Computerized White Matter and Gray Matter Extraction from MRI of Brain Image

Automated segmentation of white matter (WM) and gray matter (GM) is a very important task for detecting multiple diseases. The paper proposed a simple method for WM and GM extraction form magnetic resonance imaging (MRI) of brain. The proposed methods based on binarization, wavelet decomposition, and convexhull produce very effective results in the context of visual inspection and as well as quantifiably. It tested on three different (Transvers, Sagittal, Coronal) types of MRI of brain image and the validation of experiment indicate accurate detection and segmentation of the interesting structures or particular region of MRI of brain image.

White matter connectivity damage secondary to hippocampal and amygdala target injuries in acute limbic encephalitis Diffusion tensor image and voxel-based morphometry paired study

BACKGROUND： Limbic encephalitis is a rare syndrome that specifically affects the limbic system. Magnetic resonance imaging （MRI） has been typically used to detect brain changes in this disease. However, the mechanisms of limbic encephalitis-related white matter damage remain poorly understood. OBJECTIVE： To characterize white matter connectivity changes secondary to injuries of the limbic system in limbic encephalitis through combined application of diffusion tensor imaging （DTI） and voxel-based morphometry. DESIGN, TIME AND SETTING： A non-randomized, controlled, clinical, neuroimaging, DTI study was performed at the Department of Radiology, West China Hospital in December 2008. PARTICIPANTS： A male, 46-year-old, limbic encephalitis patient, as well as 11 age- and gender-matched healthy volunteers, were enrolled in the present study. METHODS： MRI was performed on the limbic encephalitis patient using a 3.0T MR scanner. Three-dimensional SPGR Tl-weighted images and DTI were acquired in the patient and controls. Data were analyzed using Matlab 7.0 and SPM2 software. MAIN OUTCOME MEASURES： Results from routine MRI scan with contrast enhancement of patient, as well as fractional anisotropy and mean diffusivity value map differences between patient and controls. RESULTS： Significant symmetric MRI signal intensity abnormalities were observed with routine MRI Affected bilateral hippocampi and amygdala exhibited hypointense signals in TIWI and hyperintense signals in T2 images. The DTI study revealed decreased fractional anisotropy values in the bilateral alveus and fimbria of the hippocampus, bilateral internal and external capsules, white matter of the right prefrontal area, and left corona radiate in the patient compared with normal controls （P 〈 0.001） Significantly increased fractional anisotropy, mean diffusivity, or decreased mean diffusivity were not observed in the patient, compared with controls. CONCLUSION： Secondary white matter damage to the hippocampal afveus and fimbria was apparent in the limbic encephalitis patient. In addition, other white matter fiber injuries surrounded the limbic structures, which were not attributed to secondary limbic system injuries.

Diffusion tensor imaging assesses white matter injury in neonates with hypoxic-ischemic encephalopathy

With improvements in care of at-risk neonates, more and more children survive. This makes it increasingly important to assess, soon after birth, the prognosis of children with hypoxic-ischemic encephalopathy. Computed tomography, ultrasound, and conventional magnetic resonance imaging are helpful to diagnose brain injury, but cannot quantify white matter damage. In this study, ten full-term infants without brain injury and twenty-two full-term neonates with hypoxic-ischemic encephalopathy （14 moderate cases and 8 severe cases） underwent diffusion tensor imaging to assess its feasibility in evaluating white matter damage in this condition. Results demonstrated that fractional anisotropy, voxel volume, and number of fiber bundles were different in some brain areas between infants with brain injury and those without brain injury. The correlation between fractional anisotropy values and neonatal behavioral neurological assessment scores was closest in the posterior limbs of the internal capsule. We conclude that diffusion tensor imaging can quantify white matter injury in neonates with hypoxic-ischemic encephalopathy.

