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目的探讨儿童脑室周围白质软化(PVL)MRI表现与临床症状的相关性。方法选取本科47例PVL患儿,回顾性调查其围生期感染、出生体质量、胎龄及窒息情况;分析其MRI表现,包括脑室周围异常高信号、脑室扩大、皮质损伤、脑白质减少程度和胼胝体发育不良,进行PVL、脑性瘫痪(脑瘫)程度及语言障碍分级及视听觉筛查、智力检测,语言发育明显落后的患儿进行孤独症筛查:≥2岁应用孤独症行为量表(ABC),<2岁应用孤独症儿童评定量表(CARS),有抽搐发作的患儿进行脑电图(EEG)检查。分析PVL分级与胎龄、出生体质量、围生期感染、窒息、脑瘫及语言障碍程度、视听觉障碍、智力及癫的相关性。结果 47例患儿中3例运动发育正常,其中完全性耳聋2例,孤独症1例,余44例均诊断为脑瘫,其中听力障碍24例,视觉障碍19例,其中1例皮质盲,发育商正常仅1例,并癫发作11例,其中West综合征2例。按照白质异常信号的范围、脑室扩大及白质减少程度、胼胝体发育情况及有无皮质损害将PVL分为3级,其中Ⅰ级14例,Ⅱ级21例,Ⅲ级12例。围生期感染可导致PVL分级上升(P=0.011);胎龄、出生体质量、窒息与PVL分级无明显相关性(P>0.05);随着PVL级别的上升,脑瘫、智力低下程度加重(P=0.019、0.000),视觉障碍增多(P=0.024);脑白质减少程度与语言障碍、智力低下、听觉障碍程度及视觉障碍均有相关性(P=0.000、0.000、0.001、0.000);脑室扩大程度与语言发育障碍、智力低下程度及视觉障碍有明显相关性(P=0.000、0.000、0.000);伴随皮质损害时,听觉障碍程度加重(P=0.000);胼胝体发育不良时,脑瘫、语言障碍、智力低下程度加重(P=0.008、0.001、0.000);癫的发生与PVL分级及MRI表现无明显相关。结论减少围生期感染可减轻PVL程度;PVL影响患儿的运动、语言、视听觉及智力发育,其MRI表现可反映临床及预后,程度越重,预后越差,合并胼胝体发育不良时预后不良。
Objective To investigate the correlation between periventricular leukomalacia (PVL) MRI manifestations and clinical symptoms in children. Methods Forty-seven children with PVL were enrolled in this study. The perinatal infection, birth weight, gestational age and asphyxia were retrospectively analyzed. The MRI findings including abnormally high signal around the periventricular compartment, ventricular enlargement, cortical injury, And corpus callosum dysplasia, PVL, cerebral palsy (cerebral palsy) and the degree of language impairment and visual and audio screening, mental testing, language development significantly behind the autistic children with autism screening: ≥ 2-year-old autism behavior scale (ABC), <2-year-old autistic children assessment scale (CARS), and electrocardiogram (EEG) examination in children with convulsions. The correlation between PVL grading and gestational age, birth weight, perinatal infection, apnea, cerebral palsy and degree of speech impairment, visual impairment, intelligence and epilepsy were analyzed. Results Among the 47 cases, 3 cases had normal motor development. Among them, 2 cases of complete deafness, 1 case of autism and 44 cases of cerebral palsy were diagnosed. Among them, 24 cases were hearing impairment and 19 cases were visual impairment. One case was cortical blindness and development Only 1 normal business, and epileptic seizures in 11 cases, including West syndrome in 2 cases. According to the range of white matter abnormal signal, ventricular enlargement and white matter reduction, the development of the corpus callosum and the presence or absence of cortical damage PVL is divided into three levels, of which 14 cases of grade Ⅰ, Ⅱ 21 cases, Ⅲ grade 12 cases. There was no significant correlation between gestational age, birth weight, asphyxia and PVL grading (P> 0.05). PVL grade increased cerebral palsy and mental retardation (P = 0.011) (P = 0.019,0.000), visual impairment increased (P = 0.024); the degree of white matter reduction was related to language dysfunction, mental retardation, degree of hearing impairment and visual impairment (P = 0.000,0.000,0.001,0.000) (P = 0.000,0.000,0.000). With the increase of cortical damage, the degree of hearing impairment aggravated (P = 0.000). When the corpus callosum was dysplasia, cerebral palsy, language Obstacles, mental retardation increased (P = 0.008,0.001,0.000); epilepsy incidence and PVL grading and MRI showed no significant correlation. CONCLUSIONS: Reduction of perinatal infection can reduce the degree of PVL. PVL affects the motor, language, audiovisual and intellectual development of children. The MRI findings may reflect the clinical and prognosis. The more severe and the poorer the prognosis, the worse the prognosis of patients with corpus callosum dysplasia .