磁共振弥散张量成像技术下痉挛型脑瘫儿白质纤维束各向异性FA值及粗大运动功能的临床研究

Clinical study of white matter fiber bundle anisotropic FA value and gross motor function in spastic cerebral palsy children with magnetic resonance diffusion tensor imaging

目的探讨磁共振弥散张量成像技术下痉挛型脑瘫儿白质纤维束各向异性FA值及粗大运动功能。方法选取2014年1月～2017年10月于安徽省儿童医院确诊的3岁以下痉挛型脑瘫患儿60例为观察组,选取同期30例正常儿童为对照组,对两组进行磁共振弥散张量成像检查,测量白质纤维束各向异性FA值,GMFM量表对两组粗大运动进行评测,评估粗大运动功能与FA值关系。结果相同部位观察组FA值低于对照组,差异有统计学意义(P<0.05);观察组FA值在部位上胼胝体(CC)最高,皮质脊髓束和内囊后肢ICPL居中,内囊前肢和膝部最低;观察组两次GMFM值均低于对照组,差异有统计学意义(P<0.05);两次测量GMFM改变值观察组明显低于对照组,差异有统计学意义(P<0.05);不同部位磁共振弥散张量成像FA值与GMFM测量值呈正相关(r=0.382、0.401、0.349、0.347,P<0.05),与ICPL的相关性表现最为显著(r=0.443,P<0.05)。结论痉挛型脑瘫儿粗大运动功能障碍与白质纤维束损伤有密切关联,白质纤维束各向异性FA值能够反映运动功能状况,磁共振弥散张量成像技术可以广泛应用于临床痉挛性脑瘫运动功能评价。

Objective To study the white matter fiber bundle anisotropy FA value and gross motor function in spastic cerebral palsy children with magnetic resonance diffusion tensor imaging. Methods From January 2014 to October 2017, in Anhui Provincial Children＇s Hospital, 60 children with spastic cerebral palsy under 3 years old were selected as the observation group, 30 normal children in the same period were selected as the control group. Magnetic resonance diffusion tensor imaging examination was performed in the two groups. The white matter fibroblasts anisotropy FA values were measured. The GMFM scale was used to evaluate the gross motor function of two groups, and the relationship between gross motor function and FA values was evaluated. Results FA value at the same site in the observation group was lower than the control group, the differences were statistically significant（P〈0.05）. In the observation group, FA value of corpus callosum（CC） was the highest, the corticospinal tract and the hindlimb of internal capsule were middle,and the forelimb and knee of internal capsule were the the lowest; the GMFM values at twice in the observation group were lower than the control group, the differences were statistically significant（ P〈0.05）; the two observations of GMFM change in the observation group were significantly lower than the control group, the differences were statistically significant（ P 0. 05）; the diffusion tensor imaging FA values at different sites were positively correlated with the GMFM measurements（r = 0.382, 0.401, 0.349, 0.347, P〈0.05）, correlation with ICLP was the most significant（r =0.443, P〈0.05）. Conclusion The gross motor function in spastic cerebral palsy children is closely related to white matter fiber bundle injury. The anisotropy FA value of white matter fiber bundle can reflect the motor function status.Magnetic resonance diffusion tensor imaging technology can be widely used in clinical spastic cerebral palsy motor function evaluation.