DTI在PVL合并脑瘫患儿术后脑白质恢复中的应用价值

目的 探讨扩散张量成像(DTI)技术在脑室周围白质软化症(PVL)合并脑瘫患儿术后脑白质恢复中的应用价值.方法 收集经临床诊断为PVL合并脑瘫患儿15例作为病例组,另选相匹配的正常儿童志愿者15例作为对照组,均进行常规MRI平扫及DTI检查,并获得各向异性分数(FA)图,测量病例组治疗前后与对照组皮质脊髓束(内囊膝、内囊后肢、大脑脚及脑桥水平)、基底节区核团(尾状核、豆状核)感兴趣区的FA值差异.结果 双侧内囊膝、内囊后肢、脑桥、胼胝体压部、膝部及双侧大脑脚的FA值在病例组治疗前、后(术后1个月)与对照组间有统计学差异(P＜0.05),3组豆状核、尾状核的FA值无统计学意义.进一步两两比较,双侧内囊后肢、胼胝体压部、膝部任意2组间比较均有统计学差异,双侧内囊膝、脑桥、双侧大脑脚治疗前、后无统计学意义,双侧内囊膝、脑桥、双侧大脑脚治疗前与对照组间比较均有统计学意义(P＜0.05).结论 DTI技术可显示脑白质细微结构变化,其FA值在PVL合并脑瘫患儿术后脑白质恢复中有一定参考价值,有助于指导临床医生进一步合理治疗.

Diffusion tensor imaging to assess recovery of white matter injury in periventricular leucomalacia with cerebral palsy after surgery

Objective To discuss the value of DTI on recovery of white matter injury in periventricular leucomalacia (PVL) with cerebral palsy after surgery.Methods 15 childrens suffered from PVL and 15 age-matched normal controls with normal MRI findings and no neurological abnormalities were recruited in this study.Conventional plain MRI scans and DTI sequence of brain were preformed in all subjects.FA maps of eight selected regions,which included the corpus callosum genu,splenium of corpus callosum,bilateral anterior limb of internal capsule,bilateral posterior limb of internal capsule,bilateral optic radiation,bilateral cerebral pedunculusand superior longitudinal fasciculus were compared between two groups.Results Significant differences of FA values were observed among the three group before and after the treatment and control groups(P＜0.05).FA value of the caudate nucleus and lenticular nucleus among three group was not statistically significant difference.Further pairwise comparison,FA values of the posterior limb of internal capsul,genu of corpus callosum and splenium of corpus callosum in three groups showed statistically significant differences,there was no statistically significant difference for FA value of the genu of capsulae internae,cerebral peduncle and pons among the three group.Compared to the contralateral normal areas,FA value of the genu of capsulae internae,cerebral peduncle and pons showed statistically significant differences (P＜0.05).Conclusion Quantitative DTI may show subtle changes in the structure of white matter,which has a certain reference value of FA values of white matter in periventricular leucomalacia with cerebral palsy after surgery,and help clinicians further reasonable treatment.