Correlation between white matter damage and gray matter lesions in multiple sclerosis patients

We observed the characteristics of white matter fibers and gray matter in multiple sclerosis patients, to identify changes in diffusion tensor imaging fractional anisotropy values following white matter fiber injury. We analyzed the correlation between fractional anisotropy values and changes in whole-brain gray matter volume. The participants included 20 patients with relapsing-remitting multiple sclerosis and 20 healthy volunteers as controls. All subjects underwent head magnetic resonance imaging and diffusion tensor imaging. Our results revealed that fractional anisotropy values decreased and gray matter volumes were reduced in the genu and splenium of corpus callosum, left anterior thalamic radiation, hippocampus, uncinate fasciculus, right corticospinal tract, bilateral cingulate gyri, and inferior longitudinal fasciculus in multiple sclerosis patients. Gray matter volumes were significantly different between the two groups in the right frontal lobe（superior frontal, middle frontal, precentral, and orbital gyri）, right parietal lobe（postcentral and inferior parietal gyri）, right temporal lobe（caudate nucleus）, right occipital lobe（middle occipital gyrus）, right insula, right parahippocampal gyrus, and left cingulate gyrus. The voxel sizes of atrophic gray matter positively correlated with fractional anisotropy values in white matter association fibers in the patient group. These findings suggest that white matter fiber bundles are extensively injured in multiple sclerosis patients. The main areas of gray matter atrophy in multiple sclerosis are the frontal lobe, parietal lobe, caudate nucleus, parahippocampal gyrus, and cingulate gyrus. Gray matter atrophy is strongly associated with white matter injury in multiple sclerosis patients, particularly with injury to association fibers.

Assessment of gray matter heterotopia by magnetic resonance imaging

AIM:To evaluate magnetic resonance imaging(MRI) features of different types of gray matter heterotopia.METHODS:Between June 2005 and December 2009,the medical records and MRI studies of patients with gray matter heterotopia were reviewed.The MRI morphologic findings of heterotopia were recorded along with the presence and type of associated cranial malformations.Available clinical and electrophysiological data were also recorded.RESULTS:20 patients were included in the study.Their ages ranged from 9 mo to 39 years with a mean age of 15 years.All patients suffered from epileptic seizures.According to the location of heterotopia,patients were classified into three groups:subependymal(12),subcortical(5) and band(3) heterotopia.CONCLUSION:MRI was useful in diagnosing and differentiating between various types of gray matter heterotopia.The severity of clinical manifestations of heterotopia was related to the location and pattern of heterotopia.Determination of heterotopia type and its extent is useful for management planning and predicting prognosis.

Diffusion tensor imaging pipeline measures of cerebral white matter integrity: An overview of recent advances and prospects

Cerebral small vessel disease(CSVD)is a leading cause of age-related microvascular cognitive decline,resulting in significant morbidity and decreased quality of life.Despite a progress on its key pathophysiological bases and general acceptance of key terms from neuroimaging findings as observed on the magnetic resonance imaging(MRI),key questions on CSVD remain elusive.Enhanced relationships and reliable lesion studies,such as white matter tractography using diffusion-based MRI(dMRI)are necessary in order to improve the assessment of white matter architecture and connectivity in CSVD.Diffusion tensor imaging(DTI)and tractography is an application of dMRI that provides data that can be used to non-invasively appraise the brain white matter connections via fiber tracking and enable visualization of individual patient-specific white matter fiber tracts to reflect the extent of CSVD-associated white matter damage.However,due to a lack of standardization on various sets of software or image pipeline processing utilized in this technique that driven mostly from research setting,interpreting the findings remain contentious,especially to inform an improved diagnosis and/or prognosis of CSVD for routine clinical use.In this minireview,we highlight the advances in DTI pipeline processing and the prospect of this DTI metrics as potential imaging biomarker for CSVD,even for subclinical CSVD in at-risk individuals.

Multifractal analysis of white matter structural changes on 3D magnetic resonance imaging between normal aging and early Alzheimer's disease

Applications of multifractal analysis to white matter structure changes on magnetic resonance imaging（MRI） have recently received increasing attentions. Although some progresses have been made, there is no evident study on applying multifractal analysis to evaluate the white matter structural changes on MRI for Alzheimer＇s disease（AD） research. In this paper, to explore multifractal analysis of white matter structural changes on 3D MRI volumes between normal aging and early AD, we not only extend the traditional box-counting multifractal analysis（BCMA） into the 3D case, but also propose a modified integer ratio based BCMA（IRBCMA） algorithm to compensate for the rigid division rule in BCMA. We verify multifractal characteristics in 3D white matter MRI volumes. In addition to the previously well studied multifractal feature,△α, we also demonstrated △ f as an alternative and effective multifractal feature to distinguish NC from AD subjects.Both △α and △ f are found to have strong positive correlation with the clinical MMSE scores with statistical significance.Moreover, the proposed IRBCMA can be an alternative and more accurate algorithm for 3D volume analysis. Our findings highlight the potential usefulness of multifractal analysis, which may contribute to clarify some aspects of the etiology of AD through detection of structural changes in white matter.

