| Objective: Objective: To explore the application value of MR diffusion kurtosis imaging in evaluating the diagnosis and motor function of children with spastic hemiplegia,and to analyze the relationship between the corresponding DKI parameters and function scores.Methods: Selection of Shenzhen Children’s Hospital in November 2019 to January 2021 in rehabilitation were 37 cases of spastic hemiplegia type as the experimental group,according to the age at the time of admission will be divided into 1 to 2 years old group(group A),2-5 years of age group(group B)in the two groups,select in the same period with age matched group 20 cases of normal children as control group,it can be divided into 1 to 2 years old group(group C),2-5 years of age group(group D)in the two groups.All subjects were examined by diffusion kurtosis imaging(DKI)and MRI,and the white matter regions of corticospinal tract(CST),forelimb of internal capsule(ICAL),hindlimb of internal capsule(ICPL),knee of corpus callosum(GCC)and callose pressure(SCC)on the brain stem plane were selected.The deep gray matter nuclei of thalamus and caudate head were used as ROI,and the anisotropy fraction(FA)and mean diffusion value(MK)of each ROI were measured.In the experimental group,gross motor function grading system score(GMFM-88)and Carroll upper limb function evaluation were performed before treatment.After 6 months of rehabilitation treatment in our hospital,head MRI and DKI examinations were reexamined,and GMFM-88 and Carroll upper limb function evaluation were performed.Results:1.Before treatment,the FA values of CST,ICAL,ICPL,GCC and SCC in experimental group A were all lower than those in control group,and the differences were statistically significant(P<0.05).The MK values of CST,ICAL,ICPL,GCC,SCC,thalamus and caudate nucleus head in experimental group B were all lower than those in control group,and the differences were statistically significant(P<0.05).2.Before treatment,the FA and MK values of the affected side in the experimental group were lower than those of the healthy side,indicating that the injury of the affected side was more serious than that of the contralateral side.3.The area under the ROC curve of FA value in the 2-5 year old group was ICPL=0.958(95%CI:0.878-1.000).The sensitivity was 100%,the specificity was 95.8%,and the cut-off point was 0.402.The area under the ROC curve of MK value was thalamus =0.979(95%CI: 0.940-1.000).The sensitivity was 100%,the specificity was 91.7%,and the cut-off point was 0.729.4.In the follow-up of 20 children,the average values of FA and MK in each brain region after treatment were higher than before treatment,with statistical significance(P<0.05).5.There were statistically significant differences in GMFM-88 and Carroll scores of the 20 children in the experimental group before and after treatment(P<0.05).6.The follow-up of 20 children showed that there was a correlation between the difference values of FA,MK and GMFM-88 in various brain regions before and after treatment(P<0.05),among which ICPL had the strongest correlation with gross motor function;There was a correlation between FA difference and Carroll upper extremity score difference in all brain regions except ICAL before and after treatment(P<0.05),and there was a correlation between MK difference and Carroll upper extremity score difference in all brain regions before and after treatment(P<0.05),and ICAL and thalamus had the strongest correlation with upper extremity function(P<0.05).Conclusion:MR diffusion kurtosis imaging has a good application value in the evaluation of motor function of spastic hemiplegia.Its parameters can accurately reflect the changes of brain microstructure before and after rehabilitation treatment in children with spastic hemiplegia,and can be used as an auxiliary index for diagnosis and efficacy monitoring in children with cerebral palsy. |
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