完全性生长激素缺乏患儿大脑皮质形态变化的3.0T MRI研究

Morphological changes of the cerebral cortex in children with complete growth hormone deficiency:a 3.0 T MRI study

目的探讨完全性生长激素缺乏(CGHD)患儿与特发性矮小(ISS)患儿大脑结构的灰质体积、皮层表面积及皮层厚度的差异.方法回顾性队列研究.纳入2015年1月—2019年1月山东省立医院确诊的12例CGHD患儿(男8例、女4例,年龄5~14岁,生长激素刺激释放试验峰值小于5.0μg/L)与12例ISS患儿(男9例、女3例,年龄5~14岁,生长激素刺激释放试验峰值大于10.0μg/L).在首次就诊时采集患者高分辨率、高信噪比三维T1 WI MRI.利用FreeSurfer软件图像后处理方法获得两组患儿左右大脑半球及全脑灰质体积、皮层表面积与皮层厚度值,统计分析组间的差异情况.将每组患儿的上述形态学参数值分别进行平均以获得该组患儿的均值分布图.将两组患儿的测量均值进行相减,即获得两组患儿该测量均值的差异值分布图.结果CGHD患儿左、右侧大脑半球的灰质体积分别为(228.50±36.72)cm^3、(229.10±34.95)cm^3;皮层表面积分别为(737.02±140.48)cm^2、(738.68±135.26)cm2;皮层厚度分别为(2.43±0.09)mm、(2.44±0.09)mm.ISS患儿左、右侧大脑半球的灰质体积分别为(272.36±34.77)cm^3、(272.54±32.76)cm^3;皮层表面积分别为(841.88±141.75)cm^2、(839.98±135.69)cm^2;皮层厚度分别为(2.55±0.18)mm、(2.57±0.17)mm.CGHD患儿与ISS患儿的双侧半球与全脑的灰质体积(F左=17.884,F右=20.115,F全=19.009)、皮层表面积(F左=11.105,F右=11.453,F全=11.337)及皮层厚度(F左=5.907,F右=6.109,F全=6.066)的差异均有统计学意义(P值均<0.05).测量值的均值分布图与均值的差异值分布图显示两组患儿的灰质体积、皮层表面积与皮层厚度在诸多脑区存在差异.结论CGHD患儿较ISS患儿的大脑灰质体积、皮层表面积与皮层厚度均较小,这可能与其智力、运动或其它功能发育相对落后相关.

Objective To analyze morphological differences in gray matter volume,cortical surface area,and gray matter thickness in children with complete growth hormone deficiency(CGHD)and idiopathic short stature(ISS)using 3.0 T MRI and image post-processing techniques.Methods This is a retrospective cohort study.Patients attending the Shandong Provincial Hospital and who had been diagnosed with CGHD or ISS were recruited from January 2015 to January 2019.Twelve CGHD children(8 males and 4 females,5 to 14 years old,peak growth hormone<5μg/L)and 12 ISS controls(9 males and 3 females,5 to 14 years old,peak growth hormone>10μg/L)were included in this study.High-resolution,high signal-to-noise ratio three-dimensional T1 weighted MR images were collected at their first visit.The measurements of gray matter volume,cortical surface area and gray matter thickness of the left and right cerebral hemispheres and the total brain were obtained using FreeSurfer software.The significant differences between groups were statistically analyzed.The above measurements at the same region of each group were averaged to obtain the mean values.The mean values at the same region of the two groups were subtracted to obtain the differences.All the values were delineated on the color maps.Results The gray matter volumes of the left and right cerebral hemispheres of CGHD children were(228.50±36.72)cm^3 and(229.10±34.95)cm^3,respectively;the cortical surface areas of the left and right cerebral hemispheres were(737.02±140.48)cm^2 and(738.68±135.26)cm2,respectively;the cortical thickness of the left and right cerebral hemispheres was(2.43±0.09)mm and(2.44±0.09)mm,respectively.The gray matter volumes of the left and right cerebral hemispheres of ISS children were(272.36±34.77)cm^3 and(272.54±32.76)cm^3,respectively;the cortical surface areas of the left and right cerebral hemispheres were(841.88±141.75)cm^2 and(839.98±135.69)cm2,respectively;the cortical thickness of the left and right cerebral hemispheres was(2.55±0.18)mm and(2.57±0.17)mm,respectively.There were significant differences in the bilateral hemispheric and total gray matter volume(Fleft=17.884,Fright=20.115,Ftotal=19.009),cortical surface area(Fleft=11.105,Fright=11.453,Ftotal=11.337)and gray matter thickness(Fleft=5.907,Fright=6.109,Ftotal=6.066)between CGHD and ISS children(all P values<0.05).The mean distribution map and the difference distribution map showed that the volume of gray matter,cortical surface area and cortical thickness of the two groups were different in many brain regions.Conclusions Compared with ISS children,CGHD children have smaller gray matter volume,cortical surface area,and gray matter thickness,which may be related to their relatively slower development in intelligence,motor performance,or other functions.