Rutherford M A, Pennock J M, Counsell S J, Mercuri E, Cowan F M, Dubowitz L M, Edwards A D
Robert Steiner Magnetic Resonance Unit, Imperial College of Science, Technology, and Medicine, Hammersmith Campus, London, England.
Pediatrics. 1998 Aug;102(2 Pt 1):323-8. doi: 10.1542/peds.102.2.323.
The aim of this study was to establish whether abnormal signal intensity in the posterior limb of the internal capsule (PLIC) on magnetic resonance imaging is an accurate predictor of neurodevelopmental outcome at 1 year of age in infants with hypoxic-ischemic encephalopathy (HIE).
We have examined 73 term neonates with HIE between 1 and 17 days after birth with cranial magnetic resonance imaging and related the magnetic resonance imaging findings to neurodevelopmental outcome at 1 year of age.
All infants with an abnormal signal intensity in the PLIC developed neurodevelopmental impairment although in 4 infants with very early scans the abnormal signal was not apparent until up to 4 days after birth. A normal signal intensity was associated with a normal outcome in all but 4 cases; 3 of these infants had minor impairments and all had persistent imaging changes within the white matter. The 4th infant with a normal signal intensity on day 2 died before a further image could be obtained. The absence of normal signal predicted abnormal outcome in term infants with HIE with a sensitivity of 0.90, a specificity of 1.0, a positive predictive value of 1.0, and a negative predictive value of 0.87. The test correctly predicted outcome in 93% of infants with grade II HIE, according to the Sarnat system. Applying a Bayesian approach, the predictive probability of the test (the probability that the test would predict an outcome correctly) was distributed with a mean of 0.94 and 95% confidence limits of 0.89 to 1.0.
Abnormal signal intensity in the PLIC is an accurate predictor of neurodevelopmental outcome in term infants suffering HIE.
本研究旨在确定缺氧缺血性脑病（HIE）婴儿出生1年后，内囊后肢（PLIC）磁共振成像上的异常信号强度是否为神经发育结局的准确预测指标。
我们对73例足月HIE新生儿在出生后1至17天进行了头颅磁共振成像检查，并将磁共振成像结果与1岁时的神经发育结局相关联。
PLIC信号强度异常的所有婴儿均出现神经发育障碍，不过4例极早期扫描的婴儿，其异常信号直到出生后4天才显现。除4例之外，PLIC信号强度正常者结局均正常；其中3例婴儿有轻度障碍，且白质内均有持续的影像学改变。第4例婴儿在出生第2天PLIC信号强度正常，但在能获取进一步图像之前死亡。PLIC正常信号缺失对足月HIE婴儿异常结局的预测敏感度为0.90，特异度为1.0，阳性预测值为1.0，阴性预测值为0.87。根据萨纳特系统，该检测能正确预测93%的II级HIE婴儿的结局。采用贝叶斯方法，该检测的预测概率（检测正确预测结局的概率）分布的均值为0.94，95%置信区间为0.89至1.0。
PLIC异常信号强度是足月HIE婴儿神经发育结局的准确预测指标。
