ABSTRACT
Objective:To investigate the prognostic value of texture analysis of MRI diffusion weighted imaging (DWI) for neonatal hypoglycemic encephalopathy (HE).Methods:The clinical data and MRI data of 119 patients with neonatal HE admitted to Children′s Hospital of Nanjing Medical University from July 2013 to September 2020 were retrospectively analyzed. The children were followed up to 7—8 months and scored by Bayley scales of infant and toddler development. According to the overall development index, the children were divided into three groups: normal group (≥85, group A, n=42), mild developmental retardation group (70－84, group B, n=46) and developmental retardation group (≤69, group C, n= 31). The whole brain region (except sulcus and cisterna) was delineated as region of interest (ROI) by LIFEx 3.4 software in MRI apparent diffusion coefficient images. A total of 37 parameters were calculated automatically by the software, The clinical data, including gender, gestational age, age at MRI scan, birth weight, mode of delivery, history of asphyxia at birth, maternal preeclampsia or diabetes, minimum blood glucose, duration of hypoglycemia, neonatal behavioral neurological assessment (NBNA), presence or absence of polycythemia); the texture parameters, including histogram, volume, gray level co-occurrence matrix (GLCM), gray level run length matrix (GLRLM), neighborhood gray tone difference matrix (NGTDM), gray level size zone matrix (GLSZM), in the three groups were analyzed; and the diagnostic efficacy of clinical parameters and texture parameters was analyzed. Multivariate Logistic regression was used to analyze statistically significant clinical parameters and texture parameters, and receiver operating characteristic curve (ROC) was used to evaluate the prognostic efficacy of these parameter for neonatal HE. Results:There were no significant differences in gender, gestational age, age at MRI scan, delivery mode and blood glucose minimum among the three groups ( P>0.05). There were significant differences in birth weight [(3 150±130)g, (3 020±220)g, (2 880±140)g, F=-0.31, P=0.015], history of suffocation (10 cases, 18 cases, 20 cases, P=0.001), history of maternal diabetes or preeclampsia (14 cases, 29 cases, 21 cases, P=0.002), blood glucose duration [(5.0±0.2)d, (8.0±0.4)d, (14.0±1.7)d, F=-3.09, P=0.030] and NBNA scores (32.0±3.2, 28.0±2.6, 22.0±1.9, F=-4.21, P=0.010) among three groups. There were significant differences in kurtosis and entropy of histogram (2.57±1.12, 3.66±0.98, 4.23±0.37, F=3.54, P=0.010;5.89±1.09, 7.67±2.12, 8.92±1.62, F=-4.42, P=0.020); energy, contrast and dissimilarity of GLCM (0.48±0.01, 0.36±0.02, 0.23±0.01, F=-3.12, P=0.001;2 419±21, 3 354±31, 4 313±26, F=-4.16, P=0.020;126±14, 153±23, 344±43, F=-3.50, P<0.001); long run emphasis of GLRLM (0.78±0.15, 1.12±0.12, 1.76±0.31, F=-4.13, P=0.006), run length non-uniformity and run percentage (71.7±13.9, 96.6±10.7, 104.1±13.5, F=-0.98, P=0.001;0.91±0.05, 0.84±0.21, 0.72±0.17, F=2.97, P=0.010); coarseness and busyness of NGTDM [0.09±0.01, 0.13±0.03, 0.26±0.07, F=-1.95, P=0.003;0.16(0.04, 4.14), 0.32(0.05, 9.84), 0.45(0.15, 10.14), H=-3.24, P=0.030], short-zone emphasis and short-zone high gray length emphasis of GLSZM (4.74±0.45, 3.44±1.03, 1.88±0.67, F=-3.14, P=0.040; 278 963±239, 164 607±544, 111 653±618, F=-3.84, P=0.001) among three groups. Multivariate Logistic regression showed that duration of hypoglycemia, NBNA score, energy, kurtosis, run percentage and short zone effect were independent risk factors for poor prognosis of neonatal HE ( OR=7.43, 4.09, 1.10, 2.11, 1.36, 1.68, P=0.002, 0.027, 0.001, 0.006, 0.007, 0.010, respectively). ROC curve showed that for combined hypoglycemic duration, NBNA and texture parameters, the area under the curve (AUC) was the highest (AUC=0.94, P<0.001). Conclusion:Texture analysis of the MRI diffusion weighted imaging can predict the prognosis of neonatal hypoglycemic encephalopathy at an early stage, which has better prediction efficiency when combined with clinical features.
