3T 2D-~1H MRS Imaging To Newborn HIBD Clinical Study

[Objectives]1.By a group of healthy newborns conventional MRI(T1WI,T2WI)inspection and analysis of 2D-1H MRS to examine the health of newborns method of spectral imaging.2.The health of newborns through the group a regular MRI(T1WI,T2WI) inspection and analysis of 2D-1H MRS to explore the spectral performance of the health of newborns.3.The adoption of a clinical diagnosis of hypoxic-ischemic brain injury in children with conventional MRI and 2D-1H MRS examination to explore the full-term and premature newborns with hypoxic-ischemic brain injury in the performance image.4.Through the clinical diagnosis of hypoxic-ischemic brain injury in children with clinical follow-up,sum up conventional MRI and 2D-1H MRS findings of neonatal hypoxic-ischemic brain injury after more research to determine.[Materials and Methods]1,studySource neonatal healthFrom August 8,2008 to March 2009 period 08 in the South Medical Imaging Center,Nanfang Hospital,Volunteers of five cases examined the health of newborns do conventional MRI(T1WI,T2WI)and 2D-1H MRS analysis of inspection,the final analyze the image data.The source of neonatal HIBDFrom August 8,2008 to March 2009 period 08 in the South Medical Imaging Center,Nanfang Hospital,volunteers checked 45 cases of the 18 cases of full-term newborn and premature newborns do conventional MRI(T1WI,T2WI)and 2D-1H MRS analysis of inspection,the final analysis of its image data.Prognosis of children with sourceFrom August 8,2008 to March 2009 period in the South 08 South Medical University Hospital and diagnosed with HIBD hospitalization,imaging centers also accept voluntary MRS examination;patients after discharge from hospital in time to review the provisions of the BSID;a total of 43 cases.2,equipment settings and parameters2.1 Equipment2.1.1 magnetic resonance scanner:the use of GE produced Signa ExciteⅡ3.0T superconductive magnetic resonance imaging equipment to be checked.2.1.2 coils:the use of conventional MRI scans of eight-channel head coil,by the spin-echo(SE)sequences and fast spin echo(FSE)sequence was T1, T2-weighted images(T1WI,T2WI).Scanned using magnetic resonance spectroscopy dedicated single-channel quadrature head coil,multi-voxel two-dimensional(2D-multi-voxel)point-resolved spectroscopy(PRESS)imaging sequence,in plain T1WI or T2WI pure axial position on the spectrum. Pre-positioning after the first scan,indicating semi-automatic shimming to achieve high linewidth(FWHM)98%or more to the beginning of formal spectral scanning, scan time of approximately 5 minutes. 2.1.3 stent:a self-made stent,the size of 40cm×30cm×20cm behind the soft sea shells,the middle of Au-dug.Check the infant head fixed in the middle of the sea.2.1.4 Workstation:GE workstations provided AW4.2,with its images and data to the MRS data processing software Functool.2.1.5 Picture Archiving and transmission:the use of latitude and longitude PACS(JW-PACS)(Picture Archiving and Communiations System)system,that is, picture archiving and communication system.2.2,scan parameters2.2.1 Conventional MRI scanning:the use of eight-channel head coil,by the spin-echo(SE)sequences and fast spin echo(FSE)sequence was T1,T2-weighted images(T1 WI,T2WI),scan parameters are as follows:T1WI(TR/TE,600/16ms), T2WI(TR/TE,5100/138ms),slice thickness 5-8mm,layer spacing of 1.5mm,FOV 24×18mm,matrix 512×288.2.2.3 Magnetic Resonance Spectroscopy Scanning:Mainly two kinds of imaging pulse sequence,STEAM and PRESS.Imaging single Su-way,two-dimensional,three-dimensional acquisition.This article from the pulse sequence,scanning,post-processing to introduce three spectral imaging scanning technology.Post-processing of three-dimensional spectral analysis: three-dimensional spectral analysis and post-processing of two-dimensional spectral analysis of exactly the same as basic.3,infant anesthesia:3.1 Drugs3.1.1 Phenobarbital sodium injection(Sodium Phenobarbital Injection)Pharmaco-toxicological and pharmacokinetics:This product is a colorless liquid clarity.This product has a wide range of central nervous system inhibition, with the resulting increase in the amount of sedative,hypnotic and anti-convulsive effect,when high-dose anesthetic effects,it is considered the main mechanism of the brain stem reticular formation and the blocking up of the activation system.Injection of 0.5～1 hour after the onset,2～18 hours of peak plasma concentration, distribution in tissue and body fluids with high concentrations of brain tissue, followed by skeletal muscle,the brain tissue to enter the slow through the placenta blood in 40 percent of the goods with the plasma protein binding.Half-life(t1/2) adults for the 48～144 hours,in children 40 to 70 hours,liver,renal insufficiency when the half-life(t1/2)to extend.About 65%of metabolism in the liver and converted to a p-barbital,most with glucuronic acid or