PVL脑瘫患儿MRI分级与粗大运动功能分级的相关性分析
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摘要
目的探讨PVL脑瘫患儿MRI分级与粗大运动功能分级(GMFCS)的相关性。方法回顾性分析76例经磁共振诊断为PVL的脑瘫患儿,所有患儿均行MRI常规扫描,并进行GMFCS分级评估。基于横轴位T_2WI/T_2Flair,正中矢状位T_2WI观察病变。由两名具有儿科影像诊断经验的医师分别独立评价PVL脑瘫患儿的磁共振图像,采用Kappa一致性检验,评价观察者间的一致性,Spearman相关分析评价PVL脑瘫患儿的MRI分级与GMFCS分级的相关性。结果本组76例PVL脑瘫患儿中,PVL分级(Ⅰ级1例,Ⅱ级63例,Ⅲ级12例),两观察者间的一致性Kappa值0.869(P<0.05);GMFCS分级(I级20例、Ⅱ级12例、Ⅲ级16例、Ⅳ级11例、Ⅴ级17例),PVL的MRI分级与GMFCS分级(r=0.605,P<0.05)呈正相关。结论 PVL的MRI分级可以重复性评价脑瘫患儿的损伤程度,可以通过常规MRI初步判断脑瘫患儿的粗大运动功能损伤程度,对临床预后进行初步预判及评估。
Objective To explore the correlation between MRI classification and gross motor function classification(GMFCS) in children with PVL cerebral palsy. Methods A retrospective analysis of 76 cases of MRI diagnosis of PVL in children with cerebral palsy was conducted, all patients underwent conventional MRI scanning, and GMFCS grading. Based on axial T_2WI/T_2Flair, median sagittal T_2WI, the lesion was obseved. Two physicians with pediatric imaging experience independently evaluated the magnetic resonance imaging of children with PVL cerebral palsy. Kappa consistency test was used to evaluate the consistency among observers, Spearman correlation analysis was used to evaluate the correlation between MRI classification and GMFCS classification in children with PVL cerebral palsy. Results Among 76 children with PVL cerebral palsy, PVL(1 case of grade Ⅰ, 63 cases of grade Ⅱ, 12 cases of grade Ⅲ), showed a consistent Kappa value of 0.869 between the two observers(P<0.05). GMFCS grading(grade 20 cases of grade Ⅰ, 12 cases of grade Ⅱ, 16 cases of grade Ⅲ, 11 cases of grade Ⅳ, 17 cases of grade Ⅴ), there was a positive correlation between PVL grading and GMFCS grading(r=0.605, P<0.05). Conclusion MRI grading of PVL can be used to evaluate the degree of injury in children with cerebral palsy repeatedly. Routine MRI can be used to evaluate the degree of gross motor function injury in children with cerebral palsy and to predict and evaluate the clinical prognosis.
Objective To explore the correlation between MRI classification and gross motor function classification(GMFCS) in children with PVL cerebral palsy. Methods A retrospective analysis of 76 cases of MRI diagnosis of PVL in children with cerebral palsy was conducted, all patients underwent conventional MRI scanning, and GMFCS grading. Based on axial T_2WI/T_2Flair, median sagittal T_2WI, the lesion was obseved. Two physicians with pediatric imaging experience independently evaluated the magnetic resonance imaging of children with PVL cerebral palsy. Kappa consistency test was used to evaluate the consistency among observers, Spearman correlation analysis was used to evaluate the correlation between MRI classification and GMFCS classification in children with PVL cerebral palsy. Results Among 76 children with PVL cerebral palsy, PVL(1 case of grade Ⅰ, 63 cases of grade Ⅱ, 12 cases of grade Ⅲ), showed a consistent Kappa value of 0.869 between the two observers(P<0.05). GMFCS grading(grade 20 cases of grade Ⅰ, 12 cases of grade Ⅱ, 16 cases of grade Ⅲ, 11 cases of grade Ⅳ, 17 cases of grade Ⅴ), there was a positive correlation between PVL grading and GMFCS grading(r=0.605, P<0.05). Conclusion MRI grading of PVL can be used to evaluate the degree of injury in children with cerebral palsy repeatedly. Routine MRI can be used to evaluate the degree of gross motor function injury in children with cerebral palsy and to predict and evaluate the clinical prognosis.
引文
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[2] Imamura T,Ariga H,Kaneko M,et al.Neurodevelopmental outcomes of children with periventricular leukomalacia [J].Pediatr Neonatol,2013,54(6):367-372.
[3] Graham HK,Rosenbaum P,Paneth N,et al.Cerebral palsy [J].Nat Rev Dis Primers,2016,2(7):15082.
[4] Krageloh MI,Helber A,Mader I,et al.Bilateral lesions of thalamus and basal ganglia:origin and outcome [J].Dev Med Child Nerol,2002,44(7):477-484.
[5] 刘衡,王苗苗,王小纡,等.脑瘫儿童深部灰质损伤MRI分级系统的临床价值比较[J].西安交通大学学报(医学版),2018,39(2):174-176.
[6] Chol JY,Chol 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(4):218-225.
[7] Krageloh-Mann I,Horber V.The role of magnetic resonance imaging in elucidating the pathogenesis of cerebral palsy:a systematic review [J].Dev Med Child Neurol,2007,49(2):144-151.
[8] Skiold B,Vollmer B,Bohm B,et al.Neonatal magnetic resonance imaging and outcome at age 30 months in extremely preterm infants [J].J Pediatr,2012,160(4):559-566.
[9] 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.
[10] De Vries LS,Van Haastert IL,Rademaker KJ,et al.Ultrasound ab normalities preceding cerebral palsy in high risk preterm infants [J].Pediatr,2004,144(6):815-820.
[11] 于荣,侯梅,孙殿荣,等.脑室周围白质软化与脑瘫病情相关性研究[J].中华物理医学与康复杂志,2010,32(12):944-946.
[12] Resch B,Resch E,Maurer Fellbaum U,et al.The whole spectrum of cystic periventricular leukomalacia of the peterm infant:results from a large consecutive case series [J].Childs Nerv Syst,2015,31(9):1527-1532.
[13] 潘志立,吕维富,闵红.常规MRI联合DWI在早产新生儿脑损伤中的早期诊断价值[J].医学影像学杂志,2018,28(10):1605-1607.