Tang Xiaolu, Zhang Hong, Zhou Jinyuan, Kang Huiying, Yang Shuangfeng, Cui Haijing, Peng Yun
Imaging Center Beijing Children's Hospital Capital Medical University National Center for Children's Health Beijing China.
Division of MR Research Department of Radiology Johns Hopkins University Baltimore MD USA.
Pediatr Investig. 2020 Dec 28;4(4):250-256. doi: 10.1002/ped4.12237. eCollection 2020 Dec.
The process of brain development in children with developmental delay is not well known. Amide proton transfer-weighted (APTw) imaging is a novel molecular magnetic resonance imaging (MRI) technique that can noninvasively detect cytosolic endogenous mobile proteins and peptides involved in the myelination process, and may be useful for providing insights into brain development.
To assess the contribution of amide proton transfer-weighted (APTw) imaging and magnetization transfer (MT) imaging to the evaluation of children with developmental delay (DD).
Fifty-one patients with DD were recruited to this study. The patients were divided into two groups according to the state of myelination assessed on conventional magnetic resonance imaging (MRI). Thirty patients (10 girls, 20 boys; age range: 1-8 months; median age: 4 months) in group A showed delayed myelination on MRI, while 21 patients (3 girls, 18 boys; age range: 12-36months; median age: 25months) in group B showed normal myelination on MRI. Fifty-one age- and sex-matched children with normal developmental quotient (DQ) and normal MRI appearance were recruited as normal controls. Three-slice APTw/MT axial imaging was performed at the level of the centrum semiovale, the basal ganglia and the pons. Quantitative data of the MT ratio (MTR) and APTw were analyzed for multiple brain regions. Independent-sample -tests were used to compare differences in APTw and MTR signals between the two DD groups and normal controls. Analysis of Covariance was conducted to correct the statistical results. The level of statistical significance was set to 0.05.
For group A, the MTR values were lower in all regions ( 0.004-0.033) compared with the normal controls, while the APTw values were higher in the pons, middle cerebellar peduncle, corpus callosum, frontal white matter, occipital white matter and centrum semiovale ( 0.004-0.040 ). For Group B, the MTR values were slightly reduced, and the APTw values were slightly increased compared with the normal controls, but the differences were not statistically significant ( 0.05).
For DD patients showing signs of delayed myelination on MRI, MTR and APTw imaging can help to diagnose myelination delay by quantifying semi-solid macromolecules and cytosolic endogenous mobile proteins and peptides at a molecular level, providing a new method for comprehensive evaluation of DD. For DD patients with normal myelination on MRI, the clinical values of MTR and APTw imaging remain to be explored.
发育迟缓儿童的大脑发育过程尚不清楚。酰胺质子转移加权（APTw）成像技术是一种新型分子磁共振成像（MRI）技术，它可以无创检测参与髓鞘形成过程的胞质内源性移动蛋白和肽，可能有助于深入了解大脑发育情况。
评估酰胺质子转移加权（APTw）成像和磁化传递（MT）成像在发育迟缓（DD）儿童评估中的作用。
招募51例发育迟缓患者进行本研究。根据常规磁共振成像（MRI）评估的髓鞘形成状态将患者分为两组。A组30例患者（10名女孩，20名男孩；年龄范围：1 - 8个月；中位年龄：4个月）在MRI上显示髓鞘形成延迟，而B组21例患者（3名女孩，18名男孩；年龄范围：12 - 36个月；中位年龄：25个月）在MRI上显示髓鞘形成正常。招募51名年龄和性别匹配、发育商（DQ）正常且MRI表现正常的儿童作为正常对照。在半卵圆中心、基底神经节和脑桥水平进行三层APTw/MT轴位成像。分析多个脑区的MT比率（MTR）和APTw的定量数据。采用独立样本t检验比较两组发育迟缓患者与正常对照之间APTw和MTR信号的差异。进行协方差分析以校正统计结果。统计学显著性水平设定为P < 0.05。
对于A组，与正常对照相比，所有区域的MTR值均较低（P < 0.004 - 0.033），而脑桥、小脑中脚、胼胝体、额叶白质、枕叶白质和半卵圆中心的APTw值较高（P < 0.004 - 0.040）。对于B组，与正常对照相比，MTR值略有降低，APTw值略有升高，但差异无统计学意义（P > 0.05）。
对于MRI显示有髓鞘形成延迟迹象的发育迟缓患者，MTR和APTw成像可通过在分子水平定量半固体大分子以及胞质内源性移动蛋白和肽来帮助诊断髓鞘形成延迟，为发育迟缓的综合评估提供了一种新方法。对于MRI上髓鞘形成正常的发育迟缓患者，MTR和APTw成像的临床价值仍有待探索。