sulfate-binding,and then discharged by the kidneys with the urine;27～50%of urine discharged from the prototype,some in the tubular reabsorption to the role of time.Usage and dosage:Preoperative administration of anesthesia prior to 0.5～1 hour and intramuscular injection of 100～200mg.Medication for children: Intramuscular injection:anticonvulsant,according to the weight the first 3～5mg/kg. Specifications:1ml:0.1g;ampoule 1ml×10 supportManufacturing enterprises:Tianjin Amino Acid Co.,Ltd.Jin-Yao;Approval Number-State H12020381;3.1.2 Chloral Hydrate(Chloral Hydrate)available for inspection to prevent the baby to wake upPharmaco-toxicological and pharmacokinetics:This product is hypnotic, anticonvulsant drugs.Dose within 30 minutes of hypnosis can be induced to sleep, and hypnotic effects of moderate,non-REMS shortened sleep time,no significant residual effect.Mechanism may be related to hypnotic barbiturates is similar to approximate the physiological cause of sleep,after no significant role.Larger doses have anticonvulsant effect,can be used for children with high fever,tetanus and sub-epileptic seizures caused.Large doses can cause coma and anesthesia.Inhibit the medullary respiratory and vasomotor center,leading to death.As the basis of anesthesia-assisted medication,has been very little application.Digestive tract or rectal administration can be quickly absorbed,1 hour,peaked at 4 to 8 hours to maintain.High-fat-soluble,easily through the blood-brain barrier,the distribution of the whole body of the organization.Plasma T1/2 for 7 to 10 hours a day.Rapid metabolism in the liver activity of triclosan into ethanol.Trichloro ethanol protein binding rate of 35～40%,trichloro ethanol T1/2 of approximately 4 to 6 hours. Oral chloral hydrate 30 minutes can go to sleep,duration of 4～8 hours.Trichloro ethanol further glucuronic acid binding and inactivation by the kidneys from,no hysteresis and accumulation.The drug through the placenta and secreted into the milk.Usage and consumption:the amount used in children:hypnosis,one by 50mg/kg body weight or body surface area 1.5g/m2,taken before going to bed, limited to a maximum 1g;also can be 16.7mg/kg body weight or body surface area 500mg/m2,3 times a day.Sedation,a 8mg/kg according to the weight or body surface area 250mg/m2,maximum limits for 500mg,3 times a day after meal. Enema,according to the weight of each 25mg/kg.Maximum dose for each 1g.Manufacturing enterprises:Nanfang Hospital,Southern Medical University; solution of chloral hydrate 10%4,the choice of regions of interest:Arrow next to the blood supply of distribution:the three cerebral artery(ACA ACA,middle cerebral artery MCA,posterior cerebral artery PCA)distribution area of red region hypoperfusion as the watershed areas are susceptible to cerebral ischemia;so I chose here as the main sense of interest in the district.5,statistical Data will be measured by infant gestational age and the location of ROI Acquisition classified SPSS13.0 Statistical Package for the importation,the basal ganglia were calculated and semi-oval center region of the average ratio of metabolites,with mean±standard deviation(±SD)form.Various metabolites Ch, Cr,NAA,Cr+Ch,Ch/Cr,Ch/NAA,NAA/Ch,NAA/Cr,Cr/NAA,MI,LIP, LAC value to mean±standard deviation(x±SD)of the form.(1)Comparison of basal ganglia metabolite ratio about whether the statistical difference;(2) Comparison of semi-oval around the central area of the metabolite ratios between any statistical difference;by test data in each group are in line with normal distribution.Comparison between the two groups interested in using one-way ANOVA,a significant difference in the overall circumstances,the use of LSD multiple comparison cycle 22.Region of interest with the group comparisons using paired t test.Interested in comparisons between about using independent samples t test.Test standard a value of 0.05 check.[Results]Large spectrum of metabolite resonance peaks include:1 NAA N-acetyl aspartate,at 2.0ppm,in the 1H-MRS in normal NNA is the second-highest peak.NAA mainly in neurons and their axon is seen within neuronal marker,NAA reduction reflects the loss of neurons or the volume of metabolism.2 Cho mainly phosphocholine and phosphate acetylcholine,the resonance peak at 3.2ppm.Under normal circumstances is a 1H-MRS of the No.1 high peaks.Cho and membrane phospholipid breakdown and synthesis,and to participate in the composition of cell membranes.Cho peak increased with active cell division and cell proliferation increase in metabolic abnormalities,and increased choline can cause demyelination. 