磁共振弥散张量成像对偏瘫型脑瘫患儿颈总动脉交感神经网剥脱术后脑白质恢复的评价分析

Analysis on the evaluation of magnetic resonance DTI on the recovery of cerebral white matter of pediatric patients with hemiplegic cerebral palsy after common carotid artery sympathetic nerve net stripping

目的:颈总动脉交感神经网剥脱术对偏瘫型脑瘫患儿脑白质恢复的磁共振成像(MRI)弥散张量成像(DTI)评价。方法:选取在医院行颈总动脉交感神经网剥脱术的37例偏瘫型脑瘫患儿,并将其纳入病例组,另选取20名正常儿童作为健康对照组。对两组患儿进行常规MRI及DTI检查,选取内囊前肢、内囊后肢、胼胝体膝部、胼胝体压部和脑桥为感兴趣区域并应用后处理工作软件获得各向异性分数(FA)进行统计分析。结果:病例组患儿内囊前肢、内囊后肢、胼胝体膝部、胼胝体压部和脑桥感兴趣区的FA值均小于健康对照组,差异有统计学意义(t=7.851,t=7.940,t=2.126,t=3.141,t=2.552;P<0.05)。术后1个月脑瘫患儿内囊前肢、内囊后肢、胼胝体膝部、胼胝体压部及脑桥FA值与术前相比有所增加,术后6月进一步增加,手术前后比较差异有统计学意义(F=18.002,F=8.981,F=3.724,F=5.273,F=3.27;P<0.05)。结论:颈总动脉交感神经网剥脱术可以促进脑瘫患儿脑白质的恢复,使脑瘫患儿从中获益,DTI能直观显示白质纤维形态及走行,可作为评估脑瘫患儿术后脑白质恢复无创的影像学检查方法。

Objective:To analyze the evaluation of magnetic resonance diffusion tensor imaging(DTI)on the recovery of cerebral white matter of pediatric patients with hemiplegic cerebral palsy who underwent common carotid artery sympathetic nerve net stripping.Methods:A total of 37 pediatric patients with hemiplegic cerebral palsy who underwent common carotid artery sympathetic nerve net stripping were selected and were divided into case group,and 20 normal children were divided into health control group.Both two groups underwent conventional MRI and DTI examinations,and the anterior limb of internal capsule,posterior limb of internal capsule,knee of corpus callosum,compressed part of corpus callosum and pons were selected as region of interest(ROI),and the post processing software was applied to obtain fractional anisotropy(FA)for statistical analysis.Results:The FA values of the anterior limb of internal capsule,posterior limb of internal capsule,knee of corpus callosum,compressed part of corpus callosum and pons of case group were significantly less than those of health control group(t=7.851,t=7.940,t=2.126,t=3.141,t=2.552,P<0.05),respectively.Compared with the FA values before surgery,the FA values of the anterior limb of internal capsule,posterior limb of internal capsule,knee of corpus callosum,compressed part of corpus callosum and pons of pediatric patients with hemiplegic cerebral palsy increased 1 month after surgery,and they further increased 6 months after surgery,and the differences of them between before and after surgery were significant(F=18.002,F=8.981,F=3.724,F=5.273,F=3.270,P<0.05),respectively.Conclusion:Common carotid artery sympathetic nerve net stripping can promote the recovery of cerebral white matter of pediatric patients with hemiplegic cerebral palsy,which can take pediatric patients to obtain benefit from this surgery.DIT can visually display the morphology and direction of white matter fibers,which can be used as the imaging method to assess the recovery without invasion of cerebral white matter of pediatric patients with hemiplegic cerebral palsy after surgery.