基于T2WI的视觉评估方法在筛查脑室周围白质软化症婴幼儿白质髓鞘化发育进程中的应用价值
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摘要
目的运用基于T2WI视觉评估方法评价6～20月龄脑室周围白质软化症(periventricularleukomalacia,PVL)及对照组婴幼儿皮层下白质髓鞘化发育进程,验证该方法筛查性评价婴幼儿皮层下白质髓鞘化发育进程的应用价值。材料与方法纳入2010年11月至2017年6月间接受磁共振检查的43例PVL及78例MRI未见异常的6～20月龄婴幼儿。PVL分轻、中、重度3组。运用基于常规T2WI视觉评估皮层下白质髓鞘化发育进程的评分方法,评价并获得各组婴幼儿的白质髓鞘化分数。通过Mann-Whitney U检验,比较各组髓鞘化分数;通过线性回归及Spearman相关分析探索PVL各组、对照组全脑及各脑叶皮层下白质髓鞘化分数随龄性变化。P<0.05认为有统计学意义。结果 6～20月龄阶段,PVL轻度组仅顶叶皮层下白质髓鞘化分数与对照有统计学差异(P=0.033);除颞叶外,PVL中度组及重度组的皮层下白质髓鞘化分数与对照组均有差异(P<0.05)。Spearman相关分析结果示对照组皮层下白质髓鞘化分数与年龄的相关性高于PVL组。结论基于T2WI的视觉评估方法在筛查不同程度PVL所致的异常皮层下白质髓鞘化发育进程中,具有良好的可行性。同时,该方法可根据白质髓鞘化发育进程鉴别轻度和中重度PVL。
Objective: The purpose of this study was to assess the subcortical white matter(WM) myelination progress via T2-weighted imaging(T2WI) based visual scoring method in the infant of periventricular leukomalacia(PVL) during age of 6—20 months and validate the applicability of this scoring method in screening abnormal WM myelination progress in infant with PVL. Materials and Methods: We retrospectively recruited infant with diagnosis of PVL, and infant without abnormalities on MRI during age of 6—20 months from November 2010 to June 2017. Infant with PVL were divided into three groups: mild, moderate and severe.Subcortical WM myelination progress of infant in control group, PVL groups was assessed via the T2WI-based visual scoring method. Then myelination scores of regional and whole brain were compared between different PVL groups and control group using Mann-Whitney U test.Then linear regression and Spearman correlations were applied to assess the association between myelination score and age in the control and PVL groups. Results: In this study, the significant difference in subcortical WM myeliantion score of parietal lobe was found between mild PVL group and control group(P=0.033); and except temproal lobe, other brain lobes were observed differences in subcortical WM myeliantion score between moderate, severe PVL groups and control group. The positive linear correlations between age and the myeliantion score were found in both PVL groups and control group(P<0.05). And the correlation coefficients of control group were higher than PVL groups.Conclusions: The T2WI-based visual scoring method was useful and applicable in screening myelination progress of the moderate and severe PVL in infant aged 6—20 months in clinic.
Objective: The purpose of this study was to assess the subcortical white matter(WM) myelination progress via T2-weighted imaging(T2WI) based visual scoring method in the infant of periventricular leukomalacia(PVL) during age of 6—20 months and validate the applicability of this scoring method in screening abnormal WM myelination progress in infant with PVL. Materials and Methods: We retrospectively recruited infant with diagnosis of PVL, and infant without abnormalities on MRI during age of 6—20 months from November 2010 to June 2017. Infant with PVL were divided into three groups: mild, moderate and severe.Subcortical WM myelination progress of infant in control group, PVL groups was assessed via the T2WI-based visual scoring method. Then myelination scores of regional and whole brain were compared between different PVL groups and control group using Mann-Whitney U test.Then linear regression and Spearman correlations were applied to assess the association between myelination score and age in the control and PVL groups. Results: In this study, the significant difference in subcortical WM myeliantion score of parietal lobe was found between mild PVL group and control group(P=0.033); and except temproal lobe, other brain lobes were observed differences in subcortical WM myeliantion score between moderate, severe PVL groups and control group. The positive linear correlations between age and the myeliantion score were found in both PVL groups and control group(P<0.05). And the correlation coefficients of control group were higher than PVL groups.Conclusions: The T2WI-based visual scoring method was useful and applicable in screening myelination progress of the moderate and severe PVL in infant aged 6—20 months in clinic.
引文
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[12]Ekici B,Aydinli N,Aydin K,et al.Epilepsy in children with periventricular leukomalacia.Clin Neurol Neurosur,2013,115(10):2046-2048.
[13]Barkovich AJ,Kjos BO,Jackson DE Jr,et al.Normal maturation of the neonatal and infant brain:MR imaging at 1.5 T.Radiology,1988,166(1 Pt 1):173-180.