3 Cr include creatine and creatine phosphate,and energy metabolism,and the resonance peak at 3.0ppm,is a 1H-MRS of high peak No.3.4 lactic acid(Lac)measured less than under normal circumstances,the resonance peak at 1.3ppm and 4.1ppm,double peak.Is a product of anaerobic glycolysis,the body can cause hypoxic-ischemic lactate accumulation,the diagnosis of HIBD significance.5 inositol(MI)resonance peak at 3.5ppm.With regulation of osmotic pressure, nutrition cells,anti-oxidation and generation,such as the role of surfactant.Performance machine and sequence parameters and spectral scanning technology:Can be seen from the above discussion,in order to obtain accurate spectral analysis results,it is necessary to pay attention to several key points are:a.anatomical location map must be vertical;b.positioning essential spectrum;c.recommend the use of VSS;d.spectral scanning shimming is the key;e.money each scan to be done auto prescan,observed linewidth value and the value of water suppression.MRI:the newborn is more sensitive to the imaging method;benefits: Conventional MRI gray matter(cortex,deep nuclei)injury in the high-signal T1-WI; based on injury time,pathological changes(hemorrhage,gliosis)T2-WI signal is changing;white matter damage due to ischemia,cerebral edema in the lower T1-WI signal,T2-WI signal;MRS(spectroscopy):to provide a rough and biochemical analysis of brain tissue,lactic acid,choline,creatine,NAA's HIE peak potential prognostic prediction:A literature-MRS of HIE within 24 hours sensitive than DWI.5 cases of normal neonates may show NAA,Cr,Ch,towering peaks,MI peak is slightly lower,LAC,LIP measured peak or not the low,the peak of the order of high to low Ch,NAA,Cr,MI,LAC,LIP;ratio of Cr+Ch:19551.33±4210,Ch/Cr: 1.17±0.52,Ch/NAA:1.47±0.22,NAA/Ch:1.61±0.19,NAA/Cr:1.73±0.45, Cr/NAA:1.0135±0.24.MRS organizations to quantitative analysis of chemical composition and structure of neonatal brain in vivo study of the biochemical metabolic process and provide information on cellular energy metabolism,cell membrane collapse of neuronal function and neurotransmitter activities such as selective information[18～22].MRS examination method commonly used incentive echo(STEAM)and point-resolved method(PRESS).Determination of metabolites,including the following:N2 acetyl aspartate(NAA),choline(Cho),creatine plus phosphocreatine (Cr+PCr),inositol(MI),lactate(Lac)and the Valley glutamine and glutamate complex(Glu/Gln).NAA is a neuronal marker within,at 2.0ppm Department,in full-term newborn is the second-highest peak,after Cho peak with age after birth, growth and mature neurons,NAA peak gradually increased,6 months to NAA has risen to the most significant peaks.Cho peak,including free choline,phosphocholine and phosphatidylcholine,involved in phospholipid metabolism.Normal full-term newborns peak Cho peak at 3.2ppm,the quantitative study found that Cho content in neonatal brain than adults,a few months after birth as to accelerate the completion of myelin,Cho content started to decline.Cr reflect the organization's potential energy, relative stability in the HIE,故常as a reference for other metabolites.Lac is the end product of glycolysis,is located at 1.33ppm Department,which prompted the emergence of aerobic respiration is no longer valid,and the normal low level of neonatal Lac peak.Gln/Glu at 2.3～2.5ppm spectral range,was more than saw the two difficult to separate the complexes referred to as Glx.MRS to early detection of neonatal hypoxic-ischemic brain damage,acute 6h after hypoxia-ischemia can be in the basal ganglia,thalamus and bilateral prefrontal white matter detected elevated Lac peak.A large number of research shows that children with HIE were significantly different from normal,that is,two peaks appeared in the 1,3ppm wave-like lactic acid,is due to the increase in anaerobic glycolysis,if the lactic acid content at a relatively low level,a few weeks due to local metabolism or increase the supply of oxygen,lactic acid content of the brain can gradually return to normal levels;if the lactic acid content of more than a certain critical value, continues to rise,causing acidosis cells and lead to irreversible neuronal damage loss, there decreased NAA(Figure 5).Results show that the Lac/Cr and NAA/Cr ratio in the HIE group and there are significant differences in the normal newborn,HIE group of Lac/Cr ratio was significantly increased,NAA/Cr ratio decreased significantly,and Lac/NAA and NAA/cho ratio can be used to Evaluation of prognosis of HIE.However,the determination of these values as a result of experiments,the methodology and the different MR field strength and are very different.Juliet that Lac/NAA ratio＞0.5,Floris that NAA/cho ratio＜0.8,then a poor prognosis,neurodevelopmental damage can occur.Li-Ying Chen of 52 cases diagnosed as HIE large sample study of children,according to Lac/Cr ratio of the size of the HIE is divided into mild,moderate,severe,mildly De ratio is 0.5 to 1.0, moderate for 1.0～2.0,severe were＞2.0 and above.The results showed that clinical follow-up with MRI and MRS is closely related to follow-up results,indicating that sub-MRS and MRI graduated degrees of HIE has important prognostic value of