| Objective:1.MRI images were used to observe the age-related development characteristics of brainstem morphology in healthy young children,and to analyze its differences and correlations with gender and age,so as to provide basis for children’s health monitoring and disease diagnosis and treatment.2.To explore the age-related development characteristics of atlantoaxial and cervical spinal cord in young children to fill the database of developmental anatomy of young children.Methods:1.A total of 406 cases of 3.0 T MRI images of the brain of healthy young children aged 1～6 years were collected.The anteroposterior diameters of the midbrain,pons and medulla oblongata,and the related diameters,areas and angles of the midbrain,pons and medulla oblongata were observed.2.A total of 366 cases of 3.0T MRI images and 125 cases of CT images of the neck of children aged 1～6 years were selected.Mimics 21.0 software was used to measure the atlantoaxial related indexes（the aperture line and area of each vertebra,foramen and transverse process）after three-dimensional reconstruction.The sagittal diameter of cervical spinal cord and spinal canal at the upper edge of C3and C7vertebral bodies was measured by MRI median sagittal position.Results:1.Age-related changes and differences between groups:（1）Anteroposterior diameter:In the 1-year-old to 5-year-old group,the overall trend increased with age,and the peak value of the index was mostly in the 5-year-old group.There were differences between the 1-year-old group and the 3-year-old,4-year-old,5-year-old and 6-year-old groups（Ρ<0.05）.There were differences between the 2-year-old and 3-year-old groups and the5-year-old and 6-year-old groups（Ρ<0.05）,and there was no difference between the5-year-old group and the 6-year-old group（Ρ>0.05）.（2）Longitudinal diameter:The peak value appeared in the 6-year-old group,and there was a difference between the 1-year-old group and the 6-year-old group（Ρ<0.05）and there was no difference between the 5-year-old group and the 6-year-old group（Ρ>0.05）.（3）Area:In the 1 to 6 years old group,there was an increasing trend with age.There was a difference between the 1 and 2 years old groups and each age group（Ρ<0.05）.There was a difference between the 3 years old group and the 5 and6 years old groups（Ρ<0.05）.There was a difference between the 4 years old group and the 6years old group（Ρ<0.05）.（4）Angle:The midbrain pontine angle was different between the4-year-old group and each age group（Ρ<0.05）.There was no difference between the other age groups（Ρ>0.05）,and the overall trend was slow.The pontine medullary angle and medullary spinal cord angle generally increased slowly with age,and there was no difference among all age groups（Ρ>0.05）.Correlation between correlation index and age:（1）anterior and posterior diameter and longitudinal diameter:positive correlation（r>0,Ρ<0.05）,pons and segments（r>0.5,Ρ<0.05）.（2）area:All areas had a positive correlation（r>0,Ρ<0.05）,except for the medulla oblongata area（r>0.5）.（3）Angle:weak positive correlation between midbrain angle and age（r=0.112,Ρ<0.05）.Gender differences in related indicators:（1）Anteroposterior diameter:There was no difference in the midbrain and the upper part of the medulla oblongata among the age groups（Ρ>0.05）.There were differences in the pons and the middle part of the medulla oblongata in the 3-year-old group（Ρ<0.05）,and there were differences in the lower part of the medulla oblongata in the 6-year-old group（Ρ<0.05）.（2）Longitudinal diameter:the midbrain was different in the 2-year-old group（Ρ<0.05）,and the pons were different in the 4-year-old and5-year-old groups（Ρ<0.05）;there was a difference in medulla oblongata between 1～5 years old group（Ρ<0.05）.（3）Area:There was no difference in midbrain at all ages（Ρ>0.05）;the area of pons was different in 2～5 years old group（Ρ<0.05）,the medulla oblongata was different in 1 year old,3 years old and 5 years old group（Ρ<0.05）,and the total area of brainstem was different in 2 years old,3 years old,5 years old and 6 years old group（Ρ<0.05）.（4）Angle:There were differences in the midbrain pontine angle and medullary spinal cord angle in the 3-year-old group（Ρ<0.05）,and there were differences in the pontine medullary angle in the 6-year-old group（Ρ<0.05）.Correlation between different genders and age:（1）Anteroposterior diameter:There was a positive correlation between boys and girls（r>0,Ρ<0.05）,and boys’pons,lower medulla oblongata and girls’pons were highly correlated.（r=0.566,Ρ<0.05）.（2）Longitudinal diameter:There was a weak positive correlation between the longitudinal diameter of the midbrain in boys（r=0.265,Ρ<0.05）.There was a positive correlation between the longitudinal diameter of the pons in boys and girls,and the correlation in boys was higher（r=0.566,Ρ<0.05）.There was a positive correlation between the longitudinal diameter of the medulla oblongata in girls（r=0.203,Ρ<0.05）.（3）Area:they were positively correlated with age（r>0,Ρ<0.05）,and the total area of pons and brainstem in boys and girls,and the midbrain in boys were highly correlated（r>0.5）.（4）Angle:There was no correlation between boys and girls（Ρ>0.05）.2.Age-related changes of cervical spinal cord and spinal canal related indicators and differences between groups:（1）The mean values of C3and C7cervical spinal cord diameters increased with age in the 1-year-old to 6-year-old groups,and there were differences between the 1-year-old and 2-year-old groups and the age groups（Ρ<0.05）and there was no difference between the remaining age groups（Ρ>0.05）.