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
뇌실주위백질연화증합병뇌탄환인적확산장량성상삼량여조대운동공능평분적상관성연구
Correlation between diffusion tensor imaging parameters and classification of gross motor function in infants of periventricular leucomalacia with cerebral palsy
  • 万方数据
    中华放射学杂志 중화방사학잡지
    Chinese Journal of Radiology
    2014年 11期 947-951 ,共5页

    蒋昊翔%孙亲利%李贤军%张育苗%李彦彦%宋旸%刘黎明%张增俊%杨健

    장호상%손친리%리현군%장육묘%리언언%송양%류려명%장증준%양건

    白质软化病,脑室周围%脑性瘫痪%磁共振成像,弥散 白質軟化病,腦室週圍%腦性癱瘓%磁共振成像,瀰散
    백질연화병,뇌실주위%뇌성탄탄%자공진성상,미산
    Leukomalacia,periventricular%Cerebral palsy%Diffusion magnetic resonance imaging
    目的 运用MR扩散张量成像(DTI)联合基于纤维束骨架的空间统计学(TBSS)技术,探讨脑室周围白质软化症(PVL)脑瘫患儿脑损伤部位,分析DTI参量与临床运动功能相关性.方法 前瞻性收集22例PVL合并脑瘫患儿(患儿组)与22例年龄、性别匹配的正常儿童(对照组)行常规MRI及DTI,应用粗大运动功能分级系统(GMFCS)评价患儿运动功能,其中GMFCS Ⅰ级5例、Ⅱ级5例、Ⅲ级3例、Ⅳ级7例、Ⅴ级2例.采用独立样本均数t检验比较患儿组和对照组脑白质不同部位各向异性分数(FA)、平行扩散率(AD)及垂直扩散率(RD)值的差异,Spearman相关分析患儿组不同白质纤维束DTI参量与GMFCS相关性.结果 与对照组相比,患儿组全脑白质FA值降低,其中皮质脊髓束(患儿组:左侧0.34±0.09,右侧0.34±0.06;对照组:左侧0.38±0.04,右侧0.37±0.04)、内囊后肢(患儿组:左侧0.53±0.09,右侧0.56±0.09;对照组:左侧0.62±0.04,右侧0.63±0.04)、内囊前肢(患儿组:左侧0.31±0.05,右侧0.32±0.05;对照组:左侧0.36±0.04,右侧0.38±0.04)、丘脑后辐射(患儿组:左侧0.32±0.07,右侧0.33±0.07;对照组:左侧0.40±0.02,右侧0.40±0.03)、上纵束(患儿组:左侧0.22±0.04,右侧0.24±0.05;对照组:左侧0.28±0.02,右侧0.28±0.02)、胼胝体膝部(患儿组:0.43±0.09;对照组:0.50±0.05)、胼胝体压部(患儿组:0.42±0.14;对照组:0.55±0.05)FA值在2组间差异均有统计学意义(t值为-5.044～-2.216,P值均＜0.05).RD值(双侧内囊前肢除外)增加(t值为2.176～3.766,P值均＜0.05).AD值显著升高区域位于枕顶叶白质,主要累及双侧丘脑后辐射(左侧t=2.603,P=0.016;右侧t=2.263,P=0.034)及胼胝体压部(t=2.845,P=O.009).患儿组GMFCS与双侧皮质脊髓束、双侧内囊前后肢、双侧上纵束及胼胝体压部FA值呈负相关(r值为-0.723～-0.462,P值均＜0.05),GMFCS与双侧上纵束、右侧内囊后肢及胼胝体压部RD值、AD值呈正相关(r值为0.429～0.514,P值均＜0.05).结论 DTI联合TBSS可用于精确评估PVL患儿脑白质损伤范围,运动功能障碍与部分投射纤维(皮质脊髓束、内囊和丘脑后辐射)、连合纤维(胼胝体压部)及联络纤维(上纵束)损伤相关.
    목적 운용MR확산장량성상(DTI)연합기우섬유속골가적공간통계학(TBSS)기술,탐토뇌실주위백질연화증(PVL)뇌탄환인뇌손상부위,분석DTI삼량여림상운동공능상관성.방법 전첨성수집22례PVL합병뇌탄환인(환인조)여22례년령、성별필배적정상인동(대조조)행상규MRI급DTI,응용조대운동공능분급계통(GMFCS)평개환인운동공능,기중GMFCS Ⅰ급5례、Ⅱ급5례、Ⅲ급3례、Ⅳ급7례、Ⅴ급2례.채용독립양본균수t검험비교환인조화대조조뇌백질불동부위각향이성분수(FA)、평행확산솔(AD)급수직확산솔(RD)치적차이,Spearman상관분석환인조불동백질섬유속DTI삼량여GMFCS상관성.결과 여대조조상비,환인조전뇌백질FA치강저,기중피질척수속(환인조:좌측0.34±0.09,우측0.34±0.06;대조조:좌측0.38±0.04,우측0.37±0.04)、내낭후지(환인조:좌측0.53±0.09,우측0.56±0.09;대조조:좌측0.62±0.04,우측0.63±0.04)、내낭전지(환인조:좌측0.31±0.05,우측0.32±0.05;대조조:좌측0.36±0.04,우측0.38±0.04)、구뇌후복사(환인조:좌측0.32±0.07,우측0.33±0.07;대조조:좌측0.40±0.02,우측0.40±0.03)、상종속(환인조:좌측0.22±0.04,우측0.24±0.05;대조조:좌측0.28±0.02,우측0.28±0.02)、변지체슬부(환인조:0.43±0.09;대조조:0.50±0.05)、변지체압부(환인조:0.42±0.14;대조조:0.55±0.05)FA치재2조간차이균유통계학의의(t치위-5.044～-2.216,P치균＜0.05).RD치(쌍측내낭전지제외)증가(t치위2.176～3.766,P치균＜0.05).AD치현저승고구역위우침정협백질,주요루급쌍측구뇌후복사(좌측t=2.603,P=0.016;우측t=2.263,P=0.034)급변지체압부(t=2.845,P=O.009).환인조GMFCS여쌍측피질척수속、쌍측내낭전후지、쌍측상종속급변지체압부FA치정부상관(r치위-0.723～-0.462,P치균＜0.05),GMFCS여쌍측상종속、우측내낭후지급변지체압부RD치、AD치정정상관(r치위0.429～0.514,P치균＜0.05).결론 DTI연합TBSS가용우정학평고PVL환인뇌백질손상범위,운동공능장애여부분투사섬유(피질척수속、내낭화구뇌후복사)、련합섬유(변지체압부)급련락섬유(상종속)손상상관.
