Gönül TEZEL, Mustafa AKÇAKUŞ, Nihal OYGÜR, Osman ÖZTEKİN, Salih KALAY, İsmail ÇETİNER, Sevil TURAN TURGUT

Difüzyon ağırlıklı ve konvansiyonel manyetik rezonans görüntülemenin hipoksik iskemik ansefalopatili yenidoğanlarda seyrin belirlenmesindeki etkinliğinin karşılaştırılması

Amaç: Çalışmamızda hipoksik iskemik ansefalopati Sarnat evre 2 hastalarda doğum sonrası ilk 48 saatte çekilmiş olan konvansiyonel beyin manyetik rezonans (MR) görüntülemenin ve difüzyon MR görüntülemenin nörogelişimsel ileri dönem seyri öngörmedeki değeri karşılaştırılmıştır. Gereç ve Yöntem: Akdeniz Üniversitesi Tıp Fakültesi Yenidoğan Yoğun Bakım Birimi’nde Ocak 2006 ile Ocak 2010 tarihleri arasında izlenen ve hipoksik iskemik ansefalopati tanısı alan 69 hastanın dosya kayıtları geriye dönük olarak incelendi. Sarnat Evre 2 ile uyumlu olup doğum sonrası ilk 48 saat içinde konvansiyonel beyin MR görüntüleme ve difüzyon ağırlıklı MR görüntüleme çekilen 21 hasta çalışmaya alındı. Bu olguların nörogelişimsel değerlendirmesinde Ankara Gelişimsel Tarama Envanteri kullanıldı. Genel gelişim yaşı kronolojik yaşın %30’undan düşük saptanan hastalar gelişimsel açıdan kötü, %20-30 arasındakiler sınırda, %20’nin üzeri olanlar ise iyi seyirli olarak kabul edildi. Bulgular: Ankara Gelişimsel Tarama Envanteri genel gelişim sonuçlarına göre çalışmaya alınan 21 hastanın 11’i (%52,3) iyi seyirli, 10’u (%47,7) kötü seyirli olarak değerlendirildi. Uzun dönem seyri belirleme açısından konvansiyonel beyin MR görüntülemenin Odds oranı (OR): 6,22 (0,94-41,3) iken difüzyon ağırlıklı MR görüntülemenin OR: 4,8 (0,68-33,9) idi. Konvansiyonel beyin MR görüntülemenin olumlu öngörmesi %61,5, olumsuz öngörmesi %75, duyarlılığı %80, özgüllüğü %54; difüzyon MR görüntülemenin ise olumlu öngörmesi %70, olumsuz öngörmesi %72,7, duyarlılığı %70, özgüllüğü %72,7 olarak bulundu. Çıkarımlar: İleri dönem nörolojik seyri gösterme açısından iki görüntüleme yöntemi arasında istatistiksel olarak anlamlı farklılık saptanmadı (p>0,05). Evre 2 hipoksik iskemik ansefalopati tanılı hastalarda ileri dönem nörolojik seyri belirlemede difüzyon MR görüntüleme ve konvansiyonel beyin MR görüntüleme yöntemlerinin her ikisinin de kullanılabileceği, her iki görüntüleme yönteminin biribirine üstünlüklerinin olmadığı sonucuna varıldı.

Comparison of the efficacy of diffusion-weighted magnetic resonance imaging and conventional magnetic resonance imaging in determining the prognosis in newborns with hypoxic ischemic encephalopathy

Aim: The objective of the study was to compare the conventional brain magnetic resonance imaging (MRI) and diffusion-weighted MRI performed during the first 48 postnatal hours in their relevance to predict the long-term neurodevelopmental outcome in patients with hypoxic ischemic encephalopathy Sarnat stage II. Material and Method: Medical records of 69 patients with hypoxic ischemic encephalopathy between January 2006 and January 2010 were studied retrospectively. Twenty-one patients whose data were consistent with Sarnat stage II and for whom conventional MRI and diffusionweighted MRI had been performed in the first 48 postnatal hours were included the study. Neurodevelopmental assessment of these patients was based on Ankara Developmental Screening Inventory. Patients whose overall developmental age was 30% below, within the 20-30% range and above 20% the chronologic age were classified as poor, moderate and good prognosis, respectively. Results: Based on the results of the Ankara Developmental Screening Inventory, 11 out of 21 patients (52.3%) had good and 10 (47.7%) had poor prognoses included in the study. In terms of the predictivity for long-term prognosis, the conventional brain MRI had an OR value of 6.22 (0.94-41.3), while the same value for the diffusion-weighted MRI was OR: 4.8 (0.68-33.9). Positive predictivity, negative predictivity, sensitivity, specificity of the conventional brain MRI were 61.5, 75, 80 and 54%, respectively, whilst the same values for the diffusion MRI were 70, 72.7, 70 and 72.7%, respectively. Conclusions: No statistically significant difference was noted between the two imaging methods in terms of the predictive value for long-term neurologic prognosis (p>0.05). The present study showed that both the conventional brain MRI and diffusion MRI may be used for long-term neurologic prognosis in patients with stage II HIE, with neither of the methods being superior to the other.

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