Rehabilitation Centre, University Children's Hospital, CH-8910, Affoltern am Albis, Switzerland.
Centre MR-Research, University Children's Hospital, Zurich, CH-8032, Switzerland.
Brain Imaging Behav. 2017 Oct;11(5):1373-1384. doi: 10.1007/s11682-016-9637-z.
Rehabilitation in children with acquired brain injury is a challenging endeavour. There is a large variability in motor recovery between patients, and a need to optimize therapies by exploiting cerebral plasticity and recovery mechanisms. This retrospective study aims to identify tract-based markers that could serve as predictors of functional outcome following rehabilitation.
Twenty-nine children with traumatic brain injury (n = 14) or stroke (n = 15) underwent a 3 T Magnetic Resonance Imaging (MRI) measurement, including Diffusion Tensor Imaging (DTI) between admission to the Hospital and onset of rehabilitation therapy at the Rehabilitation Centre. The Functional Independence Measure for Children (WeeFIM) was routinely applied at admission and discharge from the Rehabilitation Centre. Distinguishing between children with good versus poor functional independence was performed using ROC-analysis. A non-parametric partial correlation analysis between the DTI and WeeFIM motor scores was performed with age, time in rehabilitation, and time of MRI scan after injury as covariates.
Mean fractional anisotropy (FA) from the DTI in the ipsilesional corticospinal-tract provided the highest predictive accuracy (sensitivity = 95 %, specificity = 78 %, Youden Index = 0.73, Area under the curve = 0.9), in comparison to the lesion volume or other clinical variables. Mean FA of the ipsilesional corticospinal-tract correlated positively with the WeeFIM discharge motor scores (ρ = 0.547, p = 0.004). Prediction was poorer for the lesion volume or Glasgow Coma Scale.
The results suggest that DTI data could improve the prediction of functional outcome after rehabilitation in children and adolescents with stroke or traumatic brain injury. Specifically, mean FA shows the highest predictive accuracy in comparison to lesion volume or clinical scales.
儿童获得性脑损伤的康复是一项具有挑战性的工作。患者之间的运动恢复存在很大的差异，需要通过利用大脑的可塑性和恢复机制来优化治疗。本回顾性研究旨在确定可作为康复后功能结果预测因子的基于束的标志物。
29 名患有创伤性脑损伤（n=14）或中风（n=15）的儿童在入院后和康复中心开始康复治疗前接受了 3T 磁共振成像（MRI）测量，包括弥散张量成像（DTI）。入院时和康复中心出院时常规应用儿童功能独立性测量（WeeFIM）。使用 ROC 分析区分功能独立性良好和较差的儿童。使用年龄、康复时间和损伤后 MRI 扫描时间作为协变量，对 DTI 和 WeeFIM 运动评分之间的非参数偏相关分析。
与病灶体积或其他临床变量相比，患侧皮质脊髓束的平均各向异性分数（FA）提供了最高的预测准确性（灵敏度为 95%，特异性为 78%，Youden 指数为 0.73，曲线下面积为 0.9）。患侧皮质脊髓束的平均 FA 与 WeeFIM 出院运动评分呈正相关（ρ=0.547，p=0.004）。病灶体积或格拉斯哥昏迷量表的预测效果较差。
结果表明，DTI 数据可以提高对中风或创伤性脑损伤儿童和青少年康复后功能结果的预测。与病灶体积或临床量表相比，平均 FA 显示出最高的预测准确性。
