A Study Of Language And Communication Function In Children With Bilateral Spastic Cerebral Palsy Based On Structural Brain MRI

Objective:To investigate the structural changes of gray matter and white matter in the brain related to the verb and communication dysfunction of bilateral spastic cerebral palsy（BSCP）.To establish an individualized diagnosis model of communication dysfunction in children with BSCP based on the multi parameters of gray matter and white matter.Methods:28 children with BSCP aged 4-16 years attending the Affiliated Hospital of Zunyi Medical University,and 31 age-sex-matched control children were recruited between April 2019 and October 2021.3D-T₁WI,Diffusion Tensor Imaging（DTI）and Verbal comprehension index（VCI）of Wechsler Intelligence Scale for Children 4nd edition were performed in children with BSCP and healthy controls.Communication Function Classification System（CFCS）was assessed in children with BSCP.1.Based on 3D-T₁WI,Free Surfer 5.0 was applied to extract cortical morphological parameters in children with BSCP and healthy controls using the Destrieux Atlas.The differences of morphological parameters between the two groups were compared using two-sample t-test.Correlation between significant morphological parameters and VCI as well as CFCS levels were performed using the Spearman rank correlation,considering age and sex as a covariate.2.Based on DTI,structural brain network construction was conducted for both groups using whole brain probabilistic fiber tractography.The differences of with matter fiber numbers（FN）and fractional anisotropy（FA）between the two groups were compared using two-sample t-test.Correlation between significant FN,FA and VCI as well as CFCS levels were performed using the Spearman rank correlation,considering age and sex as a covariate.3.Parameters of gray matter and white matter fibers were extracted from two groups of children,and compared between the two groups.Significant different features of children with BSCP were obtained for feature dimensionality reduction.Support vector machine classification algorithm was used to construct a diagnostic model of communication impairment in children with BSCP.The leave-one-out cross validation method was used for the validation and filtering consistent features.Receiver operating characteristic curve was used to evaluate model performance.Result:1.Compare with the health control group,widespread cortical surface area,cortical volume,and subcortical structures volume alterations were found in BSCP group.The surface areas of the left middle temporal gyrus,middle frontal gyrus and right occipital pole cortex were negatively correlated with CFCS（rho range-0.389 to-0.452）.The volumes of the right superior frontal gyrus,middle frontal gyrus and frontopolar transverse gyrus/sulcus cortex were negatively correlated with CFCS（rho ranges from-0.388 to-0.538）.The volume of the left middle frontal sulcus cortex was positively correlated with VCI（rho=0.471）.Bilateral thalamus,hippocampus,amygdala,left lateral raphe nucleus,and pallidum volumes were negatively correlated with CFCS（rho ranges from-0.389 to-0.631）.2.Compare with the health control group,widespread fiber FA and FN alterations were found in BSCP group.Among them,FA of fibers within and between the bilateral frontal lobes,sensorimotor areas,deep gray matter nuclei,and partial temporo-occipital lobes were negatively correlated with CFCS（rho ranges from-0.412 to-0.658）.The FA of fibers within and between the left frontal lobes,deep gray matter nuclei,and bilateral sensorimotor areas were positively correlated with VCI scores（rho ranges from 0.449 to 0.590）.3.The accuracy of using gray matter parameters（cortical surface area,cortical volume,and subcortical structures volume）as characteristic information to distinguish whether children with BSCP had combined communication impairment was 78.5%,71.4%,and71.4%,respectively.The accuracy of using white matter fiber parameters（FA and FN）as characteristic information to distinguish whether children with BSCP had combined communication impairment was 76.9%and 73.0%,respectively.The consistent gray matter features that distinguished communication impairment in children with BSCP were mainly located in the bilateral middle frontal gyrus,left middle temporal gyrus,hippocampus,right superior frontal gyrus,frontopolar transverse gyrus/sulcus,middle occipital gyrus,cuneate gyrus,and amygdala.The consistent white matter fiber features were mainly located within and between the bilateral frontal lobes,sensorimotor areas,and partial temporo-occipital lobes.Conclusion:1.Communication impairment in children with BSCP was associated with morphological alterations in their bilateral frontal lobes,sensorimotor areas,partial temporo-occipital lobes and altered fiber structures within or between the above areas,which provides a preliminary basis for identifying potential neuroimaging markers of communication impairment in children with BSCP.2.The extraction parameters of gray matter and white matter fiber from structural MRI could be used to establish an individualized diagnostic model of communication impairment in children with BSCP,and this method may provide a new way to diagnose communication impairment in children with BSCP.