Zhang Chunxiang, Zhao Xin, Zhu Zitao, Wang Kaiyu, Moon Brianna F, Zhang Bohao, Sadat Sayed Noman, Guo Jinxia, Bao Jieaoxue, Zhang Ding, Zhang Xiaoan
Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Institute of Neuroscience, Zhengzhou University, Zhengzhou, China.
Quant Imaging Med Surg. 2023 Oct 1;13(10):6412-6423. doi: 10.21037/qims-22-195. Epub 2023 Sep 22.
Preterm infants with necrotizing enterocolitis (NEC) are at high risk of adverse neurodevelopmental outcomes. The aim of this study was to explore the value of diffusion tensor imaging (DTI) combined with serum C-reactive protein (CRP) and procalcitonin (PCT) in evaluating alterations of white matter (WM) microstructure in preterm infants with NEC.
A retrospective cross-sectional study was conducted in which all participants were consecutively enrolled at The Third Affiliated Hospital of Zhengzhou University from June 2017 and October 2021. Data from 30 preterm infants with NEC [mean gestational age at birth 31.41±1.15 weeks; mean age at magnetic resonance imaging (MRI) 37.53±3.08 weeks] and 40 healthy preterm infants with no NEC were recorded (mean gestational age at birth 32.27±2.09 weeks; mean age at MRI 37.15±3.23 weeks). WM was used to obtain the fractional anisotropy (FA) and mean diffusivity (MD) values of the regions of interest (ROIs). Additionally, serum levels of CRP and PCT were determined. Spearman correlation analysis was performed between the WM-derived parameters, CRP level, and the PCT serum index.
Preterm infants with NEC had reduced FA values and elevated MD values in WM regions [posterior limbs of the internal capsule (PLIC), lentiform nucleus (LN), frontal white matter (FWM)] compared to the control group (P<0.05). Additionally, the FA of the PLIC was negatively correlated with serum CRP (r=-0.846; P<0.05) and PCT (r=-0.843; P<0.05). Meanwhile, the MD of PLIC was positively correlated with serum CRP (r=0.743; P<0.05) and PCT (r=0.743; P<0.05, respectively). The area under the curve (AUC) of FA and MD combined with CRP and PCT in the diagnosis of WM microstructure alterations with NEC was 0.968, representing a considerable improvement in predicted efficacy over single indicators, including FA [AUC: 0.938; 95% confidence interval (CI): 0.840-0.950], MD (AUC: 0.807; 95% CI: 0.722-0.838), CRP (AUC: 0.867; 95% CI: 0.822-0.889), and PCT (AUC: 0.706; 95% CI: 0.701-0.758).
WM can noninvasively and quantitatively assess the WM microstructure alterations in preterm infants with NEC. WM combined with serum CRP and PCT demonstrated superior performance in detecting and evaluating WM microstructure alterations in preterm infants with NEC.
患有坏死性小肠结肠炎（NEC）的早产儿面临神经发育不良后果的高风险。本研究的目的是探讨弥散张量成像（DTI）联合血清C反应蛋白（CRP）和降钙素原（PCT）在评估患有NEC的早产儿白质（WM）微观结构改变中的价值。
进行了一项回顾性横断面研究，所有参与者于2017年6月至2021年10月在郑州大学第三附属医院连续入组。记录了30例患有NEC的早产儿的数据[出生时平均胎龄31.41±1.15周；磁共振成像（MRI）时平均年龄37.53±3.08周]和40例无NEC的健康早产儿的数据（出生时平均胎龄32.27±2.09周；MRI时平均年龄37.15±3.23周）。利用WM获取感兴趣区域（ROI）的分数各向异性（FA）和平均扩散率（MD）值。此外，测定血清CRP和PCT水平。对WM衍生参数、CRP水平和PCT血清指标进行Spearman相关性分析。
与对照组相比，患有NEC的早产儿WM区域[内囊后肢（PLIC）、豆状核（LN）、额叶白质（FWM）]的FA值降低，MD值升高（P<0.05）。此外，PLIC的FA与血清CRP（r=-0.846；P<0.05）和PCT（r=-0.843；P<0.05）呈负相关。同时，PLIC的MD与血清CRP（r=0.743；P<0.05）和PCT（r=0.743；P<0.05）呈正相关。FA和MD联合CRP和PCT诊断患有NEC的WM微观结构改变的曲线下面积（AUC）为0.968，与单一指标相比，预测效能有显著提高，单一指标包括FA[AUC：0.938；95%置信区间（CI）：0.840-0.950]、MD（AUC：0.807；95%CI：0.722-0.838）、CRP（AUC：0.867；95%CI：0.822-0.889）和PCT（AUC：0.706；95%CI：0.701-0.758）。
WM可以无创且定量地评估患有NEC的早产儿的WM微观结构改变。WM联合血清CRP和PCT在检测和评估患有NEC的早产儿的WM微观结构改变方面表现出卓越性能。
