磁共振成像分类系统在儿童脑性瘫痪中的应用

A magnetic resonance image classification system for children with cerebral palsy

目的:探讨脑性瘫痪(CP)儿童发病高危因素、临床特点与头颅磁共振成像分类系统(MRICS)的关系。方法:从我院住院电子病历信息系统及河南省CP登记管理系统中回顾性提取自2015年3月1日至2019年10月31日在我院儿童康复科住院康复的18岁以下CP儿童病案信息,包括高危因素、头颅MRI结果以及临床特点等,并根据MRICS对其MRI结果进行分类。结果:共纳入1357例CP儿童资料,有头颅MRI结果者1112例,占比81.95%(1112/1357);其中MRI正常占比为13.49%(150/1112),异常占比为86.51%(962/1112)。在MRI异常CP儿童中,以白质损伤最多见,占比为43.97%(489/1112)。在高危因素方面,不同孕周、不同出生体重、是否多胎、是否合并新生儿缺氧缺血性脑病、新生儿期是否有脑出血CP儿童其MRI分类存在统计学差异(P<0.05);有早产/低出生体重、双胎或多胎者其MRICS多为白质损伤,新生儿期有脑出血者仅有4.49%(4/89)MRICS为正常;不同性别、不同出生方式、是否合并病理性黄疸CP儿童其MRICS无统计学差异(P>0.05)。在临床特点方面,脑瘫型别、粗大运动功能分级系统(GMFCS)分级、是否合并癫痫及语言-言语障碍CP儿童其MRI分类存在统计学差异(P<0.05),是否存在智力障碍CP儿童其MRICS无统计学差异(P>0.05)。结论:MRICS与CP儿童高危因素、临床特点具有密切联系,该分类系统有助于探讨CP发病机制及预测临床结局,建议在CP儿童临床诊疗及管理中推广、应用。

Objective To explore the relationship of risk factors and clinical features to assessments of children with cerebral palsy(CP)using a magnetic resonance imaging classification system(MRICS).Methods Medical records of CP patients under 18 years old were reviewed retrospectively.Data including high-risk factors,cranial MRI results and clinical characteristics were collected.The cranial MRI results were classified according to the MRICS.Results Of 1357 patients studied,1112(82%)had received cranial MRI scans.Among them,962(86.5%)showed MRI-identified brain abnormalities,489 in the periventricular white matter.Subjects with different weeks of gestation,birth weights,delivery times,neonatal hypoxic-ischemic encephalopathy,and neonatal cerebral hemorrhage had significantly different MRI classifications according to the system.Premature birth,low birth weight and multiple births correlated with the incidence of white matter brain injury.Only 4 of the subjects with neonatal cerebral hemorrhage were classified as having normal brain structures using the MRICS.However,gender,birth method,and pathological jaundice had no significant relationship with MRICS ratings.Significant differences in MRICS classifications were observed between patients with different CP subtypes,gross motor function scores,as well as with or without epilepsy,speech or language impairment.But degrees of mental retardation were not significantly related with MRICS classifications.Conclusion MRICS classifications relate closely with risk factors and the clinical characteristics of CP patients.The system can play an important role in finding pathogenesis and predicting clinical outcomes.It is worthy of applying and promoting in the clinic.