儿童颞叶局灶性皮质发育不良的扩散张量成像应用研究

doi:10.3969/j.issn.1673-5501.2021.01.003

摘要/Abstract

摘要： 背景磁共振(MR)扩散张量成像(DTI)应用于儿童颞叶局灶性皮质发育不良(FCD)的皮质及白质病灶的诊断效用尚不清楚。目的探讨MR DTI在儿童FCD诊断中的应用价值。设计以经手术病理证实为单侧颞叶FCD患儿为研究对象,以FCD患侧的对侧和健康儿童为对照,比较DTI参数。方法收集FCD患儿始发年龄和病程,FCD患儿及与之MR检查时间、年龄和性别匹配的健康儿童MR及DTI资料,测量FCD患侧、对侧和健康儿童相应区皮质及白质的各向异性分数(FA)及表观扩散系数(ADC)。主要结局指标 FCD患侧、对侧和健康儿童DTI参数ROC曲线的AUC。结果 FCD患儿21例,平均年龄8.2(1～16)岁,平均发病年龄4.5(1～8)岁,平均病程5.8(1～9)年;健康儿童20例,平均年龄7.9(2～16)岁。患侧皮质及白质区的FA值均显著低于对侧和对照组相应区(P分别为0.029、0.014、0.018和0.007),患侧皮质区ADC值显著高于对侧和对照组相应区(P均为0.001),患侧白质区ADC值与对侧及对照组相应区差异无统计学意义(P>0.05),FCD患儿病灶与对照组相应区比较的DTI参数ROC曲线的AUC均分别大于FCD患儿两侧比较的相应DTI参数ROC曲线的AUC。患侧皮质区ADC值与FCD病程呈线性正相关(r=0.762,P=0.013),病灶白质区FA值与FCD病程呈线性负相关(r=-0.694,P=0.025)、与始发年龄呈线性正相关(r=0.705,P=0.017)。结论 DTI参数可一定程度反映儿童颞叶FCD患侧与对侧及健康对照的微观结构差异及与临床因素的相关性,FCD患侧与健康对照相应区的比较具有较优质的诊断效用,同参数下较FCD患侧和对侧比较诊断效能更好,尝试建立基于健康对照FA及ADC值的参考值具有重要意义。

关键词: 磁共振成像, 扩散张量成像, 局灶性皮质发育不良, 颞叶, 儿童

Abstract: Background The diagnostic utility of magnetic resonance (MR) diffusion tensor imaging (DTI) in the diagnosis of cortical and white matter lesions in children with focal cortical dysplasia (FCD) is unclear. Objective To evaluate the value of conventional MR and DTI in the diagnosis of FCD in children. Design The children with unilateral temporal lobe FCD confirmed by surgery and pathology were taken as the research objects, and the contralateral side of FCD and healthy children were taken as the control group. DTI parameters were compared in two groups. Methods The onset age and disease course of FCD and MR and DTI data of healthy children who have matched time of MR examination, age and gender were collected. The fractional anisotropy (FA) and apparent diffusion coefficient (ADC) of cortical and white matter of typical lesions on the affected and contralateral sides of FCD and in healthy children were measured. Main outcome measures AUC of ROC curve of DTI parameters on the affected and contralateral sides of FCD and in healthy children. Results There were 21 cases of FCD with an average age of 8.2 (1-16) years, an average age of 4.5 (1-8) years, an average course of disease of 5.8 (1-9) years, and 20 cases of healthy children with an average age of 7.9 (2-16) years. FA values of the affected cortex and white matter were significantly lower than those of the corresponding areas of the contralateral side and healthy chidren (P=0.029, 0.014, 0.018 and 0.007 respectively). ADC values of the affected cortex were significantly higher than those of the corresponding areas of the contralateral side and healthy children (P=0.001). ADC values of the affected white matter were not significantly different from those of the corresponding areas of the contralateral side and healthy children (P> 0.05). AUC of ROC curve of DTI parameters in FCD children compared with corresponding areas in healthy children was all larger than that of corresponding DTI parameters in comparison of two sides in children with FCD. The ADC value of the cortical area in the case group was positively correlated with the course of disease (r=0.762, P=0.013). The FA value in the white matter area was negatively correlated with the course of disease (r=-0.694, P=0.025), and positively correlated with the age of onset (r=0.705, P=0.017). Conclusion DTI parameters can reflect the microstructural differences among the affected side of FCD, the contralateral side of FCD and healthy children. Correlation of clinical factors can also be reflected. The comparison of the affected side of FCD and the corresponding areas in healthy children has high quality diagnostic utility, which is more significant than the comparison of the affected and contralateral sides of FCD under the same parameters. Therefore, it is of great significance to try to establish the reference values of FA (cortex and white matter) and ADC (cortex and white matter) in normal population.

Key words: Magnetic resonance imaging, Diffusion tensor imaging, Focal cortical dysplasia, Temporal lobe, Children

吴菲潇, 沈瑾, 周渊峰, 赵瑞, 胡喜红. 儿童颞叶局灶性皮质发育不良的扩散张量成像应用研究[J]. 中国循证儿科杂志, 2021, 16(1): 51-55.

WU Feixiao, SHEN Jin, ZHOU Yuanfeng, ZHAO Rui, HU Xihong. The application study of diffusion tensor imaging in children's focal cortical dysplasia of temporal lobe[J]. Chinese Journal of Evidence-Based Pediatrics, 2021, 16(1): 51-55.

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