Compression analysis of the gray and white matter of the spinal cord

The spinal cord is composed of gray matter and white matter.It is well known that the properties of these two tissues differ considerably.Spinal diseases often present with symptoms that are caused by spinal cord compression.Understanding the mechanical properties of gray and white matter would allow us to gain a deep understanding of the injuries caused to the spinal cord and provide information on the pathological changes to these distinct tissues in several disorders.Previous studies have reported on the physical properties of gray and white matter,however,these were focused on longitudinal tension tests.Little is known about the differences between gray and white matter in terms of their response to compression.We therefore performed mechanical compression test of the gray and white matter of spinal cords harvested from cows and analyzed the differences between them in response to compression.We conducted compression testing of gray matter and white matter to detect possible differences in the collapse rate.We found that increased compression(especially more than 50%compression)resulted in more severe injuries to both the gray and white matter.The present results on the mechanical differences between gray and white matter in response to compression will be useful when interpreting findings from medical imaging in patients with spinal conditions.

3D Displacement Measurement by White Light Digital Image Analysis in Frequency Domination Area

In this paper, white light digital image analysis in frequency domination area for measuring 3D displacement is put forward. The measuring system has the characteristics of whole-field, non-contact and omni-bearing measurement. It is simple and the coherent light is not demanded. Gray images before and after deformation are recorded using two CCDs at two different shooting angles, then digitalized and analyzed by frequency domination correlation arithmetic. The 2D displacement obtained is used to formulate 3D displacement via mathematical transformation. The experimental plate is 40,mm in length, 30,mm in width and 10 mm in height. The definite displacement is given using a 3D precise adjusting frame. The 3D displacement is calculated and compared with the definite displacement. The error is 4%-11% and the availability of this method was certified. Using this method, the compression deformation of a thin-wall cylinder with 140 mm in height, 64 mm in inner diameter and 64.6,mm in external diameter, was also measured. This method is proper to measure dynamic deformation.

Age-related changes of lateral ventricular width and periventricular white matter in the human brain: a diffusion tensor imaging study

Introduction Aging is the accumulation of multidimensional deterioration of process- ing of biological, psychological, and social changes with expansion over time （Bowen and Atwood, 2004; Grady, 2012）. Aging-related changes are typically accompanied by decline in cognitive function, urinary control, sensory-motor function, and gait ability （Bradley et al., 1991; Bowen and Atwood, 2004; Hedden and Gabrieli, 2004; Grady, 2012; Moran et al., 2012）. In addition, a number of studies have suggested changes in brain structure with normal aging, such as decrease in cortical thickness or increase in ventricular width （Blatter et al., 1995; Tang et al., 1997; Uylings and de Brabander, 2002; Preul et al., 2006; Apostolova et al., 2012）. In particular, ventricular enlargement has been suggested as a structural biomarker for normal aging and progression of some illnesses, such as Alzheimer＇s disease （Blatter et al., 1995; Tang et al.,

Diffusion tensor magnetic resonance imaging in brain white matter diseases

Objective To evaluate the usefulness of diffusion tensor MR imaging in brain white matter diseases. Methods A combined conventional and diffusion tensor MRI were obtained from 10 multiple sclerosis ,10 multiple lacunar infarction,3 cysticercosis,1 angiitis ,1 morphinist and 10 healthy control volunteers. After obtaining mean diffusivity (D) and fractional anisotropy images and image coregistration, the correlations of the lesions and the white matter pathways were investigated. D and AI values were measured form four big lesions which can be seen in T2WI and compared to contralateral white matter. Also D and AI value of four different anatomic locations of normal appearing white matter regions were measured in all patients and controls. Results Whereas the lesions of infarction, cysticercosis and angiitis were in and outside the white matter pathways, all plaques of multiple sclerosis were inside the whit matter pathways. The brain white matter lesions by 1 morphinist were beside the lateral ventricle with big patchy appearance, which was partly inside white matter. For MS, D value was higher in lesions than control white matter. But for other diseases, D value could be seen higher or lower compared to healthy side. AI values were lower in all lesions. D value was higher and AI was lower in normal appearing brain white matter when comparing MS to other cases or healthy control volunteers. Conclusion Diffusion tensor MR images can determine the correlations of the lesions and brain white matter pathways. The changes of D and AI values can improve specificity in differential diagnoses though quantitatively analyzing the tissue damage in lesions and normal appearing brain white matter.