[14]Parazzini C,Baldoli C,Scotti G,et al.Terminal zones of myelination:MR evaluation of children aged 20-40 months.AJNR Am J Neuroradiol,2002,23(10):1669-1673.
[15]Liu C,Jin C,Jian Z,et al.Assessment of myelination progression in subcortical white matter of children aged 6-48 months using T2-weighted imaging.Neuroradiology,2018,60(12):1343-1351.
[16]Bayley N.Bayley scales of infant development.2nd ed.Psychological San Antonio:Corporation,San Antonio,1993:26-48.
[17]Augustyniak M,Mrozek-Budzyn D,Kieltyka A,et al.(2013)Stability of the mental and motor Bayley Scales of Infant Development(2nd ed.)in infants over first three years of life.Przegl Epidemiol,2013,67(3):483-486,581-584
[18]Imamura T,Ariga H,Kaneko M,et al.Neurodevelopmental outcomes of children with periventricular leukomalacia.Pediatr Neonatol,2013,54(6):367-372.
[19]Vade A,Sukhani R,Dolenga M,et al.Chloral hydrate sedation of children undergoing CT and MR imaging:safety as judged by American Academy of Pediatrics guidelines.AJR Am J Roentgenol,1995,165(4):905-909.
[20]Bracken J,Heaslip I,Ryan S.Chloral hydrate sedation in radiology:retrospective audit of reduced dose.Pediatr Radiol,2012,42(3):349-354.
[21]Dennis EL,Jahanshad N,McMahon KL,et al..Development of insula connectivity between ages 12 and 30 revealed by high angular resolution diffusion imaging.Hum Brain Mapp,2014,35(4):1790-1800.
[22]Broekman BF,Wang C,Li Y,et al.Gestational age and neonatal brain microstructure in term born infants:a birth cohort study.PloS One,2014,9(12):e115229.
[23]Dubois J,Dehaene-Lambertz G,Perrin M,et al.Asynchrony of the early maturation of white matter bundles in healthy infants:quantitative landmarks revealed noninvasively by diffusion tensor imaging.Hum Brain Mapp,2008,29(1):14-27.
[24]Dubois J,Dehaene-Lambertz G,Kulikova S,et al.The early development of brain white matter:a review of imaging studies in fetuses,newborns and infants.Neuroscience,2014,276:48-71.
[25]Volpe JJ.Cerebral white matter injury of the premature infant-more common than you think.Pediatrics,2003,112(1 Pt 1):176-180.
[26]Zubiaurre-Elorza L,Soria-Pastor S,Junque C,et al.Gray matter volume decrements in preterm children with periventricular leukomalacia.Pediatric research,2011,69(6):554-60.
[27]Choi JY,Rha DW,Park ES.The effects of the severity of periventricular leukomalacia on the neuropsychological outcomes of preterm children.JChild Neurol,2016,31(5):603-12.
[28]Baumann N,Pham-Dinh D.Biology of oligodendrocyte and myelin in the mammalian central nervous system.Physiol Rev,2001,81(2):871-927.
[29]Qiu A,Mori S,Miller MI.Diffusion tensor imaging for understanding brain development in early life.Annu Rev Psychol,2015,66:853-876.
[30]Welker KM,Patton A.Assessment of normal myelination with magnetic resonance imaging.Semin Neurol,2012,32(1):15-28.
[2]Yang J,Wang M,Liu H,et al.Imaging assessment of brain development of preterm and young infants.Chin J Pract Pediatr,2017,32(11):825-830.杨健,王苗苗,刘衡,等.早产儿与小婴儿脑发育的影像学评估.中国实用儿科杂志,2017,32(11):825-830.
[3]Miller SP,Shevell MI,Patenaude Y,et al.Neuromotor spectrum of periventricular leukomalacia in children born at term.Pediatr Neurol,2000,23(2):155-159.
[4]Lasry O,Shevell MI,Dagenais L.Cross-sectional comparison of periventricular leukomalacia in preterm and term children.Neurology,2010,74(17):1386-1391.
[5]Krageloh-Mann I,Petersen D,Hagberg G,et al.Bilateral spastic cerebral palsy MRI pathology and origin.Analysis from a representative series of 56 cases.Dev Med Child Neurol,1995,37(5):379-397.
[6]Cornette LG,Tanner SF,Ramenghi LA,et al.Magnetic resonance imaging of the infant brain:anatomical characteristics and clinical significance of punctate lesions.Arch Dis Child Fetal Neonatal Ed,2002,86(3):F171-177.
[7]Deng W,Pleasure J,Pleasure D.Progress in periventricular leukomalacia.Arch Neurol,2008,65(10):1291-1295.
[8]Wang S,Fan G,Xu K,et al.Potential of diffusion tensor MR imaging in the assessment of cognitive impairments in children with periventricular leukomalacia born preterm.Eur J Radiol,2013,82(1):158-164.
