豆状核白质纤维异常的磁共振表现与临床分析

Correlation of magnetic resonance imaging findings with clinical manifestation in white matter disorders of lentiform nucleus

目的研究豆状核白质纤维异常的磁共振（MRI）表现及其与临床症状的关系。方法将9例豆状核白质纤维异常患儿及与其性别、年龄相匹配的9例正常儿童作为研究对象，进行常规脑MRI平扫检查后，行脑的扩散张量成像（DTI）检查。得到表观扩散系数（ADC）图、部分各向异性（FA）图及彩色编码FA图。分别于胼胝体体部及双侧豆状核、背侧丘脑、半卵圆中心、内囊前肢、内囊膝部、内囊后肢、大脑脚水平皮质脊髓束设置感兴趣区（ROI），测定每个ROI的FA、ADC值，并分别以环池水平的桥脑及矢状位的豆状核区为ROI，作出投射纤维束图。结果9例患儿均有癫痫症状，豆状核在常规MRI上均未见异常，但ADC图、FA图显示患儿双侧豆状核呈高信号，彩色编码FA图示病变区呈红色。经脑干ROI的投射纤维束图显示形态异常3例，经矢状位豆状核ROI的白质纤维束图显示较多异常纤维束呈左右走行。9例颅脑正常儿童均未见异常。与颅脑正常儿童相比，患儿双侧豆状核、背侧丘脑FA、ADC值增高，差异有统计学意义（均P〈0．01），其余部位的FA、ADC值差异均无统计学意义（均P〉0.05）。结论豆状核白质纤维异常与患儿癫痫发作具有密切的关系。癫痫发作的患儿常规MRI未见异常时，进行DTI检查是必要的。

Objective To investigate the correlation of magnetic resonance imaging （MRI） findings with clinical manifestation in white matter disorders of lentiform nucleus. Methods Nine children with white matter disorders of lentiform nucleus and 9 normal children were recruited in the study. The age and gender were matched between the groups. Conventional plain MR scans and diffusion tensor imaging （DTI） sequence of brain were performed in all subjects by Siemens Trio 3.0T MR system. ADC maps, FA maps and color-coded FA maps were obtained. FA and ADC value of regions of interest （ROI） on cerebral structures were measured, including body of corpus callosum; lentiform neucleus; dorsal thalamus; centrum semiovale; anterior limb, genu and posterior limb of internal capsule; pyramidal tract at the level of the cerebral peduncle. Three-dimensional fiber tractography （FT） was achieved regarding pons at the level of cisterna ambiens on axial and lentiform neucleus on sagittal imaging as ROI. Results Conventional MR imaging of bilateral lentiform neucleus in 9 children with epileptic seizures showed normal, but they appeared hyperintensity on ADC and FA maps and red on color-coded FA maps. Morphological abnormality of FT was found in 3 cases via ROI of pens. FT of left-right direction increased significantly via ROI of lentiform neucleus on sagittal images. Brains Images of 9 normal children showed normal. Compared to the data of controls, FA and ADC value of bilateral lentiform neucleus and dorsal thalamus of disease group showed statistically significant difference. Conclusion There is a close relationship between white matter disorders of lentiform nucleus and epileptic seizures in children, and DTI sequence should be performed when conventional MR imaging shows normal.