组织温度和损伤对新生儿缺氧缺血性脑病治疗性低温期间 ADC 的影响。
Effects of Tissue Temperature and Injury on ADC during Therapeutic Hypothermia in Newborn Hypoxic-Ischemic Encephalopathy.
机构信息
From the Los Angeles County+USC Medical Center (C.Z.).
Departments of Radiology and Pediatrics (J.L.W., B.T., S.B.).
出版信息
AJNR Am J Neuroradiol. 2022 Mar;43(3):462-467. doi: 10.3174/ajnr.A7413. Epub 2022 Feb 3.
BACKGROUND AND PURPOSE
ADC changes are useful in detecting ischemic brain injury, but mechanisms other than tissue pathology may affect the kinetic movement and diffusion of water molecules. We aimed to determine the effects of brain temperature on the corresponding ADC in infants undergoing therapeutic hypothermia.
MATERIALS AND METHODS
Brain temperature and ADC values in the basal ganglia, thalamus, cortical GM, and WM were analyzed during and after therapeutic hypothermia. The study cohort was categorized as having no-injury or injury. Among infants without injury, the correlation between ADC values and temperature was analyzed using the Pearson correlation. Intrasubject comparison of ADC changes during and after therapeutic hypothermia were analyzed, excluding patients who had an MR image interval of >5 days to minimize the effects of injury evolution.
RESULTS
Thirty-nine infants with hypoxic-ischemic encephalopathy were enrolled (23 no-injury; 16 injury). The median ADC was significantly lower during therapeutic hypothermia (837; interquartile range, 771-928, versus 906; interquartile range, 844-1032 ×10mm/s; < .001). There was no difference in the ADC between the no-injury and injury groups during therapeutic hypothermia (823; interquartile range, 782-868, versus 842; interquartile range, 770-1008 ×10mm/s; = .4). In the no-injury group, in which ADC is presumed least affected by the evolution of injury, the median ADC was significantly lower during therapeutic hypothermia (826; interquartile range, 771-866, versus 897; interquartile range, 846-936 ×10mm/s; < .001). There was a moderate correlation between temperature and ADC in the no-injury group (during therapeutic hypothermia: Spearman ρ, 0.48; < .001; after therapeutic hypothermia: ρ, 0.4; < .001).
CONCLUSIONS
Aside from brain injury, reduced tissue temperature may also contribute to diffusion restriction on MR imaging in infants undergoing therapeutic hypothermia.
背景与目的
ADC 变化有助于检测缺血性脑损伤，但除组织病理学机制以外的其他机制可能会影响水分子的动力学运动和扩散。我们旨在确定脑温对接受治疗性低温治疗的婴儿相应 ADC 的影响。
材料与方法
在治疗性低温治疗期间和之后，分析基底节、丘脑、皮质 GM 和 WM 的脑温及 ADC 值。将研究队列分为无损伤和损伤。在无损伤的婴儿中，使用 Pearson 相关性分析 ADC 值与温度之间的相关性。分析治疗性低温治疗期间和之后 ADC 变化的个体内比较，排除 MRI 图像间隔>5 天的患者，以最大限度地减少损伤演变的影响。
结果
共纳入 39 例患有缺氧缺血性脑病的婴儿（无损伤 23 例，损伤 16 例）。治疗性低温治疗期间 ADC 中位数显著降低（837；四分位距，771-928，与 906；四分位距，844-1032×10mm/s；<0.001）。治疗性低温治疗期间，无损伤组和损伤组的 ADC 之间无差异（823；四分位距，782-868，与 842；四分位距，770-1008×10mm/s；=0.4）。在无损伤组中，假设 ADC 受损伤演变影响最小，治疗性低温治疗期间 ADC 中位数显著降低（826；四分位距，771-866，与 897；四分位距，846-936×10mm/s；<0.001）。无损伤组中，温度与 ADC 之间存在中度相关性（治疗性低温治疗期间：Spearman ρ，0.48；<0.001；治疗性低温治疗后：ρ，0.4；<0.001）。
结论
除脑损伤外，组织温度降低也可能导致接受治疗性低温治疗的婴儿 MRI 上弥散受限。
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