18F-FDG PET/CT脑显像在新生儿缺血缺氧性脑病诊断及治疗后评估中的临床研究

Clinical research on using 18F-FDG PET/CT brain imaging in the diagnosis of and therapeutic effect evaluation in neonatal hypoxic-ischemic encephalopathy

  • 摘要:
    目的 应用18F-FDG PET/CT脑显像测定健康新生儿及缺氧缺血性脑病(HIE)患儿的脑葡萄糖代谢水平, 探讨18F-FDG PET/CT脑显像在HIE患儿严重程度分度及治疗后评估中的作用。
    方法 研究对象包括健康新生儿10名和不同程度HIE患儿34例, 后者包括轻度16例、中度11例、重度7例, 注射18F-FDG后显像测定患儿大脑双侧感觉运动皮质区、额叶、颞叶、枕叶、丘脑、基底节、脑干及小脑区脑组织SUVmax, 观察治疗前不同程度HIE患儿各脑组织区葡萄糖代谢情况, 并与健康新生儿脑代谢情况进行比较;HIE患儿治疗后再次行18F-FDG PET/CT脑显像, 比较治疗前后HIE患儿各脑组织区SUVmax变化情况。
    结果 对于健康新生儿及不同程度HIE患儿, 丘脑、基底节、脑干及小脑葡萄糖代谢水平均普遍较大脑皮层各叶脑组织高, 而在大脑皮层脑组织中, 感觉运动皮质区代谢较高。健康新生儿组各脑组织区葡萄糖代谢水平均显著高于HIE轻、中、重度组, 不同程度HIE患儿脑葡萄糖代谢比较可见, HIE程度越重, 患儿脑各部位葡萄糖代谢水平呈现逐步降低的趋势。不同程度HIE患儿治疗后各脑组织区葡萄糖代谢情况显著高于治疗前。
    结论 18F-FDG PET/CT脑显像在HIE患儿严重程度分度及治疗后评估中具有较好的临床适用价值, 为新生儿脑损伤提供了新的方法, 其临床意义及对新生儿的辐射安全性值得进一步研究。

     

    Abstract:
    Objective Cerebral glucose metabolism was measured using 18F-FDG PET/CT in healthy full-term neonates and infants exhibiting neonatal hypoxic-ischemic encephalopathy(HIE) to investigate the role of 18F-FDG PET/CT brain imaging in HIE diagnosis and in therapeutic effect evaluation in HIE.
    Methods Ten healthy full-term neonates and thirty-four term infants exhibiting different degrees of HIE (mild, n=16; moderate, n=11; and severe, n=7) were included in this research. The SUVmax were measured to determine the cerebral glucose metabolism in various brain anatomical regions, including bilateral sensorimotor cortex, frontal lobe, temporal lobe, occipital lobe, thalamus, basal ganglia, brain stem, and cerebellum. The cerebral glucose metabolism in healthy neonates and infants exhibiting different degrees of HIE was compared. The glucose metabolism pre- and post-treatment was also assessed using 18F-FDG PET/CT and then compared with each other.
    Results Results indicated that uptake in the major brain areas was significantly higher in healthy term newborns than in the neonatal HIE patients. Moreover, patients with severer HIE demonstrated lower cerebral glucose metabolism. Cerebral glucose metabolism in patients exhibiting different degrees of HIE was also significantly higher after treatment than before treatment.
    Conclusion 18F-FDG PET/CT brain imaging demonstrated a preferable clinical applicable value in the diagnosis and therapeutic effect evaluation of HIE patients and provides a new method for treatment of neonatal brain injury. The clinical value and neonatal radiation safety of this technique warrants further investigation.

     

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