%) had severe delay. Magnetic resonance score = 1 was seen in 17/62 (27%) patients; 5/17 (29%) were normal, 11/17 (65%) had moderate delay, and 1/17 (6%) had severe neurodevelopmental delay. Of the 52 patients with magnetic resonance scores of 0 and 1, 40% were abnormal. The negative predictive value of a normal magnetic resonance imaging was 74%. For score 1, sensitivity was 95% (confidence interval 63%-83%), specificity 84% (confidence interval 70%-90%), positive predictive value 84% (confidence interval 71%-93%), and negative predictive value 74% (confidence interval 62%-82%).
CONCLUSIONS
Caution is warranted when prognosticating about neurodevelopmental status in early childhood after hypoxic ischemic encephalopathy with cooling, and longer follow-up studies are needed to determine the prognostic significance of a neonatal magnetic resonance imaging showing no or minor degrees of brain injury.
背景
磁共振成像（MRI）是围产期缺氧缺血性脑病幸存者主要神经发育障碍的替代生物标志物，因为基底神经节/丘脑损伤高度预示着严重的神经运动和认知问题。治疗性低温可改善严重残疾情况及新生儿MRI表现。我们评估了传统MRI显示脑损伤轻微或无损伤时的神经发育结局。
方法
机构审查委员会批准的62例婴儿（≥36周；≥1800克；34名男孩/28名女孩）系列研究，这些婴儿在2005年至2011年期间因缺氧缺血性脑病接受了低温治疗，并在22±7个月大时接受了新生儿MRI检查和贝利婴幼儿发展量表第三版评估。5-14天（平均8天）时的MRI评分被分为正常（评分=0）、仅显示局灶性灰质或白质损伤（评分=1）或基底神经节/丘脑和/或分水岭区病变伴或不伴有更广泛的半球损伤（评分=2）。确定了MRI评分为0和1时的敏感性、特异性、阳性和阴性预测值，以及MRI评分与MRI检查时年龄之间的统计交互作用。
结果
62例患者中有35例MRI评分为0；其中26/35（74%）发育正常，7例（20%）有中度延迟，2例（6%）有重度延迟。62例患者中有17例（27%）MRI评分为1；其中5/17（29%）正常，11/17（65%）有中度延迟，1/17（6%）有重度神经发育延迟。在MRI评分为0和1的52例患者中，40%异常。MRI正常的阴性预测值为74%。对于评分为1的情况，敏感性为95%（置信区间63%-83%），特异性为84%（置信区间70%-90%），阳性预测值为84%（置信区间71%-93%），阴性预测值为74%（置信区间62%-82%）。
结论
对于接受低温治疗的缺氧缺血性脑病患儿，在预测其幼儿期神经发育状况时应谨慎，需要进行更长时间的随访研究，以确定显示无或轻度脑损伤的新生儿MRI的预后意义。
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