Gray Matter Volume Changes over the Whole Brain in the Bulbar-and Spinal-onset Amyotrophic Lateral Sclerosis: a Voxel-based Morphometry Study

Objective To investigate cerebral structural signatures of the bulbar-and spinal-onset amyotrophic lateral sclerosis(ALS) using voxel-based morphometry on magnetic resonance imaging.Methods The MR structural images of the brain were obtained from 65 ALS patients(15 bulbar-onset, 50 spinalonset) and 65 normal controls(NC) on a 3.0 T MRI system. Gray matter(GM) volume changes were investigated by voxel-based morphometry, and the distribution of the brain regions with volume changes was compared between ALS and normal controls, as well as between bulbar-onset and spinal-onset ALS based on Neuromorphometrics atlas.Results On voxel-level the decreased volume of brain regions in ALS patients was located in the right precentral gyrus(r Prc Gy) and right middle frontal gyrus compared with that in NC. The bulbar-onset ALS presented extramotor cortex atrophy(fronto-temporal pattern), including left medial orbital gyrus, left inferior temporal gyrus and right middle temporal gyrus; the spinal-onset ALS suffered from motor cortex atrophy(r Prc Gy dominance) and extra-motor cortex atrophy(fronto-temporal and extra-fronto-temporal pattern) compared with NC. The spinal-onset ALS featured by GM volume loss of left postcentral gyrus and bulbar-onset ALS featured by GM volume loss of left middle temporal gyrus compared with each other. Conclusions The asymmetric GM atrophy of the motor cortex and extra-motor cortex represents the common MRI structural signatures of spinal-onset ALS, and sole extra-motor cortex atrophy represents the structural signatures of bulbar-onset ALS. The present study also demonstrated that the pattern of GM damage is likely to distribute wider in spinal-onset ALS than in bulbar-onset ALS.

Regional gray matter abnormality in hepatic myelopathy patients after transjugular intrahepatic portosystemic shunt: a voxel-based morphometry study

Hepatic myelopathy is a complication seen in patients with chronic liver failure with physiologic or iatrogenic portosystemic shunting. The main symptom is progressive lower limb dyskinesia. The role of the brain motor control center in hepatic myelopathy is unknown. This study aimed to investigate the gray matter changes in patients with hepatic myelopathy secondary to transjugular intrahepatic portosystemic shunt and to examine their clinical relevance. This was a cross-sectional study. Twenty-three liver failure patients with hepatic myelopathy(hepatic myelopathy group), 23 liver failure patients without hepatic myelopathy(non-hepatic myelopathy group) after transjugular intrahepatic portosystemic shunt, and 23 demographically matched healthy volunteers were enrolled from March 2014 to November 2016 at Xijing Hospital, Air Force Military Medical University(Fourth Military Medical University), China. High-resolution magnetization-prepared rapid gradient-echo brain imaging was acquired. Group differences in regional gray matter were assessed using voxel-based morphometry analysis. The relationship between aberrant gray matter and motor characteristics was investigated. Results demonstrated that compared with the non-hepatic myelopathy group, gray matter volume abnormalities were asymmetric, with decreased volume in the left insula(P = 0.003), left thalamus(P = 0.029), left superior frontal gyrus(P = 0.006), and right middle cingulate cortex(P = 0.021), and increased volume in the right caudate nucleus(P = 0.017), corrected with open-source software. The volume of the right caudate nucleus in the hepatic myelopathy group negatively correlated with the lower limb clinical rating of the Fugl-Meyer Assessment(r = –0.53, P = 0.01). Compared with healthy controls, patients with and without hepatic myelopathy exhibited overall increased gray matter volume in both thalami, and decreased gray matter volume in both putamen, as well as in the globus pallidus, cerebellum, and vermis. The gray matter abnormalities we found predominantly involved motor-related regions, and may be associated with motor dysfunction. An enlarged right caudate nucleus might help to predict weak lower limb motor performance in patients with preclinical hepatic myelopathy after transjugular intrahepatic portosystemic shunt. This study was approved by the Ethics Committee of Xijing Hospital, Air Force Military Medical University(Fourth Military Medical University), China(approval No. 20140227-6) on February 27, 2014.

