1Division of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Departments of2Radiology and.
J Neurosurg Pediatr. 2024 Jun 7;34(3):268-277. doi: 10.3171/2024.4.PEDS23589. Print 2024 Sep 1.
The aims of this study were to 1) assess and quantify white matter (WM) microstructural characteristics derived from diffusion tensor imaging (DTI) in children with cerebral palsy (CP) prior to selective dorsal rhizotomy (SDR), and 2) investigate potential associations between WM diffusion properties and gross motor function and spasticity in children with spastic CP who underwent SDR.
This study is a multisite study based on DT images acquired prior to SDR as well as postoperative outcome data. DTI data collected from two sites were harmonized using the ComBat approach to minimize intersite scanner difference. The DTI abnormalities between children with spastic CP and controls were analyzed and correlated with the severity of impaired mobility based on the Gross Motor Function Classification System (GMFCS). The improvement in gross motor function and spasticity after SDR surgery was assessed utilizing the Gross Motor Function Measure-66 (GMFM-66), the Modified Tardieu Scale (MTS), and the modified Ashworth scale (MAS). Alterations in these outcome measures were quantified in association with DTI abnormalities.
Significant DTI alterations, including lower fractional anisotropy (FA) in the genu of the corpus callosum (gCC) and higher mean diffusivity (MD) in the gCC and posterior limb of the internal capsule (PLIC), were found in children in the SDR group when compared with the age-matched control group (all p < 0.05). Greater DTI alterations (FA in gCC and MD in gCC and PLIC) were associated with lower mobility levels as determined based on GMFCS level (p < 0.05). The pre- to post-SDR improvement in motor function based on GMFM-66 was statistically significant (p = 0.006 and 0.002 at 6-month and 12-month follow-ups, respectively). The SDR efficacy was also identified as improving spasticity in lower-extremity muscle groups assessed with the MTS and MAS. Partial correlation analysis presented a significant association between pre- to post-SDR MTS alteration and DTI abnormalities.
The findings in the present study provided initial quantitative evidence to establish the WM microstructural characteristics in children with spastic CP prior to SDR surgery. The study generated data for the association between baseline DTI characteristics and mobility in children with CP prior to SDR surgery. The study also demonstrated SDR efficacy in improving motor function and spasticity based on the GMFM-66, MTS, and MAS, respectively, in association with DTI data.
本研究旨在：1）评估和量化接受选择性脊神经后根切断术（SDR）前脑瘫（CP）儿童的弥散张量成像（DTI）衍生的白质（WM）微观结构特征；2）研究 SDR 后痉挛型 CP 儿童 WM 扩散特性与运动功能和痉挛之间的潜在关联。
本研究是一项基于 SDR 前的 DT 图像和术后结果数据的多中心研究。使用 ComBat 方法对来自两个地点的数据进行调和，以最大程度地减少站点间扫描仪差异。分析痉挛型 CP 患儿与对照组之间的 DTI 异常，并基于粗大运动功能分类系统（GMFCS）与运动障碍严重程度相关联。利用粗大运动功能测量-66 量表（GMFM-66）、改良 Tardieu 量表（MTS）和改良 Ashworth 量表（MAS）评估 SDR 手术后运动功能和痉挛的改善情况。与 DTI 异常相关联，量化这些结局测量的变化。
与年龄匹配的对照组相比，SDR 组患儿胼胝体膝部（gCC）的部分各向异性（FA）降低，gCC 和内囊后肢（PLIC）的平均弥散度（MD）升高，差异有统计学意义（均 p < 0.05）。FA 在 gCC 和 MD 在 gCC 和 PLIC 方面的 DTI 改变越大，运动功能水平越低，GMFCS 分级越高（p < 0.05）。基于 GMFM-66，SDR 后运动功能的改善具有统计学意义（6 个月和 12 个月随访时分别为 p = 0.006 和 0.002）。MTS 和 MAS 评估的下肢肌肉群的 SDR 疗效也被确定为改善痉挛。偏相关分析显示，SDR 前后 MTS 变化与 DTI 异常之间存在显著关联。
本研究提供了初步的定量证据，确立了 SDR 手术前痉挛型 CP 儿童 WM 微观结构特征。该研究生成了与 SDR 手术前 CP 儿童的基线 DTI 特征与运动功能相关联的数据。该研究还基于 GMFM-66、MTS 和 MAS 分别证明了 SDR 疗效，分别与 DTI 数据相关联，改善了运动功能和痉挛。
