桥脑扩散内生型胶质瘤行为抑制减低患儿静息态功能MRI

Children with diffuse intrinsic pontine glioma:a resting-state functional MRI study

目的:应用静息态功能磁共振成像(rs-fMRI)探讨桥脑扩散内生型胶质瘤(DIPG)行为抑制减低患儿静息态局部一致性变化情况。方法:对16例DIPG患儿(行为抑制减低组7例,无明显行为抑制减低组9例)和5例年龄、性别及教育程度相匹配的健康志愿者行rs-fMRI,每组分别进行局部一致性(ReHo)分析,运用单因素方差(ANOVA)分析及双样本t检验分别比较3组间及DIPG两组间大脑活动的变化,并对差异脑区的ReHo值与Achenbach儿童行为量表(CBCL)评分进行相关性分析。结果:三组儿童在涉及抑制控制相关脑区上出现了局部活动的显著异常[P<0.05,多重比较(AlphaSim)联合簇>89个体素],3组相比ReHo值升高的脑区有双侧眶部额中回、左侧梭状回、左侧枕中回、左侧枕上回、右侧缘上回、左侧辅助运动区及双侧罗兰迪克岛盖(bilateral Rolandic operculum)。DIPG两组间,行为抑制减低组ReHo值降低的脑区包括右额上回内侧、右侧缘上回[P<0.05,多重比较(AlphaSim)联合簇>89个体素]。DIPG组(行为抑制减低组及无行为抑制减低组)中双侧额中回、右额上回内侧、左侧梭状回的ReHo值与CBCL量表评分无显著相关(P>0.05),右侧缘上回的ReHo值与CBCL量表评分呈显著正相关(行为抑制减低组r=0.950,P=0.001;无行为抑制减低组r=0.709,P=0.033)。结论:DIPG行为抑制减低患儿出现了与抑制控制相关的脑区功能活动异常,可能由于相关脑区的"低能"、"低效"表现。本研究为脑干病变在脑功能方面的研究开辟了新思路。

Objective：To investigate regional homogeneity （ReHo） of brains in children with diffuse intrinsic pontine glioma （DIPG） using resting-state functional MRI （rs- fMRI）. Methods：Totally sixteen participants with DIPG took part in the study,including seven children with deficit in behavioral inhibition while the other nine without deficit in behaviorai inhibition. Five healthy children with age, gender and education matched to the study group also participated as the control group. These three groups underwent rs[fMR] and the results were then converted to the regional homogeneity data. These ReHo data were further analyzed by single factor analysis of variance comparing （ANOVA） among these three groups based on the whole brain levels. ReHo results were subjected to t-test of voxel wised comparison to derive the rs fMRI brain function differences between the two DIPG groups. The correlation between ReHo values of abnormal regions found in these three groups and the scores obtained according to the Child Behavior Checklist were analyzed. Results： These three groups showed significant differences in terms of the ReHo results, with the ReHo increased ＂in several brain regions （P〈0.05, corrected with AlphaSim,clusters （89 voxels）, which included bilateral orbital medial frontal gyrus, left fusiform gyrus, left middle occipital gyrus,left superior occipital gyrus, right supramarginal gyrus,left supplementary motor area and bilat eral Rolandic operculum. These two groups with DIPG showed significant differences and the DIPG group with deficit in be- havioral inhibition had ReHo decreased in several brain regions （P〈0.05, corrected with AlphaSim, clusters ）89 voxels） , including right medial superior frontal gyrus and right supramarginal gyrus. Between the two groups with DIPG,ReHo val- ues in the regions of bilateral orbital medial frontal gyrus, right medial superior frontal gyrus and left fusiform gyrus had no significant correlation with the CBCL scores （P〈0.05）. Whereas the ReHo values of right supramarginal gyrus had a posi- tive correlation with CBCL scores （group with deficit in behavioral inhibition, r= 0. 950 ,P=0. 001 ;group without deficit in behavioral inhibition, r： 0. 709, P= 0.033）. Conclusion ： DIPG children patients with deficit in behavioral inhibition have ab normal brain activity in several brain regions associated with inhibition control, and these regions can be thought of as ＂inef- ficient＂ or ＂inability＂. Furthermore,our findings may provide new insights into the brain function that involves the brain stem diseases.