脑瘫儿童深部灰质损伤mri分级系统的临床价值比较  

Comparison of the clinical value of MRI classification system of deep gray matter injury in children with cerebral palsy

作　　者：刘衡[1,2] 王苗苗[1] 王小玗[1] 赵慧芳 吴亮 蒋昊翔[2] 刘聪聪 李贤军 金超 孙亲利[1] 马敬伟[3] 王辉[4] 杨健 

机构地区：[1]西安交通大学第一附属医院影像科,陕西西安710061 [2]西安交通大学生物医学信息工程教育部重点实验室生命科学与技术学院生物医学工程系,陕西西安710049 [3]陕西省康复医院影像科,陕西西安710049 [4]西安中医脑病医院脑病科,陕西西安710032

出　　处：《西安交通大学学报（医学版）》2018年第2期174-178,193,共6页Journal of Xi’an Jiaotong University（Medical Sciences）

基　　金：国家重点研发计划(No.2016YFC0100300);国家自然科学基金面上项目(No.81471631,81171317)2011年教育部“新世纪优秀人才支持计划”(No.NCET-11-0438);西安交通大学第-附属医院青年创新基金(No.2011YK.19)

摘　　要：目的评价脑瘫(CP)儿童缺血缺氧型(HIE)深部灰质损伤(DGMI)磁共振成像(MRI)不同分级系统的一致性及其临床意义。方法回顾性分析经MRI诊断的14例HIE型DGMI的CP儿童,所有患儿均行常规头颅MRI平扫、粗大运动功能分级(GMFCS)、手功能分级(MACS)。基于横断位、冠状位T2WI,2名影像诊断医师根据三分级法和四分级法,分别独立评价CP患儿头颅MRI图像。采用Kappa检验,分别计算不同分级方法的组内及组间一致性。将GMFCS/MACS分级与两种MRI分级分别进行Spearman相关分析。结果 2种方法的组内和组间Kappa值:三分级法组内一致性Kappa值0.873(P<0.001),组间一致性Kappa值0.873(P<0.001);四分级法组内一致性Kappa值0.901(P<0.001),组间一致性Kappa值0.611(P<0.001)。三分级法与GMFCS分级(r=0.053,P>0.05)、MACS分级(r=0.128,P>0.05)均无相关。四分级法与GMFCS分级(r=0.605,P<0.05)、MACS分级(r=0.779,P<0.05)均呈正相关。结论四分级法是一个可重复的评价CP儿童HIE型DGMI的方法,可用于初步判断粗大运动功能、手功能损伤程度。Objective To investigate the reliability of MRI classification and clinical significance of deep gray matter injury(DGMI)in children with cerebral palsy(CP).Methods We made a retrospective assessment of 14 children with gross motor function classification system(GMFCS),manual ability classification system(MACS)and MRI classification system of deep gray matter injury.Based on T2 WI,two radiologists worked independently and graded MRI pictures according to three-grading system and four-grading system.To evaluate the reliability of different grading systems,intra-observer and inter-observer agreements were tested by Kappa test.Spearman correlation analysis was performed to analyze the MRI classification system with GMFCS and MACS.Results The Kappa value of the intro-observer and inter-observe agreement of three-grading system was 0.873 and 0.873,respectively(P<0.001).The Kappavalue of the intro-observer and inter-observe agreement of four-grading system was 0.901 and 0.611(P<0.001).Three-grading system had no significant correlation with GMFCS(r=0.053,P>0.05)or MACS(r=0.128,P>0.05).Four-grading system had a significant positive correlation with GMFCS(r=0.605,P<0.05)and MACS(r=0.779,P<0.05).Conclusion In the two grading systems,four-grading system is a more repeatable approach for detecting deep gray matter,gross motor function and manual function injuries in children with cerebral palsy.

关 键 词：脑瘫 深部灰质 磁共振成像(且大运动功能分级系统 手功能分级系统 

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]