Medical Imaging Research Center, Department of Radiology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
Shiraz University of Medical Sciences, Shiraz, Iran.
BMC Neurol. 2022 Mar 19;22(1):104. doi: 10.1186/s12883-022-02624-2.
Inhere we evaluated the diagnostic utility of Doppler sonography (DS) of the anterior cerebral artery (ACA), middle cerebral artery (MCA) and the basilar arteries (BA) based on resistive index (RI) for the diagnosis of asphyxia.
In this multi-centered cross-sectional study, neonates with clinical diagnosis of asphyxia, were considered for study. During the first 24 h, neonates underwent DS. MRI was done for each neonate during the first month, after discharge or during hospital admission, after obtaining clinical stability. Staging based on DS was compared with staging based on MRI.
Overall, 34 patients entered the study. DS of the ACA, MCA, BA all had significant correlation with MRI findings (regarding severity of asphyxia) (r > 0.8 and p < 0.001). In the receiver-operating-characteristic analysis, ideal cut-off point for diagnoses of asphyxia based on ACA and BA was RI ≤ 0.62 [area under the curve (AUC) = 0.957 and 95% CI: 0.819-0.997; sensitivity = 95.65; specificity = 100; positive predictive value (PPV) = 100; negative predictive value (NPV) = 90.9 and negative likelihood ratio (NLR) = 0.043]. Regarding MCA, similarly, a RI ≤ 0.62 was ideal for differentiating between normal and asphyxiated neonates (AUC = 0.990 and 95% CI: 0.873-1; sensitivity = 91.30; specificity = 100; PPV = 91.2; NPV = 100 and NLR = 0.087).
For evaluating neonates clinically suspected of asphyxia, especially in centers with limited facilities such as MRI, DS can be used as a first line diagnostic modality and RI of ≤ 0.62 is an appropriate cut-off for the diagnosis of perinatal asphyxia.
本研究旨在评估阻力指数（RI）在经颅多普勒超声（DS）诊断窒息中的应用价值，探讨其对前脑动脉（ACA）、大脑中动脉（MCA）和基底动脉（BA）的诊断效能。
本研究为多中心横断面研究，纳入临床诊断为窒息的新生儿。在出生后 24 小时内对新生儿进行 DS 检查。在出院或住院期间，获得临床稳定后，对每位新生儿进行 MRI 检查。比较基于 DS 的分期与基于 MRI 的分期。
共有 34 例患者入组研究。ACA、MCA 和 BA 的 DS 与 MRI 检查结果（窒息严重程度）均具有显著相关性（r > 0.8，p < 0.001）。在受试者工作特征曲线分析中，基于 ACA 和 BA 的 RI≤0.62 是诊断窒息的理想截断值（曲线下面积（AUC）分别为 0.957 和 0.997，95%CI：0.819-0.997；敏感性为 95.65%；特异性为 100%；阳性预测值（PPV）为 100%；阴性预测值（NPV）为 90.9%；阴性似然比（NLR）为 0.043）。MCA 也类似，RI≤0.62 是区分正常和窒息新生儿的理想截断值（AUC 为 0.990，95%CI：0.873-1；敏感性为 91.30%；特异性为 100%；PPV 为 91.2%；NPV 为 100%；NLR 为 0.087）。
对于临床怀疑窒息的新生儿，尤其是在 MRI 等设施有限的中心，DS 可作为一线诊断方法，RI≤0.62 是诊断围产期窒息的合适截断值。
