DTI成像在早期诊断脑室周围白质软化症患儿发生痉挛型脑瘫中的应用  

Application of DTI for early diagnosis of spastic cerebral palsy in children with periventricular leukomalacia

作　　者：周舟[1] 黄婷婷[1] 黄莹 邢威[1] 吴云虎 张刚[1] ZHOU Zhou;HUANG Tingting;HUANG Ying;XING Wei;WU Yunhu;ZHANG Gang(The First Affiliated Hospital of Henan University of Chinese Medicine,Zhengzhou 450000,China)

机构地区：[1]河南中医药大学第一附属医院,河南郑州450000

出　　处：《中国实用神经疾病杂志》2023年第5期540-547,共8页Chinese Journal of Practical Nervous Diseases

基　　金：国家自然科学基金项目(编号:82204933);河南省科技厅科技攻关项目(编号:182102310294);河南省卫健委国家中医药临床研究基地专项(编号:2022JDZX094);河南省中医药管理局河南省中医药研究专项课题(编号:2018ZY2003,2018ZY2088)。

摘　　要：目的探讨扩散张量成像(DTI)在早期诊断脑室周围白质软化症(PVL)患儿发生痉挛型脑瘫(CP)中的应用价值。方法前瞻性纳入河南中医药大学第一附属医院2016-12—2020-11因运动发育落后行常规MRI和DTI检查并经MRI诊断为PVL的患儿,随访至2~5岁对所有入组患儿行运动发育评估。根据CP的诊断,将患儿分为痉挛型CP组及非CP组。测量并比较2组间各感兴趣区各向异性分数(FA)及表观扩散系数(ADC)值的差异。采用偏相关分析2组间差异有统计学意义的DTI参数与粗大运动功能分级(GMFCS)之间的相关性,采用ROC曲线分析DTI参数对痉挛型CP的诊断效能。结果共纳入PVL-痉挛型CP患儿及与之年龄匹配的PVL-非CP患儿各20例。双侧皮质脊髓束、内囊后肢及胼胝体压部的FA值下降为诊断痉挛型CP的重要影像学指标,与GMFCS呈负相关,三者联合诊断的AUC为0.94(95%CI:0.87~0.99),敏感度90%,特异度90%。结论DTI能定量评估PVL患儿白质神经纤维束的损伤程度并能早期识别痉挛型CP高危风险患儿。Objective To investigate the value of the diffusion tensor imaging(DTI)in the early diagno⁃sis of spastic cerebral palsy(CP)in children with periventricular leukomalacia(PVL).Methods Children who underwent conventional MRI and DTI due to motor retardation,and were diagnosed with PVL by conventional MRI from December 2016 to November 2021 were included in our study,All children performed motor develop⁃ment assessment from the age of 2 to 5 years.According to the diagnosis of CP,all eligible children were divided into spastic CP group and non CP group.The differences of fractional anisotropy(FA)and apparent diffusion coef⁃ficient(ADC)of each region of interest between the two groups were measured and compared.Partial correlation analysis was used to analyze the relationship between DTI parameters with statistical differences and gross motor function classification system(GMFCS)levels.ROC curve was used to evaluate the diagnostic performance of DTI parameters for spastic CP.Results A total of 20 PVL children with spastic CP and 20 age-matched PVL-non CP children were included in this study.The decrease of FA values in bilateral corticospinal tract,poste⁃rior limbs of internal capsule and splenium of corpus callosum were important imaging markers of spastic CP,and negative correlation with GMFCS levels.The AUC of the combination diagnosis was 0.94(95%CI:0.87~0.99),sensitivity was 90%and specificity was 90%.Conclusion DTI could quantitatively evaluated the severity of white matter fiber injury and early identify children at high risk of spastic CP in children with PVL.

关 键 词：痉挛型脑瘫 脑室周围白质软化症 磁共振 扩散张量成像 各向异性分数 

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]