Gonçalves Fabrício Guimarães, Freeman Colbey, Khrichenko Dmitry, Hwang Misun
Radiology, The Children's Hospital of Philadelphia, Philadelphia, United States.
Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, United States.
Ultrasound Int Open. 2022 Nov 16;8(2):E43-E52. doi: 10.1055/a-1958-3985. eCollection 2022 Nov.
Neurosonography evaluation of neonatal hypoxic-ischemic encephalopathy (HIE) is mainly qualitative. We aimed to quantitatively compare the echogenicity of several brain regions in patients with HIE to healthy controls. 20 term neonates with clinical/MRI evidence of HIE and 20 term healthy neonates were evaluated. Seven brain regions were assessed [frontal, parietal, occipital, and perirolandic white matter (WM), caudate nucleus head, lentiform nucleus, and thalamus]. The echogenicity of the calvarial bones (bone) and the choroid plexus (CP) was used for ratio calculation. Differences in the ratios were determined between neonates with HIE and controls. Ratios were significantly higher for HIE neonates in each region (p<0.05). The differences were greatest for the perirolandic WM, with CP and bone ratios being 0.23 and 0.22 greater, respectively, for the HIE compared to the healthy neonates (p<0.001). The perirolandic WM had a high AUC, at 0.980 for both the CP and bone ratios. The intra-observer reliability for all ratios was high, with the caudate to bone ratio being the lowest at 0.832 and the anterior WM to CP ratio being the highest at 0.992. When coupled with internal controls, quantitative neurosonography represents a potential tool to identify early neonatal HIE changes. Larger cohort studies could reveal whether a quantitative approach can discern between degrees of severity of HIE. Future neurosonography protocols should be tailored to evaluate the perirolandic region, which requires posterior coronal scanning.
新生儿缺氧缺血性脑病（HIE）的神经超声检查评估主要是定性的。我们旨在定量比较HIE患者与健康对照者几个脑区的回声性。对20例有HIE临床/MRI证据的足月儿和20例健康足月儿进行了评估。评估了七个脑区[额叶、顶叶、枕叶和中央沟周围白质（WM）、尾状核头、豆状核和丘脑]。使用颅骨（骨）和脉络丛（CP）的回声性进行比值计算。确定了HIE新生儿与对照组之间比值的差异。HIE新生儿每个区域的比值均显著更高（p<0.05）。中央沟周围白质的差异最大，与健康新生儿相比，HIE的CP和骨比值分别高0.23和0.22（p<0.001）。中央沟周围白质的AUC较高，CP和骨比值的AUC均为0.980。所有比值观察者内可靠性均较高，尾状核与骨的比值最低，为0.832，前WM与CP的比值最高，为0.992。当与内部对照相结合时，定量神经超声检查是识别早期新生儿HIE变化的潜在工具。更大规模的队列研究可以揭示定量方法是否能够区分HIE的严重程度。未来的神经超声检查方案应专门针对中央沟周围区域进行评估，这需要进行后冠状扫描。
