脑瘫儿童深部灰质损伤MRI分级系统的临床价值比较
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摘要
目的评价脑瘫(CP)儿童缺血缺氧型(HIE)深部灰质损伤(DGMI)磁共振成像(MRI)不同分级系统的一致性及其临床意义。方法回顾性分析经MRI诊断的14例HIE型DGMI的CP儿童,所有患儿均行常规头颅MRI平扫、粗大运动功能分级(GMFCS)、手功能分级(MACS)。基于横断位、冠状位T2WI,2名影像诊断医师根据三分级法和四分级法,分别独立评价CP患儿头颅MRI图像。采用Kappa检验,分别计算不同分级方法的组内及组间一致性。将GMFCS/MACS分级与两种MRI分级分别进行Spearman相关分析。结果 2种方法的组内和组间Kappa值:三分级法组内一致性Kappa值0.873(P<0.001),组间一致性Kappa值0.873(P<0.001);四分级法组内一致性Kappa值0.901(P<0.001),组间一致性Kappa值0.611(P<0.001)。三分级法与GMFCS分级(r=0.053,P>0.05)、MACS分级(r=0.128,P>0.05)均无相关。四分级法与GMFCS分级(r=0.605,P<0.05)、MACS分级(r=0.779,P<0.05)均呈正相关。结论四分级法是一个可重复的评价CP儿童HIE型DGMI的方法,可用于初步判断粗大运动功能、手功能损伤程度。
Objective To investigate the reliability of MRI classification and clinical significance of deep gray matter injury(DGMI)in children with cerebral palsy(CP).Methods We made a retrospective assessment of 14 children with gross motor function classification system(GMFCS),manual ability classification system(MACS)and MRI classification system of deep gray matter injury.Based on T2 WI,two radiologists worked independently and graded MRI pictures according to three-grading system and four-grading system.To evaluate the reliability of different grading systems,intra-observer and inter-observer agreements were tested by Kappa test.Spearman correlation analysis was performed to analyze the MRI classification system with GMFCS and MACS.Results The Kappa value of the intro-observer and inter-observe agreement of three-grading system was 0.873 and 0.873,respectively(P<0.001).The Kappavalue of the intro-observer and inter-observe agreement of four-grading system was 0.901 and 0.611(P<0.001).Three-grading system had no significant correlation with GMFCS(r=0.053,P>0.05)or MACS(r=0.128,P>0.05).Four-grading system had a significant positive correlation with GMFCS(r=0.605,P<0.05)and MACS(r=0.779,P<0.05).Conclusion In the two grading systems,four-grading system is a more repeatable approach for detecting deep gray matter,gross motor function and manual function injuries in children with cerebral palsy.
Objective To investigate the reliability of MRI classification and clinical significance of deep gray matter injury(DGMI)in children with cerebral palsy(CP).Methods We made a retrospective assessment of 14 children with gross motor function classification system(GMFCS),manual ability classification system(MACS)and MRI classification system of deep gray matter injury.Based on T2 WI,two radiologists worked independently and graded MRI pictures according to three-grading system and four-grading system.To evaluate the reliability of different grading systems,intra-observer and inter-observer agreements were tested by Kappa test.Spearman correlation analysis was performed to analyze the MRI classification system with GMFCS and MACS.Results The Kappa value of the intro-observer and inter-observe agreement of three-grading system was 0.873 and 0.873,respectively(P<0.001).The Kappavalue of the intro-observer and inter-observe agreement of four-grading system was 0.901 and 0.611(P<0.001).Three-grading system had no significant correlation with GMFCS(r=0.053,P>0.05)or MACS(r=0.128,P>0.05).Four-grading system had a significant positive correlation with GMFCS(r=0.605,P<0.05)and MACS(r=0.779,P<0.05).Conclusion In the two grading systems,four-grading system is a more repeatable approach for detecting deep gray matter,gross motor function and manual function injuries in children with cerebral palsy.
引文
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[18]KRAGELOH MI,HELBER A,MADER I,et al.Bilateral lesions of thalamus and basal ganglia:Origin and outcome[J].Dev Med Child Neurol,2002,44(7):477-484.
[19]OKEREAFOR A,ALLSOP J,COUNSELL SJ,et al.Patterns of brain injury in neonates exposed to perinatal sentinel events[J].Pediatrics,2008,121(5):906-914.
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[22]TWOMEY E,TWOMEY A,RYAN S,et al.MR imaging of term infants with hypoxic-ischaemic encephalopathy as a predictor of neurodevelopmental outcome and late MRI appearances[J].Pediatr Radiol,2010,40(9):1526.
