Agut Thais, León Marisol, Rebollo Mónica, Muchart Jordi, Arca Gemma, Garcia-Alix Alfredo
Deparment of Neonatology, Agrupació Sanitaria Hospital Sant Joan de Déu-Hospital Clinic-Maternitat, University of Barcelona, Barcelona, Spain.
BMC Pediatr. 2014 Jul 8;14:177. doi: 10.1186/1471-2431-14-177.
Despite therapeutic hypothermia 30-70% of newborns with moderate or severe hypoxic ischemic encephalopathy will die or survive with significant long-term impairments. Magnetic resonance imaging (MRI) in the first days of life is being used for early identification of these infants and end of life decisions are relying more and more on it. The purpose of this study was to evaluate how MRI performed around day 4 of life correlates with the ones obtained in the second week of life in infants with hypoxic-ischemic encephalopathy (HIE) treated with hypothermia.
Prospective observational cohort study between April 2009 and July 2011. Consecutive newborns with HIE evaluated for therapeutic hypothermia were included. Two sequential MR studies were performed: an 'early' study around the 4th day of life and a 'late' study during the second week of life. MRI were assessed and scored by two neuroradiologists who were blinded to the clinical condition of the infants.
Forty-eight MRI scans were obtained in the 40 newborns. Fifteen infants underwent two sequential MR scans. The localization, extension and severity of hypoxic-ischemic injury in early and late scans were highly correlated. Hypoxic-ischemic injury scores from conventional sequences (T1/T2) in the early MRI correlated with the scores of the late MRI (Spearman ρ = 0.940; p < .001) as did the scores between diffusion-weighted images in early scans and conventional images in late MR studies (Spearman ρ = 0.866; p < .001). There were no significant differences in MR images between the two sequential scans.
MRI in the first days of life may be a useful prognostic tool for clinicians and can help parents and neonatologist in medical decisions, as it highly depicts hypoxic-ischemic brain injury seen in scans performed around the second week of life.
尽管采用了治疗性低温疗法，但仍有30%-70%患有中度或重度缺氧缺血性脑病的新生儿会死亡，或存活下来但伴有严重的长期损伤。出生后几天内的磁共振成像（MRI）正被用于早期识别这些婴儿，并且临终决策越来越依赖于此。本研究的目的是评估出生后第4天左右进行的MRI检查结果与接受低温治疗的缺氧缺血性脑病（HIE）婴儿出生后第二周获得的MRI检查结果之间的相关性。
2009年4月至2011年7月进行前瞻性观察队列研究。纳入接受治疗性低温评估的连续性HIE新生儿。进行了两项连续的MR研究：一项是出生后第4天左右的“早期”研究，另一项是出生后第二周的“晚期”研究。由两名对婴儿临床状况不知情的神经放射科医生对MRI进行评估和评分。
40名新生儿共获得48次MRI扫描。15名婴儿接受了两次连续的MR扫描。早期和晚期扫描中缺氧缺血性损伤的定位、范围和严重程度高度相关。早期MRI常规序列（T1/T2）的缺氧缺血性损伤评分与晚期MRI评分相关（Spearman ρ = 0.940；p < 0.001），早期扫描的扩散加权图像评分与晚期MR研究的常规图像评分也相关（Spearman ρ = 0.866；p < 0.001）。两次连续扫描的MR图像之间无显著差异。
出生后几天内的MRI检查可能是临床医生有用的预后工具，并且可以帮助家长和新生儿科医生做出医疗决策，因为它能很好地显示出生后第二周左右扫描中所见的缺氧缺血性脑损伤。
