血管周围间隙扩散张量分析方法对急性淋巴性白血病患儿脑类淋巴系统改变的探讨  

The Exploration of Glymphatic System Alteration in Pediatric Acute Lymphoblastic Leukemia Using DTI-ALPS Method

作　　者：候威锋 苏舒[1] 陈颖茜 钱龙 唐燕来 黄礼彬[3] 杨智云[1] 林丽萍[1] HOU Wei-feng;SU Shu;CHEN Ying-qian;QIAN Long;TANG Yan-lai;HUANG Li-bin;YANG Zhi-yun;LIN Li-ping(Department of Radiology,The First Affiliated Hospital of Sun Yat-sen University,Guangzhou 510080,China;MR Research,GE Healthcare,Beijing 100020,China;Department of Pediatrics,The First Affiliated Hospital of Sun Yat sen University,Guangzhou 510080,China)

机构地区：[1]中山大学附属第一医院放射科,广东广州510080 [2]GE医疗磁共振科研部,北京100020 [3]中山大学附属第一医院儿科,广东广州510080

出　　处：《中山大学学报（医学科学版）》2023年第3期456-461,共6页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：国家自然科学基金青年基金(82001439);广东省自然科学基金(2022A1515011910)。

摘　　要：【目的】类淋巴系统调节脑脊液及间质液转运,可能是中枢神经系统(CNS)白血病的早期途径之一。本研究旨在基于血管周围间隙扩散张量成像分析(DTI-ALPS),探讨临床未诊断出CNS浸润的急性淋巴细胞性白血病(ALL)患儿脑类淋巴系统的改变。【方法】前瞻性纳入ALL患儿及典型发育(TD)儿童各25例,所有被试者均行颅脑DTI检查。使用协方差分析方法评估脑水扩散系数和ALPS指数的组间差异。使用斯皮尔曼等级相关分析评估有统计学意义的组间参数与ALL患儿生物学特征相关性。【结果】与TD儿童相比,ALL患儿的Dxassoc值(PFDR校正=0.048)减少而Dzassoc值(PFDR校正=0.033)增加,因此ALPS指数(PFDR校正<0.001)减少。ALL患儿ALPS指数与临床危险等级(rs=-0.47,P=0.018)、免疫分型(rs=-0.40,P=0.046)均呈负相关。【结论】临床未诊断CNS浸润的ALL患儿存在类淋巴系统功能障碍,提示类淋巴系统可能是白血病细胞浸润CNS的早期途径之一。DTI-ALPS方法可用于评估ALL患儿脑类淋巴功能受损情况,为探索ALL患儿CNS浸润的机制和早期诊断提供了新的方法。【Objective】The glymphatic system regulates cerebral spinal fluid and interstitial fluid transport which might be one of the pathways of central nervous system(CNS)leukemia at the early stage.This study aimed to investigate the alteration of glymphatic system based on diffusion tensor image-analysis along the perivascular space(DTI-ALPS)in pediatric acute lymphoblastic leukemia(ALL)without clinically diagnosed CNS infiltration.【Methods】Twenty-five ALL and typically developing(TD)children were prospectively recruited,and all subjects underwent DTI.Group differences in brain water diffusivities and ALPS-index were evaluated using the analysis of covariance.The Spearman correlation analysis was used to evaluate the relationship between biological characteristics and significant parameters in pediatric ALL.【Results】Compared with TDs,decreased D xassoc value(P FDR-corrected=0.048)and increased D zassoc value(P FDR-corrected=0.033)were found in pediatric ALL.Hence,lower ALPS-index was found in children with ALL(P FDR-corrected<0.001).ALPS-index was negatively associated with the risk classification(r s=-0.47,P=0.018)as well as immunophenotype(r s=-0.40,P=0.046)in pediatric ALL.【Conclusions】Our results show dysfunction of the glymphatic system is present-ed in pediatric ALL without clinically diagnosed CNS infiltration,which suggests that the glymphatic system might be one of pathway in the early-stage of ALL CNS infiltration.The DTI-ALPS method can be used to evaluate the change of glymphatic system,providing a new method for exploring the underlying mechanisms and early detection of pediatric ALL CNS infiltration.

关 键 词：急性淋巴细胞性白血病 儿童 中枢神经系统 核磁共振成像 类淋巴系统 

分 类 号：R445.2[医药卫生—影像医学与核医学]