The Application Value Of Multi-mode Magnetic Resonance Imaging In The Diagnosis Of Neonatal Hypoxic-ischemic Brain Damage

Background and Objective The index of assess HIBD degree mainly depends on theclinical manifestations and clinical Apgar score currently, and lack of objectiveevaluation standard. MRI can provide highly detailed images of brain structures withoutexposing infants to ionizing radiation and associated health risks.In addition, it is theonly technique which can distinguish the presence or absence of myelin in the neonatalbrain. it is increasingly used in clinical practice as the main imaging method fordetecting neonatal brain injury and predicting neurodevelopmental outcomes,This studyaims to analysis HIBD MRI presentation features, distinguish premature and full-termneonatal HIBD types, and retrospectively compare value of different MRI techniquesand pulse sequences in HIBD lesions detection used1.5T AVantoMR.Materials and Methods1.40cases HIBD neonatal were collected.premature neonatal20cases,averagegestational age33.7w, and20cases full-term neonatal with average gestational age41.4w.21cases of male and the female19cases. All patients had varying degrees ofperinatal asphyxia,8cases of severe asphyxia, in line with the standard5cases of HIEdiagnosis. All cases were ruled out may include neonatal hyperbilirubinemia, neonatalhypoglycemia, inflammation, metabolic disease and congenital disease caused by thebrain damage. 2.all neonates underwent1.5T AVantoMR imaging within10days after birth as thefirst time scanning and imaging sequence including axial T1WI, T2WI, sagittal T1WI,FLAIR, DWI and SWI sequence.Routine clinical follow-up work of the researchobjects was done meanwhile and the same sequence scanning was taken again as returnvisit at3,6months after birth to verify the first time scan information.The statisticalsoftware SPSS19.0was used to determine whether the differences between groups (P<0.05)were significant.Intraclass correlation coefficients (ICCs) was performed toanalyze the performance of the separate pulse sequences in showing lesions of thedifferent location within different time ranges, correlation between the individualsequence assessments and the reference standard was to compare value of varioussequence in HIBD lesion detection.Results1. The HIBD lesions distribution: forty cases, the basal ganglia injury in15cases, theperiventricular white matter injury in29cases, the cortex and watershed area whitematter injury in7caces, the corpus callosum injury in15cases, the brain stem andcerebellum and/or hippocampal damage7cases.2.The full-term and premature HIBD injury differences:The cortical and watershedwhite matter area injury types mainly been observed in term neonatal includingparasagittal cortex and anterior/posterior watershed white matter injury.Theperiventricular white matter hemorrhagic injury types mainly been observed in pretermneonatal including hemorrhages inside the deep white matter and germinativematrix.The periventricular white matter ischemic injury been observed in pretermneonatal and term neonatal including periventricular deep white matter，but focus on theform is different.The basal ganglia injury types been observed in preterm neonatal andterm neonatal including lentiform nucleus, caudate nucleus,dorsal thalamus andinternal capsule ischemia injury. 3.The lesions detection value comparison of different sequence:For lesions in the basalganglia nuclear area T1WI performed best,there was no important differences inperformance between the group imaged earlier and the group imaged later. For lesionsin the periventricular white matter,the cortex and watershed white matter areas DWIperformed best, especially in the group imaged earlier.However, FLAIR performancebetter for the lesions in the periventricular white matter area and T1WI performancebetter for lesions in the cortex and watershed white matter area in the group imagedlater than DWI.Conclusion1.Multiple sequence MRI can find mild and early HIBD lesions2. HIBD MR imaging has characteristic injury types differences that vary according tothe neonates gestational ages and the degree of the severity of the asphyxia.3.Comprehensive comparison, The T1WI and DWI are best for detecting HIBD lesions.4.HIBD MRI findings are nonspecific, clinical diagnosis should be closely combinedwith clinical history.