儿童无骨折脱位型脊髓损伤特异性脑白质纤维束改变-基于白质骨架的弥散定量分析

Specific changes of white matter fiber bundles in children with spinal cord injury without fracture and dislocation:tract-based spatial statistics

目的 探讨儿童无骨折脱位型脊髓损伤(SCIWOFD)患者脑白质纤维束的特异性改变。方法 选取25例儿童SCIWOFD患者(SCIWOFD组)及27例年龄、性别相匹配的正常发育儿童(对照组)的弥散张量成像(DTI)数据,利用基于白质纤维骨架的空间统计学方法(TBSS)分析两组之间脑白质纤维束的差异,并进一步量化分析儿童SCIWOFD患者脑白质纤维束改变与临床指标之间的相关性,最后采用受试者工作特征曲线(ROC)分析,计算利用TBSS进行儿童SCIWOFD诊断的敏感性和特异性。结果 与HCs相比,儿童SCIWOFD患者右侧上纵束、左侧胼胝体压部和右侧内囊后肢的各向异性分数(FA)显著增加,平均扩散率(MD)、纵向弥散率(RD)显著减低,未发现DTI相关指标与感觉运动评分、患者年龄、病程之间的显著相关性。在使用右侧上纵束的FA值作为两组样本的分类指标时,其曲线下面积(AUC)达到了0.903。结论 儿童SCIWOFD患者存在显著的脑白质纤维束改变,同时TBSS作为儿童SCIWOFD筛查工具具有一定的潜力,并为未来的康复治疗提供了新视角。

Objective To investigate the specific changes of white matter fiber tracts in children with spinal cord injury with-out fracture and dislocation(SCIWOFD).Methods Diffusion tensor imaging(DTI)data were obtained from 25 children with SCIWOFD and 27 age-and gender-matched healthy controls(HCs).Tract-based spatial statistics(TBSS)was used to analyze the differences of white matter fiber tracts between the two groups,the correlation between white matter fiber bundle changes and clinical indicators in children with SCIWOFD was further quantitatively analyzed.Finally,receiver operating characteristic curve(ROC)analysis was used to calculate the sensitivity and specificity of TBSS in the diagnosis of children with SCIWOFD.Re-sults Compared with HCs,children with SCIWOFD showed significantly increased fractional anisotropy(FA)in the right supe-rior longitudinal fasciculus,left splenium of the corpus callosum,and right posterior limb of the internal capsule,as well as sig-nificantly decreased mean diffusivity(MD)and radial diffusivity(RD).No significant correlations were found between DTI-related indicators and sensory motor scores,patient age,or disease duration.When using the FA value of the right superior longi-tudinal fasciculus as a classification indicator for the two groups,the area under the curve(AUC)value reached 0.903.Conclu-sions There are significant white matter fiber bundle changes in children with SCIWOFD,and TBSS has certain potential as a screening tool for children with SCIWOFD,which provides a new perspective for future rehabilitation treatment.