MR扩散张量成像在痉挛型脑瘫诊断中的应用价值  

Application value of MR diffusion tensor imaging in the diagnosis of spastic cerebral palsy

作　　者：蒋昊翔[1,2] 宋旸[3] 齐乃新[1] 白芝兰[1] 张增俊[2] 李敏[1] 张晓娜[1] 

机构地区：[1]西安交通大学医学院第二附属医院放射科,陕西西安710004 [2]西安市儿童医院放射科 [3]西安交通大学医学院第一附属医院儿保科

出　　处：《实用放射学杂志》2014年第2期283-287,共5页Journal of Practical Radiology

基　　金：西安市科技计划项目（HM1119）.

摘　　要：目的 探讨MR扩散张量成像（diffusion tensor imaging,DTI）及纤维束示踪成像（fiber tractography,FT）在痉挛型脑瘫（cerebral palsy,CP）诊断中的应用价值.方法 21例痉挛型CP合并脑室周围白质软化症（periventricular leucomalacia,PVL）患儿与26例同龄正常儿童行颅脑常规MRI及DTI检查,测量脑桥及内囊后肢水平面皮质脊髓束、内囊前肢、丘脑后辐射、胼胝体膝部和胼胝体压部的各向异性分数（fractional anisotropy,FA）及平均扩散（mean diffusivity,MD）值,并对白质纤维束进行FT三维重建.以独立样本均数t检验进行组间比较,以Spearman相关分析DTI与CP粗大运动功能的相关性.结果 与对照组相比,病例组患儿白质纤维束FA值显著降低（P＜0.01）;丘脑后辐射、胼胝体压部及胼胝体膝部MD值显著增高（P＜0.01,P＜0.01,P＜0.05）;FT显示病变区白质纤维束明显稀疏.此外,病例组患儿粗大运动功能分级系统（gross motor function classification sys-tem,GMFCS）与FA值呈负相关（P＜0.05）,而与MD值呈正相关（P＜0.05）.GMFCS与内囊后肢水平面皮质脊髓束FA值相关程度最高（r=-0.80,P＜0.01）.结论 DTI可被用于评估脑白质纤维束损伤情况,皮质脊髓束FA值可作为痉挛型CP患儿早期监测及病情评估的敏感指标.Objective To evaluate the application values of diffusion tensor imaging （DTI） and fiber tractography（FT） in the diagnosis of spastic cerebral palsy（CP） in children（0-2years）.Methods 21 children with spastic cerebral palsy （CP） combined with periventricular leucomalacia（PVL）and 26 normal age matched children accepted the brain examination by magnetic resonance ima ging （MRI） and DTI.The fractional anisotropy （FA） and mean diffusivity （MD） values were calculated for the regions including the corticospinal tract （CST） at the level of pons and posterior limb of internal capsule （ICPL）,the anterior limb of internal capsule （ICAL）,the posterior thalamic radiation （PTR）,the genu of corpus callosum （GCC）,the splenium of corpus callosum （SCC）.3D reconstruction of white matter （WM） tracts were employed with FT.The two group t-test for independent samples was used to test the difference between two groups,Spearman relativity analysis was used to analyze the correlation between DTI and clinical motor function.Results Compared with the control group,the FA value of WM tracts in the patient group was significantly decreased（P ＜0.01）,while the MD values in PTR （P＜0.01）,SCC （P＜0.01）,and GCC （P=0.02） were significantly increased.The FT implied the substantial loss of WM tracts in injured regions.In addition,the GMFCS in the patient group were negatively correlated with the FA values （P＜0.05）,but positively correlated with the MD values （P＜0.05）.Moreover,the relativity between the GMFCS and the FA value of CST at the ICPL level was the highest（r=-0.80,P＜0.01）.Conclusion DTI could be used to assess the injury degree of WM tracts.The FA value of CST could serve as a sensitive parameter for the early detection and injury estimation of the children with spastic CP.

关 键 词：脑瘫 扩散张量成像 白质纤维束 

分 类 号：R742[医药卫生—神经病学与精神病学] R445.2[医药卫生—临床医学]