Effect of MR Field Strength on the Texture Features of Cerebral T2-FLAIR Images: A Pilot Study

Objective To investigate effect of MR field strength on texture features of cerebral T2 fluid attenuated inversion recovery(T2-FLAIR)images.Methods We acquired cerebral 3 D T2-FLAIR images of thirty patients who were diagnosed with ischemic white matter lesion(WML)with MR-1.5 T and MR-3.0 T scanners.Histogram texture features which included mean signal intensity(Mean),Skewness and Kurtosis,and gray level co-occurrence matrix(GLCM)texture features which included angular second moment(ASM),Contrast,Correlation,Inverse difference moment(IDM)and Entropy,of regions of interest located in the area of WML and normal white matter(NWM)were measured by ImageJ software.The texture parameters acquired with MR-1.5 T scanning were compared with MR-3.0 T scanning.Results The Mean of both WML and NWM obtained with MR-1.5 T scanning was significantly lower than that acquired with MR-3.0 T(P<0.001),while Skewness and Kurtosis between MR-1.5 T and MR-3.0 T scanning showed no significant difference(P>0.05).ASM,Correlation and IDM of both WML and NWM acquired with MR-1.5 T revealed significantly lower values than those with MR-3.0 T(P<0.001),while Contrast and Entropy acquired with MR-1.5 T showed significantly higher values than those with MR-3.0 T(P<0.001).Conclusion MR field strength showed no significant effect on histogram textures,while had significant effect on GLCM texture features of cerebral T2-FLAIR images,which indicated that it should be cautious to explain the texture results acquired based on the different MR field strength.

Assessing gray matter volume in patients with idiopathic rapid eye movement sleep behavior disorder

Idiopathic rapid eye movement sleep behavior disorder(iRBD) is often a precursor to neurodegenerative disease. However, voxel-based morphological studies evaluating structural abnormalities in the brains of iRBD patients are relatively rare. This study aimed to explore cerebral structural alterations using magnetic resonance imaging and to determine their association with clinical parameters in iRBD patients. Brain structural T1-weighted MRI scans were acquired from 19 polysomnogram-confirmed iRBD patients(male:female 16:3; mean age 66.6 ± 7.0 years) and 20 age-matched healthy controls(male:female 5:15; mean age 63.7 ± 5.9 years). Gray matter volume(GMV) data were analyzed based on Statistical Parametric Mapping 8, using a voxel-based morphometry method and two-sample t-test and multiple regression analysis. Compared with controls, iRBD patients had increased GMV in the middle temporal gyrus and cerebellar posterior lobe, but decreased GMV in the Rolandic operculum, postcentral gyrus, insular lobe, cingulate gyrus, precuneus, rectus gyrus, and superior frontal gyrus. iRBD duration was positively correlated with GMV in the precuneus, cuneus, superior parietal gyrus, postcentral gyrus, posterior cingulate gyrus, hippocampus, lingual gyrus, middle occipital gyrus, middle temporal gyrus, and cerebellum posterior lobe. Furthermore, phasic chin electromyographic activity was positively correlated with GMV in the hippocampus, precuneus, fusiform gyrus, precentral gyrus, superior frontal gyrus, cuneus, inferior parietal lobule, angular gyrus, superior parietal gyrus, paracentral lobule, and cerebellar posterior lobe. There were no significant negative correlations of brain GMV with disease duration or electromyographic activity in iRBD patients. These findings expand the spectrum of known gray matter modifications in iRBD patients and provide evidence of a correlation between brain dysfunction and clinical manifestations in such patients. The protocol was approved by the Ethics Committee of Huashan Hospital(approval No. KY2013-336) on January 6, 2014. This trial was registered in the ISRCTN registry(ISRCTN18238599).