evaluation.Other manifestations include elevated Glx caused as a result of hypoxic-ischemic neurotransmitter into the synaptic cleft caused by the release.MI increased with tips and myelination gliosis bad.Mental development indexThe influence of various factors,mental development index of the correlation analysis showed that the mental development index were significantly correlated in the four variables,LAC and intellectual development of the most relevant index(r= 0.355 89,P Second 0.000 1),Study of the premature infants also confirmed this point.NAA is one aspect of it,the ratio of children's intellectual development and the correlation between the results,although not the same,but the correlation coefficient is generally believed that for low to moderate level,high-score of children with high levels of intellectual development,but in different age groups and inconsistent,2 months ago in the correlation is very small,between 3 months began to emerge related to the long-term after a few months in line with related significantly also.For infants and young children,the sound of early treatment of central nervous system development and maturation has a crucial role.The results of this study show that the more medical intervention,the mental development index was higher in line with related research.In addition,the Canadian Chamber of the spirit of the parents have a significant effect on movement operations.Of HIBD in the process of growth and development of children's recognition of the importance of a deeper level.Therefore,infants and young children need to attach great importance to score situation HIBD period.The impact of mental development index of gestational age may be due to a terms of gestational age from infants and young children indicates that the degree of maturity at birth,especially the development of brain systems development in infants and young children as a starting point, especially in young infants on the mental development index an even greater impact.Psychomotor development indexThe role of early motor development index indicates the correlation analysis showed that significant movement-related development index are:medical intervention,early diagnosis and gestational age;sports development index of one-way ANOVA showed that the medication during pregnancy in this group show, the infant psychomotor development index is also different;results and the impact of intellectual development index similar factors.Children's movements and the control of the body so that they can flexibly adapt to the new,ever-changing environment, such as infant and child development skills to promote a variety of other basic intelligence of the development and application of the process,when the mental and motor scale points between the high positive correlation.Its clinical significance of the motor function disorders can be used as early signs of nerve injury.[Conclusions]1.MRS normal neonatal examination:Spectrum Scanning:Scanning of conventional coils T1,T2,FLAIR image;the use of a dedicated single-channel quadrature head coil,multi-voxel two-dimensional (2D-multi-voxel)point-resolved spectroscopy(PRESS)imaging sequence,TR/TE: 1000ms/144ms,frequency encoding is set to 16,the frequency encoding direction of A/P,the thickness of voxel(voxel thickness)10mm,spacing 20mm,NEX 1, FOV 18mm×18mm.T1WI or T2WI in plain pure axial position on the spectrum, spectral scanning field(VOI)size of the case may be based on disease should include the infant with bilateral basal ganglia and semi-oval center region,to avoid including the skull,scalp fat,Gas image quality,such as the impact of the organizational spectrum.Pre-positioning after the first scan,indicating semi-automatic shimming to achieve high linewidth(FWHM)98%or more to the beginning of formal spectral scanning,scan time of approximately 5 minutes.Image post-processing:the use of GE Company 3.0T magnetic resonance analysis of a random configuration package"FuncTool"automatically scan spectrum of chemical frequency chart baseline correction,the frequency of reversal,a retrospective voxel-transfer post-processing after the post-processing workstations can simultaneously access four graphics,that is,chemical shift map(ChemicalShift Image,CSI),Spectral map(Spectrum,SI),metabolic map(Metabolic Images,MI), as well as metabolic and anatomical map of the overlay map(AI+MI,referred to as"-A Solution Map")(see Figure 1).The device pre-set size of a voxel machines recommended 31.6mm.In the"metabolism-anatomical overlay map(AI+MI)"to place the two regions of interest(ROI),are located in the basal ganglia region (ROI-1),semi-oval center region(ROI-2),post-processing software automatically access to all VOI voxel location,the number of individual-endoperoxide and the spectral information(see Figure 1B,1C).In the post-processing,in accordance with the scope of choice in the"on behalf of-solution