[9]Jiang HX,Sun QL,Li XJ,et al.Correlation between diffusion tensor imaging parameters and classification of gross motor function in infants of periventricular leucomalacia with cerebral palsy.Chin J Radiol,2014,48(11):947-951.蒋昊翔,孙亲利,李贤军,等.脑室周围白质软化症合并脑瘫患儿的扩散张量成像参量与粗大运动功能评分的相关性研究.中华放射学杂志,2014,48(11):947-951.
[10]Liu H,Wang MM,Wang XY,et al.Comparison of the clinical value of MRI classification system of deep gray matter injury in children with cerebral palsy.J Xi'an Jiaotong University(Med Sci),2018,39(2):174-178.刘衡,王苗苗,王小玗,等.脑瘫儿童深部灰质损伤MRI分级系统的临床价值比较.西安交通大学学报(医学版),2018,39(2):174-178.
[11]Jacobson LK,Dutton GN.Periventricular leukomalacia:an important cause of visual and ocular motility dysfunction in children.Surv Ophthalmol,2000,45(1):1-13.
[12]Ekici B,Aydinli N,Aydin K,et al.Epilepsy in children with periventricular leukomalacia.Clin Neurol Neurosur,2013,115(10):2046-2048.
[13]Barkovich AJ,Kjos BO,Jackson DE Jr,et al.Normal maturation of the neonatal and infant brain:MR imaging at 1.5 T.Radiology,1988,166(1 Pt 1):173-180.
[14]Parazzini C,Baldoli C,Scotti G,et al.Terminal zones of myelination:MR evaluation of children aged 20-40 months.AJNR Am J Neuroradiol,2002,23(10):1669-1673.
[15]Liu C,Jin C,Jian Z,et al.Assessment of myelination progression in subcortical white matter of children aged 6-48 months using T2-weighted imaging.Neuroradiology,2018,60(12):1343-1351.
[16]Bayley N.Bayley scales of infant development.2nd ed.Psychological San Antonio:Corporation,San Antonio,1993:26-48.
[17]Augustyniak M,Mrozek-Budzyn D,Kieltyka A,et al.(2013)Stability of the mental and motor Bayley Scales of Infant Development(2nd ed.)in infants over first three years of life.Przegl Epidemiol,2013,67(3):483-486,581-584
[18]Imamura T,Ariga H,Kaneko M,et al.Neurodevelopmental outcomes of children with periventricular leukomalacia.Pediatr Neonatol,2013,54(6):367-372.
[19]Vade A,Sukhani R,Dolenga M,et al.Chloral hydrate sedation of children undergoing CT and MR imaging:safety as judged by American Academy of Pediatrics guidelines.AJR Am J Roentgenol,1995,165(4):905-909.
[20]Bracken J,Heaslip I,Ryan S.Chloral hydrate sedation in radiology:retrospective audit of reduced dose.Pediatr Radiol,2012,42(3):349-354.
[21]Dennis EL,Jahanshad N,McMahon KL,et al..Development of insula connectivity between ages 12 and 30 revealed by high angular resolution diffusion imaging.Hum Brain Mapp,2014,35(4):1790-1800.
[22]Broekman BF,Wang C,Li Y,et al.Gestational age and neonatal brain microstructure in term born infants:a birth cohort study.PloS One,2014,9(12):e115229.
[23]Dubois J,Dehaene-Lambertz G,Perrin M,et al.Asynchrony of the early maturation of white matter bundles in healthy infants:quantitative landmarks revealed noninvasively by diffusion tensor imaging.Hum Brain Mapp,2008,29(1):14-27.
[24]Dubois J,Dehaene-Lambertz G,Kulikova S,et al.The early development of brain white matter:a review of imaging studies in fetuses,newborns and infants.Neuroscience,2014,276:48-71.
[25]Volpe JJ.Cerebral white matter injury of the premature infant-more common than you think.Pediatrics,2003,112(1 Pt 1):176-180.
[26]Zubiaurre-Elorza L,Soria-Pastor S,Junque C,et al.Gray matter volume decrements in preterm children with periventricular leukomalacia.Pediatric research,2011,69(6):554-60.
[27]Choi JY,Rha DW,Park ES.The effects of the severity of periventricular leukomalacia on the neuropsychological outcomes of preterm children.JChild Neurol,2016,31(5):603-12.
[28]Baumann N,Pham-Dinh D.Biology of oligodendrocyte and myelin in the mammalian central nervous system.Physiol Rev,2001,81(2):871-927.
[29]Qiu A,Mori S,Miller MI.Diffusion tensor imaging for understanding brain development in early life.Annu Rev Psychol,2015,66:853-876.
[30]Welker KM,Patton A.Assessment of normal myelination with magnetic resonance imaging.Semin Neurol,2012,32(1):15-28.