脑性瘫痪儿童的MRI特征

Magnetic resonance imaging findings in children with cerebral palsy

目的 探讨脑性瘫痪 (脑瘫 )患儿脑MRI的表现及其与出生胎龄和脑瘫类型的关系。方法 回顾性分析 10 4例脑瘫患儿的病史、临床与MRI表现。结果 早产与足月儿脑瘫类型构成显著不同 ,早产儿以痉挛性双瘫多见 (占 6 6 0 % ) ,而足月儿偏瘫和失调型高于早产儿。 10 4例脑瘫患儿MRI异常率为 84 7% ,早产和足月儿组MRI异常率差异无显著性。痉挛型双瘫、四肢瘫、偏瘫、手足徐动型和失调型脑瘫MRI异常率分别为 89 4 %、10 0 %、10 0 %、5 4 5 %和 90 0 %。 31/42例痉挛性双瘫表现为脑室周围白质软化症 (PVL) ,而以早产儿双瘫更多见 (90 % ) ;各类型脑瘫的MRI异常表现不同 ,双瘫以PVL为主 ,徐动型表现为基底节病变或PVL ,失调型绝大部分存在先天性小脑发育不全 ,偏瘫型突出表现为单侧脑损伤。出生胎龄与MRI特点有关 ,早产儿组以PVL为特征 ,见于除失调型外的其他脑瘫类型 ;足月儿脑瘫MRI异常表现变化多且病变广泛。结论 MRI有助于评价各型脑瘫的病理特点及其与出生胎龄的关系 ,对脑瘫病因的推测有帮助。

Objective To study the clinical and neurological abnormalities in children with cerebral palsy (CP) and to attempt to correlate the types of CP and the gestational age at birth with radiological abnormalities detected by magnetic resonance imaging (MRI) of the brain.Methods This is a hospital-based study, the subjects included 104 children with cerebral palsy who were hospitalized in the Qingdao Rehibilitation Center For Disabled Children. All the 104 hospitalized CP cases (47 with spastic diplegia,9 with tetraplegia,15 with hemiplegia,22 with athetosis, and 11 with ataxia) were examined neurologically and their perinatal history was reviewed. Their cranial MRI findings were studied. The association between the gestational ages, CP types, and the radiological findings were studied. Results The type distribution was significantly different between term- and preterm- infants. Spastic diplegia was the main type in preterm infants while hemiplegia and ataxia were mainly seen in term infants. MRI abnormalities were found in 88 of the 104 cases and abnormal rates of spastic diplegia,tetraplegia,hemiplegia,athetosis,and ataxia were 89.4%, 100%, 100%, 54.5% and 90.9%, respectively. There was no significant difference in abnormal rates between term and preterm groups. Thirty-one of 42 (73.8%) children with spastic diplegia had significant periventricular leukomalacia (PVL), which was more common among preterm-born children (90%). Of the 15 children with hemiplegia, 13 had unilateral lesions on neuroimaging. Spastic tetraplegia was associated with extensive, bilateral, diffuse brain damage. The abnormalities in term-born infants with athetoid cerebral palsy were mainly located in the basal ganglia region whereas the major abnormality in premature infants was PVL. Of the 11 children with ataxic cerebral palsy, 8 cases showed congenital cerebellum dysplasia on brain imaging. Conclusions Radiological abnormalities of the brain were correlated with CP types and the gestational age at birth;MRI scan was useful in revealing underlying brain abnormalities and speculating on the etiology of cerebral palsy.