Conventional MRI signal changes and quantitative susceptibility mapping to assess potential brain damage in neonates with hyperbilirubinemia
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摘要:
目的 探究常规MRI信号改变及定量磁敏感加权图像（QSM）定量评估足月新生儿高胆红素血症患儿潜在脑损伤的价值。 方法 回顾性分析2019年1月~2020年12月我院收治的临床综合诊断为高胆红素血症的足月新生儿50例（Ⅰ组），另选48例胆红素不高的无脑相关疾病的足月新生儿作为对照组（Ⅱ组）。再根据血清总胆红素水平将Ⅰ组分为轻中度升高组和重度及极重度升高组。所有患儿均行治疗前MR平扫、扩散加权成像扫描，其中38例患儿行QSM检查，对比不同组别患儿MR信号强度之间差异及其与血清总胆红素水平的相关性；比较胆红素升高患儿与对照组患儿不同核团磁化率之间的差异，及其与血清总胆红素水平之间的相关性。 结果 胆红素升高患儿更容易出现苍白球（GP）T1WI高信号表现（36/12 vs 13/37，P < 0.001）；3组之间GP的T1WI信号强度（SI1）/T2WI信号强度（SI2）比值的差异有统计学意义（P=0.034），但SI1GP、SI2GP、SI1P、SI2P、SI1FWM、SI2FWM、SI1FGM、SI2FGM、SI1GP/SI1P、SI1GP/SI1FWM、SI1GP/SI1FGM、△SI1（GP-P）、△SI1（GP-FGM）、△SI1（GP-P）/SI1GP、△SI1（GP-P）/△SI1（GP-FGM）、△SI1（GP-P）/△SI1（GP-FWM）的差异均无统计学意义（P > 0.05）；SI1 GP/SI2GP与血清总胆红素水平呈极弱相关关系（r=0.261，P=0.009），当日龄与出生体质量控制时，SI1 GP/SI2GP、△SI1（GP-P）/△SI1（GP-FGM）与血清总胆红素仍呈极弱相关（r=0.230，P=0.014；r=-0.184，P=0.014）。胆红素升高组与对照组之间苍白球、壳核、丘脑底核及脑干的磁化率之间的差异均有统计学意义（P < 0.05）；且壳核及丘脑底核与血清总胆红素水平呈轻度相关（r=-0.419，P= 0.011；r=-0.391，P=0.018），而苍白球及脑干与血清胆红素呈中度相关（r=-0.620，P < 0.001；r=-0.630，P < 0.001）。 结论 高胆红素血症新生儿单纯评价苍白球T1WI高信号有一定的诊断意义，但是常规MR信号强度与血清胆红素是否升高没有明确相关性；而苍白球、壳核、丘脑底核及脑干QSM测定的磁化率可能可以更早的发现高胆红素血症新生儿潜在脑损伤。 Abstract:Objective To explore the value of conventional MRI signal changes and quantitative susceptibility mapping (QSM) in quantitative assessment of potential brain injury in neonates with hyperbilirubinemia. Methods Fifty neonates (group Ⅰ) who were clinically diagnosed with neonatal hyperbilirubinemia in our hospital were retrospectively analyzed from January 2019 to December 2020. Forty-eight neonates without hyperbilirubinemia and brain-related diseases were the control group (group Ⅱ). All children underwent MR plain scan and diffusion weighted imaging scan before treatment, and 38 children underwent QSM examination. The differences between the MR signal intensities of children in different groups and their correlation with serum total bilirubin levels were compared. The differences between the magnetic susceptibility of different nuclei in children with elevated bilirubin and the control group were compared, and their correlation with serum total bilirubin levels were analyzed. Results Children with hyperbilirubinemia were more inclined to have high signal intensity of the globus pallidus on T1WI (36/12 vs 13/37, P < 0.001). The difference of SI1GP/SI2GP was statistically significant (P=0.034), while the difference of other indicators were not statistically significant (P > 0.05). There was a very weak correlation between the SI1GP/SI2GP with serum total bilirubin level (r=0.261, P=0.009).When the age and birth weight were controlled, the SI1 GP/SI2GP, ΔSI1(GP-P)/ΔSI1(GP-FGM) was a very weak correlated(r=0.230, P=0.014; r=-0.184, P=0.014). There were statistically significant