    Objective To assess white matter (WM) injury regions in infants of periventricular leukomalacia (PVL) with cerebral palsy (CP) by using diffusion tensor imaging (DTI) analyzed with tract-based spatial statistics (TBSS),and to observe the correlation between DTI parameters and clinical motor function.Methods Twenty-two patients with PVL and CP and 22 normal infants matched in terms of age and gender underwent conventional magnetic resonance imaging (MRI) and DTI.The gross motor function classification system (GMFCS) was applied to evaluate motor function in patients with PVL.The distribution of GMFCS levels was as follows:level Ⅰ,5; level Ⅱ,5; level Ⅲ,3; level Ⅳ,7; and level V,2.Two-sample t-test was performed to compare the difference in the values of fractional anisotropy (FA),axial diffusivity (AD),and radial diffusivity (RD) in WM regions between patients group and controls group.Spearman relativity analysis was performed to assess correlation between DTI parameters in different WM fiber bundles and GMFCS in patients.Results In comparison to the control group,the WM FA values in the patient group decreased.There were significant differences between two groups in bilateral corticospinal tract (CST) (patients group:left 0.34 ±0.09,right 0.34±0.06; controls group:left 0.38 ± 0.04,right 0.37 ± 0.04); bilateral posterior limb internal capsule (PLIC)(patients group:left 0.53 ±.097,right 0.56±0.09;controls group:left 0.62 ± 0.04,right 0.63 ± 0.04); bilateral anterior limb internal capsule (ALIC) (patients group:left 0.31±0.05,right 0.32±0.05; controls group:left 0.36±0.04,right0.38±0.04); bilateral posterior thalamic radiation (PTR)(patients group:left 0.32±0.07,right 0.33±0.07; controls group:left 0.40±0.02,right 0.40±0.03); bilateral superior longitudinal fasciculus (SLF)(patients group:left 0.22±0.04,right 0.24± 0.05; controls group:left 0.28±0.02,right 0.28±0.02); genu of corpus callosum(GCC)(patients group:0.43± 0.09,controls group:0.50±0.05); splenium of corpus callosum (SCC)(patients group:0.42±0.14,controls group:0.55±0.05) (t=-5.044 to-2.216,P＜0.05),while the RD values increased except for bilateral ALIC (t=2.176 to 3.766,P＜0.05).The AD values increased significantly in the parietal and occipital WM,mainly involving bilateral PTR (left t=2.603,P=0.016; right t=2.263,P=0.034) and SCC (t=2.845,P=0.009).The GMFCS in the patient group were negatively correlated with the FA values in bilateral CST,bilateral PLIC,bilateral ALIC,bilateral SLF and SCC (r=-0.723 to-0.462,P＜0.05),while positively correlated with the RD values and AD values in bilateral SLF,right PLIC and SCC (r=0.429 to 0.514,P＜0.05).Conclusions DTI combined with TBSS can be used to assess injured WM regions in infants with PVL.The motor dysfunction is associated with injury in parts of projection fibers (CST,internal capsule and PTR),commissural fibers (SC C) and association fibers (SLF).
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