Neuroprotection and neuroregeneration:roles for the white matter

Efficient strategies for neuroprotection and repair are still an unmet medical need for neurodegenerative diseases and lesions of the central nervous system.Over the last few decades,a great deal of attention has been focused on white matter as a potential therapeutic target,mainly due to the discovery of the oligodendrocyte precursor cells in the adult central nervous system,a cell type able to fully repair myelin damage,and to the development of advanced imaging techniques to visualize and measure white matter lesions.The combination of these two events has greatly increased the body of research into white matter alte rations in central nervous system lesions and neurodegenerative diseases and has identified the oligodendrocyte precursor cell as a putative target for white matter lesion repair,thus indirectly contributing to neuroprotection.This review aims to discuss the potential of white matter as a therapeutic target for neuroprotection in lesions and diseases of the central nervous system.Pivot conditions are discussed,specifically multiple scle rosis as a white matter disease;spinal cord injury,the acute lesion of a central nervous system component where white matter prevails over the gray matte r,and Alzheimer's disease,where the white matter was considered an ancilla ry component until recently.We first describe oligodendrocyte precursor cell biology and developmental myelination,and its regulation by thyroid hormones,then briefly describe white matter imaging techniques,which are providing information on white matter involvement in central nervous system lesions and degenerative diseases.Finally,we discuss pathological mechanisms which interfere with myelin repair in adulthood.

Healthy individuals vs patients with bipolar or unipolar depression in gray matter volume

BACKGROUND Previous studies using voxel-based morphometry(VBM)revealed changes in gray matter volume(GMV)of patients with depression,but the differences between patients with bipolar disorder(BD)and unipolar depression(UD)are less known.AIM To analyze the whole-brain GMV data of patients with untreated UD and BD compared with healthy controls.METHODS Fourteen patients with BD and 20 with UD were recruited from the Mental Health Center of Shantou University between August 2014 and July 2015,and 20 nondepressive controls were recruited.After routine three-plane positioning,axial T2WI scanning was performed.The connecting line between the anterior and posterior commissures was used as the scanning baseline.The scanning range extended from the cranial apex to the foramen magnum.Categorical data are presented as frequencies and were analyzed using the Fisher exact test.RESULTS There were no significant intergroup differences in gender,age,or years of education.Disease course,age at the first episode,and Hamilton depression rating scale scores were similar between patients with UD and those with BD.Compared with the non-depressive controls,patients with BD showed smaller GMVs in the right inferior temporal gyrus,left middle temporal gyrus,right middle occipital gyrus,and right superior parietal gyrus and larger GMVs in the midbrain,left superior frontal gyrus,and right cerebellum.In contrast,UD patients showed smaller GMVs than the controls in the right fusiform gyrus,left inferior occipital gyrus,left paracentral lobule,right superior and inferior temporal gyri,and the right posterior lobe of the cerebellum,and larger GMVs than the controls in the left posterior central gyrus and left middle frontal gyrus.There was no difference in GMV between patients with BD and UD.CONCLUSION Using VBM,the present study revealed that patients with UD and BD have different patterns of changes in GMV when compared with healthy controls.

新生儿脑白质损伤时空分布规律的病灶概率映射研究

目的采用基于T1WI的病灶映射方法刻画新生儿局灶性脑白质损伤(punctate white matter lesions,PWML)的好发区域并探究其时空分布规律。材料与方法回顾性纳入PWML新生儿94例,其中轻度损伤60例(早产/足月:24/36),重度损伤34例(早产/足月:20/14)。基于T1WI手动标记病灶,与约翰霍普金斯大学新生儿T1WI模板配准后叠加图谱,最终生成PWML概率映射图并计算病灶在不同区域的分布概率。对轻重度PWML组间以及不同分组内早产与足月儿各脑叶病灶体积进行比较。结果轻度PWML的分布均以颞顶叶为主(病灶体积于颞顶叶>额叶>枕叶,P<0.008),尤其是丘脑后辐射、角回及缘上回;早产儿损伤范围较足月儿增加,且向额叶延伸。重度PWML主要分布于额颞顶叶(病灶体积于额颞顶叶>枕叶,P<0.008),早产与足月损伤分布范围较为一致,共同累及的区域包括丘脑后辐射、角回及上放射冠。结论基于T1WI的病灶概率映射于脑区水平细化了不同程度PWML病灶的时空分布特征,为深入理解PWML的病理生理机制及预后评估提供了解剖基础。