map"set from 1-4 individual Su-box integration as a region of interest(ROI)size,size of general interest to the individual by 1-4 Su-component.In the"on behalf of-solution"map to observe the distribution of metabolite concentrations,in the corresponding spectral map(SI)on regions of interest to observe the performance of the peak.At the same time, graphical analysis software automatically identify and calculate the area under the metabolite peak on behalf of its concentration,and automatic calculation of the relative metabolite ratios.In the"on behalf of-solution map"on the observation of the metabolite concentration of the pseudo-color distribution,the corresponding spectrum in the ROI map(Spectrum,SI)on the observation of the peak level of metabolites,the horizontal axis represent the chemical shifts of metabolites location, unit ppm expressed in(ppm position as shown in table 1),on behalf of the longitudinal axis of the peaks and the situation of metabolites.At the same time, graphics workstations and the analysis software automatically identify and calculate the ROI of the corresponding N-acetyl aspartate(NAA),choline(Cho),creatine(Cr), lactate(Lac)and lipid(Lip),etc.under the metabolite peak area values from the representative of the concentration of the material and automatically calculated the relative metabolite ratios.In this study,all patients in the MR and MRS data at the time of diagnosis experienced by the three images together practitioners reading piece,image post-processing and data measurement,recording the ROI of the Ch,Cr, NAA,Cr+Ch,Ch/Cr,Ch/NAA,NAA/Ch,NAA/Cr,Cr/NAA,MI,LIP,LAC value and relative metabolite ratios,at the same time record peak Lip or Lac peak in the group respectively,the number of cases.2.Performance of normal newborns MRS:5 cases of normal neonates may show NAA,Cr,Ch,towering peaks,MI peak is slightly lower,LAC,LIP measured peak or not the low,the peak of the order of high to low Ch,NAA,Cr,MI,LAC,LIP;ratio of Cr+Ch:19551.33±4210,Ch/Cr: 1.17±0.52,Ch/NAA:1.47±0.22,NAA/Ch:1.61±0.19,NAA/Cr:1.73±0.45, Cr/NAA:1.0135±0.24.The accurate measurement of in vivo effects of metabolites on the treatment and other purposes of analysis play a very important role.Measured by value and the true metabolite metabolites or different values;can not represent the actual value. Susceptible to lipid molecules such as lactic acid and the effects of giant molecules is higher than the actual value,inositol in the body due to its low content of difficult to measure or smaller than the actual value,using PRESS sequence can not effectively distinguish between N-acetyl-and other containing N-acetyl amino acid Kiki mission,such as N-acetyl-aspartate salt,N-acetyl glutamic acid and N-acetyl group,or glutamic acid/glutamine resonance frequency,so in vivo MRS able to measure the value of N-acetyl-aspartate was significantly higher than high-performance liquid chromatography measurement of the value of N-acetyl aspartate.MRS can detect specific brain metabolites in various levels,from the perspective of quantitative biochemical indicators reflect the additional changes. Biopsy is also capable of chemical substances in non-invasive detection of the only way,in many diseases and the development process,metabolic changes often early in the morphological changes,so fully understand the MRS can provide metabolic information and the pros and cons of no doubt help the early diagnosis of disease.HIBD evaluation of neonatal MRI method has many other advantages of unparalleled,and can more accurately reflect the site of brain lesions,scope,nature and the relationship with the surrounding structures,MRS can detect the specific metabolism of the brain material level,from the perspective of quantitative biochemical indices reflect more.However,a variety of imaging(DWI,PWI)will be a joint application to reveal the depth of neonatal brain injury HIBD pathologic basis of imaging can be accurate diagnosis of early lesions and the severity of the disease and to determine accurately assess the prognosis for the best rehabilitation programs have important clinical value.MRS magnetic resonance technology can predict the prognosis of children with HIBD and assessment through the comparison and found that the value of MRS metabolites can be a direct response to children with the prognosis,again based on the application of appropriate medical intervention,HIBD score reflects the value of MRS basically the same;With the popularization of magnetic resonance MRS examination,BSID and promote the wider use of MRS technology to provide early screening of patients HIBD to address the issue of its early diagnosis.And neonatal awareness,monitoring and treatment of dyskinesia of the efficacy of intervention to provide a means to observe and promote the study of the treatment and HIBD depth,and ultimately improve the quality of life of some of the crowd.