（2）The mean diameter of C3and C7spinal canals increased with age in the 1～5 years old group.There was a difference between the1-year-old group and each age group（Ρ<0.05）.There was a difference between the 2-year-old group and the 5-year-old group（Ρ<0.05）.There was no difference between the 5-year-old group and the 6-year-old group（Ρ>0.05）.The percentage of spinal cord:The percentage of normal children aged 1～6 years was41.29%～45.63%,but,there is no obvious change pattern with increasing age.Age-related indicators of atlas and differences between groups:（1）Transverse and sagittal diameter of atlas:The transverse diameter of atlas was different between 1-year-old,2-year-old,3-year-old group and each age group（Ρ<0.05）,4-year-old group and 6-year-old group（Ρ<0.05）,4-year-old,5-year-old group and 6-year-old group（Ρ>0.05）.The 1～6 years old group showed an increasing trend with age;the sagittal diameter of atlas was different between 1-year-old group,2-year-old group and 6-year-old group（Ρ<0.05）.The 1 to 6 years old group showed a gentle growth trend with age,and the values of each age group were close.（2）Transverse and sagittal diameter of atlas foramen:There were differences between the 1-year-old group and each age group（Ρ<0.05）,and the 1～6-year-old group showed a gentle growth trend with age.（3）Transverse and sagittal diameter of atlas bilateral transverse foramen:There were differences between the 1-year-old and 2-year-old groups and the4-year-old,5-year-old and 6-year-old groups（Ρ<0.05）.There was no difference in bilateral transverse diameter between 3 years old,4 years old,5 years old and 6 years old groups（Ρ>0.05）.In the 2-year-old to 6-year-old group,the overall growth trend was stepwise,and the bilateral sagittal diameter was generally larger than the transverse diameter in each age group.（4）The area of atlas foramen:The 1～4 year-old group showed a stepwise increase with age,and there was a difference between the 1-year-old and 2-year-old groups（Ρ<0.05）,which was different from the other age groups（Ρ<0.05）.The age-related indicators of the axis and the differences between groups:（1）Axial transverse and sagittal diameter:There were differences between 1-year-old group,2-year-old group and each age group（Ρ<0.05）,and there were differences between 3-year-old group and 6-year-old group.In each age group,the overall trend is increasing with age.（2）Transverse and sagittal diameter of axis foramen:There were differences between the1-year-old and 2-year-old groups and the 3-year-old,4-year-old,5-year-old and 6-year-old groups（Ρ<0.05）.There was no difference between the 3-year-old,4-year-old,5-year-old and6-year-old groups（Ρ>0.05）.All of them showed a slow growth trend with age from 1 to 6years old.（3）Transverse and sagittal diameter of bilateral transverse foramen of axis:There were differences between the 1-year-old group and the 3-year-old,4-year-old,5-year-old and6-year-old groups（Ρ<0.05）.There was no difference in bilateral transverse diameter between2-year-old,3-year-old,4-year-old,5-year-old and 6-year-old groups（Ρ>0.05）.There was no difference in bilateral sagittal diameter between 3-year-old,4-year-old,5-year-old and6-year-old groups（Ρ>0.05）,but there was a difference between 3-year-old group and2-year-old group（Ρ<0.05）.In the 1 to 6 years old group,there was a step-by-step growth trend with age,and the bilateral transverse diameter was generally larger than the sagittal diameter in each age group.（4）Area of axis foramen:The area of the axis foramen was different between the 1-year-old,2-year-old group and each age group（Ρ<0.05）.There was no difference between the 3-year-old,4-year-old,5-year-old and 6-year-old groups（Ρ>0.05）.In the 1 to 5 years old group,there was an increasing trend with age.Conclusion:1.The image of brainstem measured by 3.0T MRI is clear,which can provide accurate developmental dynamic information.The diameter and area index were in the stage of rapid development and change during 1～2 years old,2～3 years old and 4～5years old.The three groups of age intervals can be used as the main stage of brain stem development in young children.The anteroposterior diameter of pons and lower medulla oblongata,the longitudinal diameter of pons and the total area of midbrain,pons and brainstem are closely related to age,and their morphological development increases significantly with age,which can be used as a key index for clinical observation of brainstem development in young children.To obtain the data of the structural and morphological characteristics of the brainstem in Chinese children with age and gender,and to provide a basis for clinical diagnosis and treatment and accurate evaluation of the development of the brainstem in young children.The morphological analysis of the brainstem structure roughly infers the gender and age of the corpse source,which helps criminal investigation and case analysis.2.The biological characteristics and age-related development of cervical spinal cord and cervical spinal canal in young children were obtained,which filled the anatomical data database of different age groups.The cervical spinal cord and cervical spinal canal grow rapidly in the 1-year-old and 2-year-old groups,and there are differences between different age groups and genders.Age and gender factors should be considered in clinical evaluation of cervical spinal cord development and spinal canal stenosis in young children.The atlantoaxial indexes of children aged 1-6 years old showed a gentle growth trend with age,and there were morphological differences among different ages.The study of morphological characteristics of age-related development was helpful to the diagnosis and treatment of diseases in this area,and could provide a basis for forensic identification of injuries. |
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