ABSTRACT
Objective To investigate the imaging features of necrotizing pneumonia(NP)caused by mycoplasma pneumoniae in children and to review the changes of serum CGreactive protein (CRP)and plasma DGdimer,which may provide an objective and effective help for clinicians.Methods 54 children with mycoplasma pneumoniae pneumonia (MPP)infection in our hospital were studied retrospectively,including 24 cases of NP and 30 cases of nonGNP (the control group).The dynamic changes of chest imaging,serum CRP and plasma DGdimer were compared between two groups.Results Chest imaging in NP group:All cases showed consolidation and necrosis,accompanied by pulmonary cavities,pleural effusion,bronchiectasia,and thickening of the bronchial wall.Decreased enhancement areas could be found in all 24 cases by enhanced CT.The review after treatment showed that the pulmonary consolidation was absorbted or narrowed,accompanied by cavities in lung,atelectasis,and pleura thickening.The imaging of non NP group showed mainly patches and spots shadow in lung, and only a little consolidation.After treatment,the lung lesions were basically absorbed.Only a few cases had fibrotic streaks and pleural thickening.The peak values of serum CRP in group NP and non NP group were respectively 91(33－266)mg/L,37(18－189) mg/L,and the duration of the abnormity were 1 9(1 1－3 8)d and 8(4－1 9)d.The peak values of plasma DGdimer in the 2 groups were respectively 2 3 78(1 9 84－5 908)ng/mL,1 7 6(1 2－41 9)ng/mL,and the duration of the abnormity were 24(13－64)d and 3(0－10)d. There were significant differences between the 2 groups with all parameters above.Conclusion The imaging characteristics of NP caused by MP in children include consolidation,necrosis (decreased enhancement areas in consolidation),pneumothorax ,cavities ,cystic degenerations, atelectasis,bronchial wall thickening,pleural effusion and pleura thickening.The course of NP was long,and the absorption was slow. The peaks value of serum CRP and plasma DGdimer in NP group were significantly higher than those in the non NP group,and the duration was longer than that in non NP group.Therefore,the clinicians should pay more attention to CR,DGdimer and chest imaging,which may help clinicians with the diagnosis and treatment.
ABSTRACT
Objective To study the value of MRI and proton magnetic resonance spectroscopy(H 1-MRS)for neonatal hypoxic-is-chemic encephalopathy(HIE).Methods Magnetic resonance imaging (MRI)and proton magnetic resonance spectroscopy (H 1-MRS)were performed in 30 cases of full-term neonates with HIE,and 10 infant control group without evidence of birth asphyxia. Cerebral MRI and H 1-MRS were performed within 1 5 days after birth.The results of H 1-MRS such as subwave crest values of me-tabolites in lesion areas were recorded.The data were analyzed statistically.Results (1)MRI showed abnormal fetures of HIE such as diffuse cerebral edema,loss of hyperintensity in the posterior limb of the internal capsule on T1 WI,gyrus sign,diffuse parenchy-mal hemorrhage,which could predict the severity of brain damage.(2)On H 1-MRS,the ratio of Lac/Cr in HIE group was much higer than that in control group,which was statistically significant (P <0.05).The ratio of Lac/Cr showed a rising trend with clini-cal grading of HIE.The ratio of NAA/Cr and NAA/Cho were lower in HIE group than that in control group (P <0.05),which showed a trend of gradually reduce with clinical grading of HIE.The difference between ratio of Glx-α/Cr in HIE group and control group was also significantly,the moderate-severe group was much higher than the mild group and control group.There was no sig-nificant difference in the ratio of Cho/Cr between the 4 groups.Conclusion The combination of MRI and H 1-MRS can objectively re-flect brain morphology and metabolic changes of HIE,and evaluate the severity of the brain injury,and provide an effective evidence for clinical diagnosis and treatment.