Study And Application Of DTI Technique In Grading Of Children With Spastic Cerebral Palsy

Background With the liberalization of the birth policy,the birth rate of newborns increases,and the incidence of cerebral palsy is also gradually increasing.The occurrence of cerebral palsy not only has a serious impact on the study and life of children,but also brings a heavy burden to the society and family.It is very important to understand the severity of children with cerebral palsy and to help clinically choose accurate treatment plan through grading.Objective This topic using diffusion tensor imaging(DTI)technique to explore the cerebral palsy children with spastic type cerebral white matter fiber tracts injury situation,understand the characteristics of the changes in the DTI in children with spastic type cerebral palsy,analyze DTI and gross motor function classification system(GMFCS),to help clinical diagnosis of spasm cerebral palsy,provide the certain reference value for clinical choice treatment.Methods(1)Children with spastic cerebral palsy aged 1～4 years who were diagnosed and treated in the outpatient and inpatient department of pediatrics and children’s rehabilitation from September 2019 to March 2021 in Renhe Hospital Affiliated to Three Gorges University were selected as the study group,and healthy children with matched age were selected as the control group.(2)All subjects underwent MRI plain scan and DTI scan using combined 3.0T magnetic resonance,and the obtained images were post-processed on the FADTI tensor.The principle of selecting ROI is in the region where white matter fibers travel and the anatomical structure is clear.The selected ROI includes:Internal capsule forelimb(ICL),internal capsule hindlimb(ICPL),corpus callosum knee(GCC),corpus callosum compression(SCC),and craniocorticospinal tract(CST)were selected as the regions of interest in the contralateral brain for children with hemiplegia,and bilateral symmetric parts were selected as the regions of interest for children with bilateral paralysis,and the average value was taken.The ROI was placed in a uniform area of 10±3 mm~2,and the ROI was drawn by semi-automatic method.The ROI of all parts was circular.The required ROI was selected at different positions on the FADTI image by seed tracer method,and the corresponding DTI parameters were recorded.(3)All children with spastic cerebral palsy were graded according to GMFCS.(4)All data were summarized in Excel,and SPSS 23.0and Graph Pad Prism 8 software were used for statistical analysis.Gender in general data is tested by chi-square.Birth,risk factors,and MRI plain scan data were statistically analyzed using Fisher’s exact test.And measurement data were expressed as mean±standard deviation.Normal analysis was performed for all data in each group.ANOVA analysis was used for comparison between groups,and LSD-t test was used for comparison between two groups.Graph Pad Prism 8 was used to compare the DTI parameters of each part between the study group and the control group,and to analyze the correlation between the DTI parameters of each part and GMFCS in the study group.Results(1)There were 56 children in the study group,including 20 full-term infants and36 premature infants.The number of GMFCS grade I to V cases were 16,15,10,8,and 7,respectively.In the study group,there were 41 patients with risk factors before and after birth,among which postnatal cerebral ischemia and hypoxic disease was most common(33 cases).In the control group,37 cases were all delivered at term and had good health status.(2)Comparison between the study group and the control group showed that there was no statistical significance between the sexes(P>0.05).There were statistically significant differences in birth status,risk factors and MRI plain scan results(P<0.05).There was no significant difference in age and birth weight between the study group and the control group(P>0.05).The positive rate of MRI plain scan in the study group was about 84%.All the 9negative cases were in grade I or II.(3)(1)The anisotropy fraction(FA)of all parts of grade I to V in the study group was lower than that in the control group,and the differences in FA between the two groups were statistically significant(P<0.05).There were statistically significant differences in FA between each grade in the study group(P<0.05).(2)The apparent dispersion coefficient(ADC)of grade I to V in the study group was higher than that in the control group,and the difference of ADC between them was statistically significant(P<0.05).There were statistically significant differences in ADC among different grades in the study group(P<0.05).(3)The mean diffusion rate(MD)of i Cal and CST sites in the study group was higher than that in the control group,and the difference between them was statistically significant(P<0.05).There was no significant difference in MD values of i Cal,GCC and SCC sites between Grade I children and the control group(P>0.05).MD values in all parts of the children with grade II to V were increased compared with those in the control group,and the difference between two groups was statistically significant(P<0.05).There were statistically significant differences in MD among different grades in the study group(P<0.05).(4)There was a negative correlation between FA and GMFCS in all parts of the study group.The higher the GMFCS level was,the lower the FA was.In the study group,ADC,MD and GMFCS were positively correlated.The higher the GMFCS level was,the higher the ADC and MD were.Conclusion Neonatal hypoxic ischemic encephalopathy and premature delivery are risk factors of CP children.MRI plain scan has a certain preliminary screening significance in the diagnosis of children with spastic cerebral palsy,and positive MRI plain scan indicates high risk of cerebral palsy.The quantification of DTI parameters can help clinicians to provide a basis for the diagnosis of spastic cerebral palsy,and it has certain diagnostic value for children with negative MRI plain scan.There was a correlation between DTI and GMFCS grade in children with spastic cerebral palsy.DTI analyzes the destruction of white matter fiber bundles in a quantitative way,which helps clinical classification to a certain extent and provides some reference for clinical diagnosis and treatment of children.