扩散张量成像在儿童痉挛性双瘫中的应用价值  

Application of Diffusion Tensor Image in Spastic Diplegia

作　　者：叶文宏[1] 张黎[1] 干芸根[2] 孙龙伟[2] 何玲[1] 

机构地区：[1]重庆医科大学附属儿童医院放射科,儿童发育疾病研究教育部重点实验室,儿童发育重大疾病国家国际科技合作基地,儿科学重庆市重点实验室,重庆400014 [2]深圳市儿童医院放射科,广东深圳518038

出　　处：《中国医学影像学杂志》2016年第11期810-814,共5页Chinese Journal of Medical Imaging

基　　金：重庆市卫计委医学科研计划面上项目(2015MSXM033);重庆医科大学附属儿童医院临床研究项目(lcyj2014-4);深圳市科技局项目(201102072)

摘　　要：目的探讨3.0T MR扩散张量成像(DTI)在痉挛性双瘫(SD)定量分析的应用价值,为临床诊断及治疗提供依据。资料与方法对43例SD患儿的DTI进行前瞻性分析,同时期收集41例健康儿童(对照组)的DTI数据,选择皮质脊髓束经过双侧大脑脚、双侧内囊后肢及胼胝体膝部、压部为感兴趣区,测量表观扩散系数(ADC)、各向异性分数(FA)、容积再现(VR);同时使用粗大运动功能分级系统(GMFCS)对SD患儿进行临床分级。结果 43例SD患儿中,按GMFCS临床分级,Ⅰ级12例,Ⅱ级17例,Ⅲ级10例,Ⅳ级3例,Ⅴ级1例。MRI检查异常率91%,DTI显示均有不同程度的白质纤维束稀疏和缺失。胼胝体压部、双侧内囊后肢、双侧大脑脚ADC值较对照组偏高,差异无统计学意义(P>0.05);其FA值、1-VR值较对照组低,差异有统计学意义(P<0.05);胼胝体膝部ADC值较对照组高,FA值和1-VR值均较对照组低,差异有统计学意义(P<0.05)。不同部位的FA值与GMFCS临床分级呈负相关(胼胝体膝部:r=-0.44,P<0.05;胼胝体压部:r=-0.39,P<0.05;右侧内囊后肢:r=-0.76,P<0.05;左侧内囊后肢:r=-0.68,P<0.05;右侧大脑脚:r=-0.66,P<0.05;左侧大脑脚:r=-0.60,P<0.05),以内囊后肢相关性明显。结论 DTI能客观地评价SD患儿白质纤维束受损的程度,为临床早期诊断、早期干预和准确评估预后提供可靠的影像信息。Purpose To explore the application of diffusion tensor imaging（DTI） in quantitative analysis of spastic diplegia, and provide objective basis for clinical diagnosis and treatment. Materials and Methods DTI data of 43 spastic diplegia cases and 41 healthy cases were collected and prospectively analyzed. Regions of interests（ROIs） were set along bilateral corticospinal tract（CST） on cerebral peduncle level, internal capsule level, as well as corpus callosum（genu and splenium）. Apparent diffusion coefficient（ADC）, fractional anisotropy（FA）, volume ratio（VR） were calculated. Gross motor function classification system（GMFCS） was applied to measure diplegia patients＇ motor function. Results According to GMFCS results, 43 diplegia cases were divided into five grades： Grade Ⅰ 12 cases, Grade Ⅱ 17 cases, Grade Ⅲ 10 cases, Grade Ⅳ 3 cases, Grade Ⅴ 1 case. The MRI positive rate was 90%, DTI showed white matter fiber tracts had different degrees of sparse or missing. The ADC values of corpus callosum splenium, internal capsule, cerebral peduncle in diplegiapatients were slightly higher than those in healthy patients, but without statistically significant difference（P0.05）; on the contrary, the same regions＇ FA values and 1- VR values in diplegia patients were significantly lower than those in healthy patients（P0.05）. Indiplegia group, the ADC values of corpus callosum genu was higher; FA values and 1- VR values in the same region were lower（P0.05 vs.control group）. In diplegia group, there was statistically negative correlation between FA values and GMFM scores, especially in the posterior limb of internal capsule（genu of corpus callosum： r=-0.44, P0.05; splenium of corpus callosum： r=-0.39, P0.05; right posterior limb of internal capsule： r=-0.76, P0.05; left posterior limb of internal capsule： r=-0.68, P0.05; right cerebral peduncle： r=-0.66, P0.05; left cerebral peduncle： r=-0.60, P0.05）. Conclusion DTI can objectively evaluate the white matter fi

关 键 词：脑性瘫痪 磁共振成像 扩散张量成像 儿童 

分 类 号：R445.2[医药卫生—影像医学与核医学] R742.3[医药卫生—诊断学]