differences in the magnetic susceptibility of the globus pallidus, putamen, subthalamic nucleus and brainstem between the elevated bilirubin group and the control group(P < 0.05).The magnetic susceptibility of putamen and subthalamic nucleus were slightly correlated with serum total bilirubin levels (r=-0.419, P=0.011; r=-0.391, P=0.018), while there was a moderate correlation between the magnetic susceptibility of globus pallidus and brainstem and serum bilirubin levels (r=-0.620, P < 0.001; r=-0.630, P < 0.001). Conclusion The evaluating signal intensity of the globus pallidus on T1WI is helpful for thediagnosis of neonates with hyperbilirubinemia. There is no clear correlation between the signal intensity of conventional MR and the increase of serum bilirubin. The magnetic susceptibility measured by QSM in the globus pallidus, putamen, subthalamic nucleus and brainste may earlier indicate the potential brain damage in neonates with hyperbilirubinemia. -
图 1 两患儿的T1WI/T2WI/DWI平扫图像及QSM后处理图像
A~D: 高胆红素血症患儿, 男, 日龄19 d, 出生孕周38周3 d; 血清总胆红素425.6 μmol/L; 常规MR平扫示苍白球对称性T1WI高信号; E~H：正常对照组新生儿, 女, 日龄10 d, 出生孕周39周3 d；血清总胆红素77.7 μmol/L; 常规MR平扫未见异常信号. D、H均为QSM重建后图像.
Figure 1. The T1WI/T2WI/DWI plain scan images and QSM post-processed images of two children.
表 1 各组患儿常规MR信号强度及各计算值之间的差异
Table 1. Differences between conventional MRI signal intensity and the calculated values of children in each group (Mean±SD)
指标 所有患者 Ⅰa组 Ⅰb组 Ⅱ组 F/Z P SI1GP 1233.65±726.26 1184.16±659.41 1148.54±729.17 1173.68±761.97 1.294 0.279 SI2GP 1905.37±863.77 1910.54±882.79 1880.64±832.10 1911.19±880.38 0.009 0.991 SI1P 910.79±529.61 886.77±486.27 1097.38±521.21 856.84±555.06 1.411 0.249 SI2P 2051.64±973.31 2056.60±1000.18 2021.72±911.91 2059.60±997.06 0.010 0.990 SI1FWM 763.39±422.58 735.15±386.86 901.64±404.47 730.38±449.08 1.186 0.310 SI2FWM 2046.70±994.21 2047.79±1004.65 2089.12±958.43 2030.07±1020.31 0.023 0.978 SI1FGM 548.60±338.29 513.39±300.37 686.62±354.95 520.32±349.49 1.872 0.159 SI2FGM 2698.55±1387.83 2747.05±1501.95 2696.23±1190.37 2667.09±1404.28 0.031 0.969 SI1GP/SI1P 1.36±0.15 1.34±0.14 1.34±0.09 1.37±0.17 0.740 0.480 SI1GP/SI1FWM 2.15（1.33, 5.27） 2.28（1.43, 5.11） 2.09（1.61, 3.23） 2.12（1.33, 5.27） 2.097 0.350 SI1GP/SI1FGM 1.59±0.28 1.60±0.29 1.59±0.25 1.59±0.28 0.002 0.998 ΔSI1（GP-FGM） 685.05±454.09 670.78±425.70 794.95±433.90 653.36±481.82 0.655 0.522 ΔSI1（GP-P） 322.86±233.89 297.39±207.55 384.17±234.30 316.85±250.43 0.821 0.443 SI1GP/SI2GP 0.64±0.27 0.63±0.266 0.78±0.22 0.59±0.28 3.493 0.034 ΔSI1（GP-P）/SI1GP 0.25±0.08 0.24±0.08 0.25±0.06 0.26±0.08 0.577 0.564 ΔSI1（GP-P）/ΔSI1（GP-FGM） 1.43±0.38 1.52±0.41 1.47±0.46 1.35±0.32 2.082 0.130 ΔSI1（GP-P）/ΔSI1（GP-FWM） 2.25±0.55 2.38±0.57 2.13±0.48 2.20±0.54 1.602 0.207 组Ⅰa: 轻中度升高组; 组Ⅰb: 重度及极重度升高组; 组Ⅱ: 对照组. SI1: T1WI信号强度; SI2: T2WI信号强度; GP: 苍白球; P: 壳核; FWM: 额叶白质; FGM: 额叶灰质. 
