脑性瘫痪的临床与MRI表现分析

目的 探讨脑性瘫痪(脑瘫)患儿脑MRI的表现及其与脑瘫类型、出生胎龄、年龄、高危因素之间的关系。 方法 回顾性分析184例脑瘫患儿的临床与MRI表现。 结果 184例脑瘫患儿MRI异常率为88.6%,早产和足月儿组MRI异常率分别为95.9%和83.6%。痉挛型双瘫、四肢瘫、偏瘫、肌张力低下型、不随意运动型、共济失调型和混合型脑瘫MRI异常率分别为82.1%、100%、100%、80.6%、80.0%、100%和81.8%。各类型脑瘫的MRI异常表现不同:痉挛性四肢瘫的异常MRI表现广泛、弥漫的两侧脑损伤,痉挛性双瘫以脑室周围白质软化(periventricular leukomalacia,PVL)为主(56.7%),不随意运动型多有基底节区病变(75%),共济失调型均有小脑发育不良,偏瘫型多为单侧脑损伤(90%)。不同出生胎龄的MRI特点不同,早产儿脑损伤以PVL多见(71.6%);足月儿脑损伤表现多样性且病变广泛。在不同年龄段中,1岁以内的患儿MRI异常率最高(93.6%),头颅MRI异常率随着年龄增长逐渐降低。高危因素中MRI异常率较高的依次是:出生低体重、早产、缺氧窒息。 结论 MRI 影像改变与脑瘫类型、胎龄、年龄、高危因素密切相关。

Clinical and magnetic resonance imaging features findings of cerebral palsy

Objective To investigate the relationship between the brain MRI and cerebral palsy (CP) types,gestational age,age and risky factors. Method All the 184 hospitalized CP cases were examined neurologically and their perinatal history were reviewed. Results MRI abnormalities were found in 163 of the 184 cases and abnormal rates of spastic diplegia,tetraplegia,hemiplegia,athetosis,hypotonia,ataxia and mixed were 82.1%,100%,100%,80.0%,80.6%,100% and 81.8%,respectively.Spastic tetraplegia was associated with extensive,bilateral,diffuse brain damage.38 of 55(69.1%) children with spastic diplegia had significant periventricular leukomalacia(PVL).Of the 20 children with hemiplegia,18 had unilateral lesions on neuroimaging.In different age groups,children less than 1 year of age had the highest rate of MRI abnormalities (93.6%),brain MRI abnormality rate decreased gradually with age.Risky factors in the higher rate of MRI abnormalities were:low birth weight,prematurity and hypoxia asphyxia. Conclusion MRI changes are closely related to CP types,gestational age,age and risky factors.