扩散张量成像评价颈总动脉交感神经网剥脱术治疗儿童脑瘫的价值

目的应用磁共振扩散张量成像(diffusion tensor imaging,DTI)及扩散张量纤维束成像(diffusion tensor tracking,DTT),探讨其对脑瘫患儿颈总动脉交感神经网剥脱术后脑白质恢复的评估价值。材料与方法对30例痉挛型单侧脑瘫患儿手术前、后进行临床评估和常规MRI、DTI检查,测量并比较术前术侧和对侧、术前和术后双侧内囊后肢及大脑脚的各向异性分数(fractional anisotropy,FA)值,并对白质纤维束进行三维重建。运用粗大运动功能分级系统(gross motor function classification system,GMFCS)评价患儿运动功能。采用配对样本t检验比较术前术侧和对侧、术前和术后脑白质不同部位FA值的差异,以Spearman相关分析不同白质纤维束DTI参量与GMFCS的相关性。结果术前术侧不同部位白质纤维束FA值均显著低于对侧,差异有统计学意义(P0.01)。术后6个月脑瘫患儿术侧不同部位白质纤维束FA值与术前相比显著增加(P0.01),粗大运动功能获得改善。术后6个月患儿对侧不同部位白质纤维束FA值与术前相比差异无统计学意义(P0.05)。患儿临床GMFCS与FA值呈负相关(P0.01),且与内囊后肢、大脑脚的相关性都较高(r=-0.933,P0.01;r=-0.873,P0.01)。结论 DTI联合DTT可用于定量评价脑瘫患儿术后脑白质的恢复情况,对辅助临床治疗和预后评估具有重要作用。

Diffusion tensor imaging to evaluate the value of treatment with cervical perivascular sympathectomy in children with cerebral palsy

Objective: To explpore the value of magnetic resonance diffusion tensor imaging (DTI) and diffusion tensor tracking (DTT), on evaluating the cerebral white matter recovery in children with cerebral palsy after cervical perivascular sympathectomy. Materials and Methods: Thirty children with hemiplegic cerebral palsy accepted clinical assessment and routine MRI and DTI examination before and after operation. The fractional anisotropy (FA) values for the regions including internal capsule and cerebral peduncle in the preoperative operation side and the opposite side, preoperative and postoperative, were measured and compared. 3D reconstruction of white matter tracts was employed. The gross motor function classification system (GMFCS) was used to evaluate the movement function of cerebral palsy in children. Paired sample t test was performed to compare the differences of FA values between the preoperative operation side and the lateral, preoperative and postoperative white matter. Spearman relativity analysis was performed to assess correlation between DTI parameters in different white matter fiber bundles and GMFCS in patients. Results:The FA values of white matter fiber bundle in different parts of the preoperative operation side were significantly lower of the preoperative contralateral, the differences were statistically significant (P<0.01). Compared to preoperative, the FA values of white matter fiber bundle in different parts of the operation side were significantly increased in the six months after surgery (P<0.01), the gross motor function had been improved. There was no statistically significant difference between the six months after surgery and the preoperative period of the FA value of white matter fiber bundles in different parts of the contralateral (P>0.05). The clinical GMFCS in the patients were negatively correlated with the FA values (P<0.01). Moreover, the relativity between the GMFCS and the FA value of internal capsule and cerebral peduncle were both higher (r=-0.933, P<0.01; r=-0.873, P<0.01). Conclusions: DTI combined with DTT can be used to quantitatively evaluate the postoperative recovery of white matter in children with cerebral palsy; it plays an important role in adjuvant clinical treatment and prognosis assessment.