脑性瘫痪患儿脑白质数量的CT图像及模糊判据分析

Computer Tomography Quantitative Analysis and Vague Criterion of Brain White Matter in Children with Cerebral Palsy

目的利用CT图像,分析脑性瘫痪患儿脑白质数量减少程度,并对脑白质数量减少进行模糊判据分析。方法选择1～3岁临床诊断为脑性瘫痪病例,根据CT检查结果筛选出未见异常、脑白质偏少、脑室旁脑白质软化(PVL)3类病例。将这3类病例,依照年龄每3个月分为一小组,每一小组随机选取6例,共分为24个小组,共144例。利用CT工作站软件测量每例患儿半卵圆层面的脑白质和大脑半球的面积并进行统计分析;根据脑白质面积与大脑半球面积的比值对脑白质减少的性质进行疾病隶属度的模糊判据。结果 1.未见异常组、脑白质偏少组和PVL组患儿脑白质面积数量的中位数依次为2 000 mm2、1 738 mm2和1 387 mm2,未见异常组与脑白质偏少组、PVL组之间的差异均有统计学意义(P<0.05,0.01);脑白质偏少组与PVL组间差异无统计学意义(P>0.05)。2.大脑半球面积的中位数分别为5 809 mm2、5 618 mm2和5 370 mm2,3组间的差异均无统计学意义(Pa>0.05)。3.脑白质数量的隶属度图显示脑白质偏少组与PVL组、未见异常组均有交集,但是与PVL组有更多交集;当脑白质与大脑半球的面积比值<0.255时,患儿属于PVL的隶属度≥0.5。结论影像科诊断医师对脑白质数量的评估较为准确;脑白质偏少可视为轻度PVL。计算半卵圆脑白质与大脑半球的面积比值并由此确认脑白质减少的隶属度对确认病情的严重程度有参考意义。

Objective To study the area of brain white matter on CT imagos of the young children with cerebral palsy and analyze the vague criterion about quality of the area of brain white matter. Methods The CT images of young children （ 1 - 3 years old） with cerebral palsy diagnosed by clinicians were collected. And they were divided into 3 groups according to CT diagnosis： the group of no abnormal finding, the group of brain white matter being less（simplified as lessened group）and the group of periventricular leukomalacia（PVL）. Every group was subdivided into 8 smaller group＇s according to the age span of every 3 months, and each smaller group contained 6 cases after random selection. So,altogether,there were 144 cases in this study. The CT software was used to measure the areas of the brain white matter and cerebral hemisphere on the same slice of semioval center and to calculate the ratio between them. Vague criterion of membership grade about quality of the area of brain white matter was analyzed based on the ratio. Results 1. The area medians of brain white matter in the group of no abnormal finding,lessened group and PVL group were as follows：2 000 mm^2 ,1 738 mm^2 and 1 387 mm^2. The discrepancies between the group of no abnormal finding and PVL group as well as lessened group had significant differences （P 〈0.05,0.01 ）. But,no significant difference existed between the PVL group and lessened group（ P 〉 0.05 ）. 2. The area medians of cerebral hemisphere in the group of no - abnormal finding, lessened group and PVL group were as follows：5 809 mm^2 ,5 618 mm^2 and 5 370 mm^2. No significant difference existed between the 3 groups （ Pa 〉 0.05 ）. 3. The picture of membership grade of areas of brain white showed： the scope in the lessened group had intersection with either of the other 2 groups. But, compared with the lessened group and the group of no -abnormal finding, there was more overlap between the lessened group and the PVL group. When the area ratio was less than 0. 255 ,the diagnosis was prone to PVL, with membership grade of PVL being equal to or greater than 0.5. Conclusions The amount of brain white matter area can be estimated reliably by the radiologists on CT images; but the diagnosis of the brain white matter being less might be replaced by the mild PVL. To calculate the ratio of the area of white matter of semioval center and cerebral hemisphere is useful to confirm the quality of the lessened brain white matter. The membership grade is of reference value to evaluate the severity of the disease.