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表 2 常规MR信号强度及各计算值与血清总胆红素水平的相关性研究
Table 2. The correlation between the conventional MR signal intensity and the calculated values with serum total bilirubin level
指标 r P r1* P1* SI1GP 0.132 0.194 0.124 0.120 SI2GP -0.028 0.787 0.001 0.498 SI1P 0.149 0.143 0.129 0.112 SI2P -0.031 0.760 0.003 0.487 SI1FWM 0.136 0.181 0.126 0.117 SI2FWM -0.010 0.926 0.019 0.430 SI1FGM 0.165 0.104 0.156 0.070 SI2FGM -0.012 0.903 0.018 0.434 SI1GP/SI1P -0.093 0.361 -0.014 0.447 SI1GP/SI1FWM -0.117 0.253 -0.065 0.270 SI1GP/SI1FGM -0.016 0.878 0.011 0.458 ΔSI1（GP-FGM） 0.089 0.385 0.083 0.216 ΔSI1（GP-P） 0.074 0.471 0.096 0.182 SI1GP/SI2GP 0.261 0.009 0.230 0.014 ΔSI1（GP-P）/SI1GP -0.062 0.547 0.032 0.380 ΔSI1（GP-P）/ΔSI1（GP-FGM） 0.108 0.292 0.018 0.434 ΔSI1（GP-P）/ΔSI1（GP-FWM） -0.064 0.530 -0.184 0.041 *r1为纠正日龄及体质量后的r值，P1为对应的P值.
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表 3 胆红素升高组与对照组之间各核团磁化率的差异
Table 3. Differences in the magnetic susceptibility of each nucleus between the elevated bilirubin group and the control group (Mean±SD)
指标 总体 胆红素升高组 对照组 T P 苍白球 156.35±105.70 253.39±75.52 94.60±69.41 6.468 < 0.001 壳核 255.04±172.53 364.00±207.47 185.70±100.08 3.466 0.001 内囊后肢 253.42±133.07 260.14±114.63 249.14±146.05 0.239 0.813 内囊前肢 198.59±128.65 231.20±149.28 177.84±112.38 1.222 0.230 丘脑底核 304.74±165.63 379.29±204.36 257.30±117.51 2.280 0.029 丘脑背侧核 293.01±157.79 325.14±158.77 272.57±157.37 0.974 0.337 大脑脚 254.52±165.47 290.18±151.07 231.82±173.56 1.032 0.309 小脑齿状核 265.89±143.20 299.73±205.34 244.36±82.63 1.136 0.264 桥臂 371.14±217.84 432.21±150.74 332.27±246.89 1.358 0.183 红核黑质 244.20±209.80 203.21±110.20 270.29±252.99 -0.934 0.357 脑干 325.95±151.98 451.00±116.59 246.37±114.10 5.202 < 0.001
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表 4 所有进行QSM检查的患儿各核团磁化率与血清总胆红素水平之间的相关性研究
Table 4. The correlation between the magnetic susceptibility of each nucleus and the serum total bilirubin level in all children who underwent QSM examination
指标 r P 苍白球 -0.620 < 0.001 壳核 -0.419 0.011 内囊后肢 0.267 0.115 内囊前肢 -0.104 0.545 丘脑底核 -0.391 0.018 丘脑背侧核 -0.018 0.916 大脑脚 0.091 0.598 小脑齿状核 -0.163 0.343 桥臂 -0.300 0.076 红核黑质 0.304 0.072 脑干 -0.630 < 0.001
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