扩散张量成像在痉挛型脑瘫诊断及脑瘫严重程度评价中的应用研究
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摘要
目的研究扩散张量成像纤维束追踪技术在评价痉挛型脑瘫患儿脑瘫严重程度中的应用价值。方法收集临床确诊为痉挛型脑瘫患者27例作为病例组,根据粗大运动功能分级系统进行分级,同时收集健康志愿者32例作为对照组,比较病例组与对照组皮质脊髓束的纤维数量(FN)及各项异性分数(FA)的差异,分析病例组皮质脊髓束FN、FA值与粗大运动功能分级系统(GMFCS)的相关性。结果病例组皮质脊髓束FA值为0. 45±0. 04,FN值为82. 39±56. 37;对照组FA值为0. 49±0. 03,FN值为212. 55±105. 06,均较对照组减低,差异有统计学意义(P <0. 05)。FA、FN值与GMFCS存在负相关性(P <0. 05)。结论 DTI纤维束追踪可用于描述纤维束完整程度,提供较常规MRI扫描更多的诊断信息; DTI可用于评估痉挛型脑瘫严重程度,FN、FA值可作为临床诊断、病情评估的敏感指标。
Objective To evaluate the application value of diffusion tensor imaging( DTI) and fiber tracking( FT) in spastic cerebral palsy in children( 6-14 years). Method 27 children with spastic cerebral palsy( CP group) and 32 normal age matched children( control group) accepted examination of conventional brain magnetic resonance imaging( MRI) and DTI. The difference of Fiber numbers( FN) and tract-based fractional anisotropy( FA) of corticospinal tract( CST) were compared between the two groups and their correlation with the gross motor function classification system( GMFCS) levels were analyzed. Result Compared with the CST of control group,the FN and FA of CP group were decreased significantly( P < 0. 05). Moreover,there were significant negative correlation between the parameters of CST in CP group with GMFCS distribution. Conclusion Provided with more diagnostic information than conventional MRI,DTI can be used to describe the integrity of white matter tracts. The FN and FA of CST can be used as sensitive parameters to diagnose and assess the severity of spastic cerebral palsy children.
Objective To evaluate the application value of diffusion tensor imaging( DTI) and fiber tracking( FT) in spastic cerebral palsy in children( 6-14 years). Method 27 children with spastic cerebral palsy( CP group) and 32 normal age matched children( control group) accepted examination of conventional brain magnetic resonance imaging( MRI) and DTI. The difference of Fiber numbers( FN) and tract-based fractional anisotropy( FA) of corticospinal tract( CST) were compared between the two groups and their correlation with the gross motor function classification system( GMFCS) levels were analyzed. Result Compared with the CST of control group,the FN and FA of CP group were decreased significantly( P < 0. 05). Moreover,there were significant negative correlation between the parameters of CST in CP group with GMFCS distribution. Conclusion Provided with more diagnostic information than conventional MRI,DTI can be used to describe the integrity of white matter tracts. The FN and FA of CST can be used as sensitive parameters to diagnose and assess the severity of spastic cerebral palsy children.
引文
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[12]蒋昊翔,宋旸,齐乃新,等. MR扩散张量成像在痉挛型脑瘫诊断中的应用价值[J].实用放射学杂志,2014,30(2):283-287.
[13]李同欢,宋赣军,毕晓燕,等.痉挛型脑瘫严重程度与磁共振弥散张量成像的相关性分析[J].中国妇幼保健,2015,30(12):1859-1861.
[2] Ho PC,Chang CH,Granlund M,et al. The relationships between capacity and performance in youths with cerebral palsy differ for GMFCS levels[J]. Pediatric Physical Therapy,2017,29(1):23-29.
[3]史惟,杨红,施炳培,等.国内外脑性瘫痪定义、临床分型及功能分级新进展[J].中国康复理论与实践,2009,15(9):801-803.
[4] Najar B,Kachroo A,Gattoo I,et al. Cerebral palsy:risk factors,comorbidities and associated MRI findings,a hospital based observational study[J]. International Journal of Contemporary Pediatrics,2015,2(2):90.
[5]杜晓红.小儿脑瘫康复护理早期干预及效果评价[J].现代诊断与治疗,2018,10:1677-1678.
[6] Rha DW,Chang WH,Kim J,et al. Comparing quantitative tractography metrics of motor and sensory pathways in children with periventricular leukomalacia and different levels of gross motor function[J]. Neuroradiology,2012,54(6):615-621.
[7] Yoshida S,Hayakawa K,Yamamoto A,et al. Quantitative diffusion tensor tractography of the motor and sensory tract in children with cerebral palsy[J]. Developmental Medicine and Child Neurology,2010,52(10):935-940.
[8] Yoshida S,Oishi K,Faria AV,et al. Diffusion tensor imaging of normal brain development[J]. Pediatric Radiology,2013,43(1):15-27.
[9]肖江喜,郭雪梅,谢晟,等.应用扩散张量成像对正常儿童脑白质发育的初步研究[J].中华放射学杂志,2005,39(12):1252-1255.
[10] Murakami A,Morimoto M,Yamada K,et al. Fiber-tracking techniques can predict the degree of neurologic impairment for periventricular leukomalacia[J]. Pediatrics,2008,122(3):500-506.
[11] Reid SM,Carlin JB,Reddihough DS. Using the gross motor function classification system to describe patterns of motor severity in cerebral palsy[J]. Developmental Medicine and Child Neurology,2011,53(11):1007-1012.
[12]蒋昊翔,宋旸,齐乃新,等. MR扩散张量成像在痉挛型脑瘫诊断中的应用价值[J].实用放射学杂志,2014,30(2):283-287.
[13]李同欢,宋赣军,毕晓燕,等.痉挛型脑瘫严重程度与磁共振弥散张量成像的相关性分析[J].中国妇幼保健,2015,30(12):1859-1861.