[2]REID SM,DAGIA CD,DITCHFIELD MR,et al.An Australian population study of factors associated with MRI patterns in cerebral palsy[J].Dev Med Child Neurol,2014,56(2):178-184.
[3]JR HA.Neuroimaging in cerebral palsy:Patterns of brain dysgenesis and injury[J].J Child Neurol,2005,20(12):936-939.
[4]RUTHERFORD M,MALAMATENIOU C,MCGUINNESS A,et al.Magnetic resonance imaging in hypoxic-ischaemic encephalopathy[J].Early Hum Dev,2010,86(6):351-360.
[5]MANCHANDA S,PRASAD A,BARUAH BP.MRI findings in kernicterus[J].Indian J Pediatr,2013,80(2):181-182.
[6]MARTINEZ BM,DIEZ SJ,KAPELLOU O,et al.Predicting motor outcome and death in term hypoxic-ischemic encephalopathy[J].Neurology,2011,76(24):2055-2061.
[7]CHOI JY,CHOI YS,RHA DW,et al.The clinical outcomes of deep gray matter injury in children with cerebral palsy in relation with brain magnetic resonance imaging[J].Res Dev Disabil,2016,55:218-225.
[8]KRAGELOH MI,HELBER A,MADER I,et al.Bilateral lesions of thalamus and basal ganglia:Origin and outcome[J].Dev Med Child Neurol,2002,44(7):477-484.
[9]HIMMELMANN K,HORBER V,DE LCJ,et al.MRI classification system(MRICS)for children with cerebral palsy:Development,reliability,and recommendations[J].Dev Med Child Neurol,2017,59(1):57-64.
[10]李初阳,史惟,周美琴,等.脑瘫粗大运动功能分级系统修订扩展版(中文版)的信度和效度研究[J].中国康复理论与实践,2011,17(12):1112-1115.
[11]史惟,李惠,苏怡,等.中文版脑瘫患儿手功能分级系统的信度和效度研究[J].中国循证儿科杂志,2009,4(3):263-269.
[12]PLASSCHAERT VF,KETELAAR M,NIJNUIS MG,et al.Classification of manual abilities in children with cerebral palsy under 5 years of age:How reliable is the Manual Ability Classification System?[J].Clin Rehabil,2009,23(2):164-170.
[13]LANDIS JR,KOCH GG.The measurement of observer agreement for categorical data[J].Biometrics,1977,33(1):159-174.
[14]WOODWARD LJ,ANDERSON PJ,AUSTIN NC,et al.Neonatal MRI to predict neurodevelopmental outcomes in preterm infants[J].N Engl J Med,2006,355(7):685-694.
[15]KRAGELOH MI,TOFT P,LUNDING J,et al.Brain lesions in preterms:Origin,consequences and compensation[J].Acta Paediatr,1999,88(8):897-908.
[16]YOKOCHI K.Thalamic lesions revealed by MR associated with periventricular leukomalacia and clinical profiles of subjects[J].Acta Paediatr,1997,86(5):493-96.
[17]REID SM,DAGIA CD,DITCHFIELD MR,et al.Grey matter injury patterns in cerebral palsy:Associations between structural involvement on MRI and clinical outcomes[J].Dev Med Child Neurol,2015,57(12):1159-1167.
[18]KRAGELOH MI,HELBER A,MADER I,et al.Bilateral lesions of thalamus and basal ganglia:Origin and outcome[J].Dev Med Child Neurol,2002,44(7):477-484.
[19]OKEREAFOR A,ALLSOP J,COUNSELL SJ,et al.Patterns of brain injury in neonates exposed to perinatal sentinel events[J].Pediatrics,2008,121(5):906-914.
[20]MARTINEZ BM,DIEZ SJ,RUTHERFORD MA,et al.Outcomes after central grey matter injury in term perinatal hypoxic-ischaemic encephalopathy[J].Early Hum Dev,2010,86(11):675-682.
[21]WILLIAMS PA,DOU P,DUDEK FE.Epilepsy and synaptic reorganization in a perinatal rat model of hypoxia-ischemia[J].Epilepsia,2004,459(10):1210-1218.
[22]TWOMEY E,TWOMEY A,RYAN S,et al.MR imaging of term infants with hypoxic-ischaemic encephalopathy as a predictor of neurodevelopmental outcome and late MRI appearances[J].Pediatr Radiol,2010,40(9):1526.