Boddaert Nathalie, Zilbovicius Mônica, Philipe Anne, Robel Laurence, Bourgeois Marie, Barthélemy Catherine, Seidenwurm David, Meresse Isabelle, Laurier Laurence, Desguerre Isabelle, Bahi-Buisson Nadia, Brunelle Francis, Munnich Arnold, Samson Yves, Mouren Marie-Christine, Chabane Nadia
INSERM-CEA U 797, Service Hospitalier Frédéric Joliot, CEA, Orsay, France.
PLoS One. 2009;4(2):e4415. doi: 10.1371/journal.pone.0004415. Epub 2009 Feb 10.
The clinical relevance of MR scanning in children with autism is still an open question and must be considered in light of the evolution of this technology. MRI was judged to be of insufficient value to be included in the standard clinical evaluation of autism according to the guidelines of the American Academy of Neurology and Child Neurology Society in 2000. However, this statement was based on results obtained from small samples of patients and, more importantly, included mostly insufficient MRI sequences. Our main objective was to evaluate the prevalence of brain abnormalities in a large group of children with a non-syndromic autistic disorder (AD) using T1, T2 and FLAIR MRI sequences.
MRI inspection of 77 children and adolescents with non-syndromic AD (mean age 7.4+/-3.6) was performed. All met the DSM-IV and ADI -R criteria for autism. Based on recommended clinical and biological screenings, we excluded patients with infectious, metabolic or genetic diseases, seizures or any other neurological symptoms. Identical MRI inspections of 77 children (mean age 7.0+/-4.2) without AD, developmental or neurological disorders were also performed. All MRIs were acquired with a 1.5-T Signa GE (3-D T1-FSPGR, T2, FLAIR coronal and axial sequences). Two neuroradiologists independently inspected cortical and sub-cortical regions. MRIs were reported to be normal, abnormal or uninterpretable.
MRIs were judged as uninterpretable in 10% (8/77) of the cases. In 48% of the children (33/69 patients), abnormalities were reported. Three predominant abnormalities were observed, including white matter signal abnormalities (19/69), major dilated Virchow-Robin spaces (12/69) and temporal lobe abnormalities (20/69). In all, 52% of the MRIs were interpreted as normal (36/69 patients).
An unexpectedly high rate of MRI abnormalities was found in the first large series of clinical MRI investigations in non-syndromic autism. These results could contribute to further etiopathogenetic research into autism.
磁共振成像（MR）扫描在自闭症儿童中的临床相关性仍是一个悬而未决的问题，且必须结合该技术的发展来考虑。根据2000年美国神经病学学会和儿童神经病学会的指南，MRI被认为在自闭症的标准临床评估中价值不足。然而，这一结论是基于对少量患者样本的研究结果得出的，更重要的是，所采用的MRI序列大多不充分。我们的主要目的是使用T1、T2和液体衰减反转恢复（FLAIR）MRI序列，评估一大组非综合征性自闭症谱系障碍（AD）儿童的脑异常患病率。
对77名患有非综合征性AD的儿童和青少年（平均年龄7.4±3.6岁）进行了MRI检查。所有患者均符合DSM-IV和自闭症诊断访谈量表修订版（ADI-R）的自闭症标准。基于推荐的临床和生物学筛查，我们排除了患有感染性、代谢性或遗传性疾病、癫痫或任何其他神经症状的患者。同时，对77名无AD、发育或神经障碍的儿童（平均年龄7.0±4.2岁）进行了相同的MRI检查。所有MRI均使用1.5-T Signa GE设备采集（三维T1-快速扰相梯度回波序列、T2序列、FLAIR冠状位和轴位序列）。两名神经放射科医生独立检查皮质和皮质下区域。MRI报告分为正常、异常或无法解读。
10%（8/77）的病例中MRI被判定为无法解读。48%的儿童（33/69例患者）报告存在异常。观察到三种主要异常，包括白质信号异常（19/69）、主要扩张的Virchow-Robin间隙（12/69）和颞叶异常（20/69）。总体而言，52%的MRI被解读为正常（36/69例患者）。
在首个针对非综合征性自闭症的大型临床MRI研究系列中，发现MRI异常率出奇地高。这些结果可能有助于自闭症的进一步病因学研究。
