T2WI视觉评估方法在鉴别脑室周围白质软化症患儿脑瘫分型中的价值  

Value of T2WI visual assessment method in identification of cerebral palsy types in children with periventricular leukomalacia

作　　者：黄婷婷[1] 邢威[2] 吴云虎 张岚[2] HUANG Tingting;XING Wei;WU Yunhu;ZHANG Lan(Department of Radiology,the First Affiliated Hospital of He’nan University of Chinese Medicine,Zheng zhou 450001,China;MRI Room,the First Affiliated Hospital of He’nan University of Chinese Medicine,Zheng zhou 450001,China)

机构地区：[1]河南中医药大学第一附属医院放射科,河南郑州450001 [2]河南中医药大学第一附属医院磁共振科,河南郑州450001

出　　处：《实用放射学杂志》2020年第10期1643-1646,1658,共5页Journal of Practical Radiology

基　　金：国家自然科学基金项目(81901832);河南省科技厅科技攻关项目(182102310294);河南中医药大学科研苗圃工程项目(MP2016-48)。

摘　　要：目的探讨T2 WI视觉评估方法在鉴别脑室周围白质软化症(PVL)患儿脑瘫(CP)分型中的应用价值。方法回顾性纳入诊断为PVL合并CP的患儿112例,分为痉挛型组及混合型组(痉挛型+不随意运动型)。采用T2 WI的视觉评估方法对PVL的影像学征象进行评分,单因素分析及多因素逻辑回归筛选痉挛型CP的独立预测因素。采用Bootstrap法进行内部验证,Hosmer-Lemeshow拟合优度检验评估模型的校准度,ROC曲线评价模型的预测效能。结果多因素逻辑回归分析显示侧脑室体中部高信号、内囊后肢高信号、白质体积减少、豆状核高信号为痉挛型CP的独立预测因素。AUC为0.85(95%CI 0.77~0.91),敏感度84.4%,特异度85.7%。内部验证的AUC为0.83,Hosmer-Lemeshow拟合优度检验显示预测的概率与实际发生的概率无显著差异(χ^2=0.885,P=0.927)。结论基于T2 WI视觉评估方法建立的回归模型具有良好的可行性及判别效能,可用于早期初步鉴别PVL患儿的CP分型。Objective To explore the value of T2WI visual assessment method in identification of cerebral palsy(CP)types in children with periventricular leukomalacia(PVL).Methods A total of 112 children diagnosed as PVL with CP were retrospectively recruited in this study.They were divided into spastic and mixed group(spastic+dyskinetic).T2WI visual assessment method was used to assess MR signs of PVL.Univariate analysis and multivariate Logistic regression were used to screen the independent risk factors of spastic CP.The Bootstrap method was used to internal verification,Hosmer-Lemeshow goodness-of-fit test and the ROC curve were used to evaluate the calibration and discriminant performance of the model.Results Multivariate Logistic regression analysis showed that the independent predictors of spastic CP were hyperintensity in the middle of the lateral ventricle,hyperintensity in posterior limb of internal capsule,white matter volume reduction and hyperintensity in lenticular nucleus.The AUC was 0.85(95%CI 0.77-0.91),the sensitivity was 84.4% and specificity was 85.7%.The AUC of internal validation was 0.83.Hosmer-Lemeshow goodness-of-fit test showed that there was no significant difference between the predicted and the actual probability(χ^2=0.885,P=0.927).Conclusion The regression model based on T2WI visual assessment method has good feasibility and discriminant performance,which can be used to early identify CP types in children with PVL.

关 键 词：脑室周围白质软化症 脑瘫 磁共振成像 

分 类 号：R742[医药卫生—神经病学与精神病学] R748[医药卫生—临床医学]