目的 采用基于T1WI的病灶映射方法刻画新生儿局灶性脑白质损伤(punctate white matter lesions,PWML)的好发区域并探究其时空分布规律.材料与方法 回顾性纳入PWML新生儿94例,其中轻度损伤60例(早产/足月:24/36),重度损伤34例(早产/足月:20/14).基于T1WI手动标记病灶,与约翰霍普金斯大学新生儿T1WI模板配准后叠加图谱,最终生成PWML概率映射图并计算病灶在不同区域的分布概率.对轻重度PWML组间以及不同分组内早产与足月儿各脑叶病灶体积进行比较.结果 轻度PWML的分布均以颞顶叶为主(病灶体积于颞顶叶>额叶>枕叶,P<0.008),尤其是丘脑后辐射、角回及缘上回;早产儿损伤范围较足月儿增加,且向额叶延伸.重度PWML主要分布于额颞顶叶(病灶体积于额颞顶叶>枕叶,P<0.008),早产与足月损伤分布范围较为一致,共同累及的区域包括丘脑后辐射、角回及上放射冠.结论 基于T1WI的病灶概率映射于脑区水平细化了不同程度PWML病灶的时空分布特征,为深入理解PWML的病理生理机制及预后评估提供了解剖基础.
Evaluation of spatiotemporal distribution of neonatal punctate white matter lesions based on probabilistic lesion mapping
Objective:To detailed the common location of neonatal punctate white matter lesions (PWML) and further investigate the spatiotemporal distribution based on the probabilistic lesion mapping of T1WI. Materials and Methods:A total of 94 neonates with PWML were retrospectively enrolled,including 60 mild type (preterm/term 24/36) and 34 severe type (preterm/term 20/14). The manually labeled lesions on each neonatal T1WI was registered to the John Hopkins University template and further added to the corresponding atlas. The probabilistic PWML map and values were then generated based on the cumulative number of PWML lesions that occurred in homologous brain regions across participants in the standard atlas. The PWML volume between mild and severe groups and between preterm and term neonates within groups were further compared. Results:Mild PWML were mainly distributed in temporal and occipital lobes (lesion volume was larger in the tempor-parietal lobes than that in the frontal and occipital lobes,P<0.008),especially in the posterior thalamic radiation,angular gyrus and supramarginal gyrus. The injury was extensive in the preterm than the term,and extended to the frontal lobe. Severe injury was extensively involved the fronto-tempor-occipital lobes (lesion volume was larger in the fronto-tempor-occipital lobes than that in the occipital lobe,P<0.008). The distribution range of preterm and term PWML is relatively consistent,and the common involved areas include posterior radiation of thalamus,angular gyrus and superior corona radiata. Conclusions:The T1WI based lesion probabilistic mapping defined the spatio-temporal distribution characteristics of neonatal PWML at brain region level. This provides an anatomical basis for further understanding the pathophysiological mechanism and prognosis evaluation of PWML.
neonatespunctate white matter lesionsmagnetic resonance imaginglesion distributionlesion probabilistic mapping
万方数据
维普