脑室周围白质损伤患儿发生混合型脑性瘫痪预测模型的建立

目的建立脑室周围白质损伤(PWMI)患儿发生混合型脑性瘫痪的预测模型。资料与方法回顾性纳入2015年9月—2022年10月河南中医药大学第一附属医院经MRI诊断为PWMI(6个月~2岁)并随访至2岁后确诊为混合型脑性瘫痪的患儿,将其分为混合型组和痉挛型组。使用多因素Logistic回归分析筛选与PWMI混合型脑性瘫痪相关的MRI征象并建立预测模型,采用五折交叉及重复交叉验证对模型进行内部验证。评估模型的区分度、校准度并进行决策曲线分析。分析独立MRI征象与混合型脑性瘫痪粗大运动功能分级的相关性。结果共纳入135例PWMI脑性瘫痪患儿,痉挛型100例,混合型35例。丘脑腹外侧核(OR=27.500,95%CI 8.293~90.942)、后壳核(OR=13.700,95%CI 4.489~41.549)、海马(OR=7.200,95%CI 1.702~30.813)及尾状核损伤(OR=5.800,95%CI1.973~16.950)与混合型脑性瘫痪相关,并基于以上4个变量构建预测模型。模型的曲线下面积为0.960(95%CI0.934~0.988),五折交叉及重复交叉验证的曲线下面积分别为0.95、0.96;并具有良好的校准度(χ^(2)=3.712,P=0.529)及临床应用性。模型的4个独立MRI征象均与粗大运动功能分级相关(r=0.559、0.581、0.171、0.409,P均<0.05)。结论本研究建立的预测模型可早期准确地预测PWMI混合型脑性瘫痪高危患儿。

磁共振波谱成像联合弥散加权成像在早产儿脑白质损伤诊断及预后评估中的应用

目的探讨磁共振波谱成像(MRS)联合弥散加权成像(DWI)在早产儿脑白质损伤早期诊断以及其预后评估中的应用价值。方法选取2021年1月-2023年1月102例脑白质损伤早产儿作为病例组,同期选取98例非脑白质损伤早产儿作为对照组,记录两组早产儿相关临床指标,并在出生后7d实施MRS、DWI检查,比较两组MRS代谢指标、DWI参数差异,使用点二列相关性检验MRS代谢指标、DWI参数与早产儿脑白质损伤的关系,并绘制受试者工作曲线(ROC)分析MRS联合DWI对早产儿脑白质损伤的早期诊断价值。予以病例组患儿长期随访,在矫正年龄6个月时使用Gesell发育诊断量表将患儿分为预后不良组与预后良好组,比较并分析2组患儿MRS代谢指标、DWI参数对早产儿脑白质损伤预后的评估价值。结果病例组N-乙酰天冬氨酸(NAA)、NAA/Cr、rADC明显低于对照组,肌酸(Cr)明显高于对照组,差异有统计学意义(P<0.05)。经点二列相关性检验显示NAA、NAA/Cr、rADC与早产儿脑白质损伤存在负相关关系(r<0,P<0.05);Cr与早产儿脑白质损伤存在正相关关系(r>0,P<0.05)。绘制ROC显示NAA、Cr、NAA/Cr以及rADC对早产儿脑白质损伤诊断具有较低的诊断价值,AUC分别为0.629、0.630、0.605、0.603;MRS联合DWI具有良好的诊断价值,AUC为0.713。随访结果显示102例患儿中21例为边缘状态,53例为发育异常,共74例为预后不良组,另28例发育良好为预后良好组。预后不良组患儿NAA、NAA/Cr、rADC明显低于预后良好组,Cr明显高于预后良好组,差异有统计学意义(P<0.05)。经点二列相关性检验显示NAA、NAA/Cr、rADC与脑白质损伤患儿预后不良存在负相关关系(r<0,P<0.05);Cr与预后不良存在正相关关系(r>0,P<0.05)。绘制ROC曲线显示NAA、NAA/Cr以及rADC对脑白质损伤患儿预后具有较低的评估价值,AUC分别为0.641、0.639、0.688;Cr、MRS联合DWI对脑白质损伤患儿预后具有良好的评估价值,AUC分别为0.755、0.833,以联合评估价值最高。结论MRS联合DWI对早产儿脑白质损伤以及其预后均有良好的评估价值。