Clinical and Experimental Pediatrics

대한소아청소년과학회 (The Korean Pediatric Society)
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편마비를 가진 뇌성마비 환아에서 확산 텐서강조영상을 이용한 3차원 피질척수로 영상의 유용성

Usefulness of DTI-based three dimensional corticospinal tractography in children with hemiplegic cerebral palsy

  • 여지현 (영남대학교 의과대학 소아과학교실) ;
  • 손수민 (영남대학교 의과대학 재활의학교실) ;
  • 이은실 (영남대학교 의과대학 소아과학교실) ;
  • 문한구 (영남대학교 의과대학 소아과학교실)
  • Yeo, Ji Hyun (Department of Pediatrics, the Department of Physical Medicine College of Medicine, Yeungnam Univeristy) ;
  • Son, Su Min (Department of Pediatrics, the Department of Rehabilitation College of Medicine, Yeungnam Univeristy) ;
  • Lee, Eun Sil (Department of Pediatrics, the Department of Physical Medicine College of Medicine, Yeungnam Univeristy) ;
  • Moon, Han Ku (Department of Pediatrics, the Department of Physical Medicine College of Medicine, Yeungnam Univeristy)
  • 투고 : 2008.09.02
  • 심사 : 2008.10.16
  • 발행 : 2009.01.15
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초록

목 적 : 편마비를 가진 뇌성마비 환아에서 확산 텐서강조영상을 이용한 3차원 피질척수로 영상의 이상 소견의 유형과 임상적인 소견과의 일치도를 알아보기 위하여 연구를 시행하였다. 방 법 : 2003년 3월부터 2007년 8월까지 영남대학교 의과대학 부속병원 소아과 및 재활의학과에서 확산 텐서강조영상 검사를 시행했던 편마비를 가진 뇌성마비 환아 13예를 대상으로 FACT기법을 사용하여 피질척수로의 3차원 신경섬유로 영상을 재구성하여 분석하였다. 기본 관심영역은 전 뇌교, 두 번째 관심영역은 전 수질을 통과하는 피질척수로로 설정하여 두 부위를 동시에 통과하는 신경섬유로를 최종 관심 신경섬유로로 하였다. 분할비등방도와 각의 종료 기준은 각각 0.3과 70도로 하였다. 결 과 : 삼차원 피질척수로 영상에서 이상 소견으로는 피질척수로의 단절과 신경섬유의 양적 감소, 피질척수로의 무형성, 횡뇌량 신경섬유 그리고 비정상적인 피질척수로의 재구성 등의 유형이 있었으며 전체 13예 중 피질척수로의 단절이 10예(76.9%), 신경섬유의 양적 감소가 8예(61.5%)에서 관찰되었다. 피질척수로의 무형성은 3예(23.1%)에서 관찰되었고 횡뇌량 신경섬유로는 2예(15.4%), 비정상적인 피질척수로의 재구성은 4예(30.8%)에서 관찰되었다. 임상적인 소견과 3차원 피질척수로의 이상소견이 일치되는 예가 13예 중 11예(84.6%)였다. 결 론 : 확산 텐서강조영상을 이용한 3차원 피질척수로 영상은 다양한 이상 소견과 임상적인 소견과의 높은 일치도를 보여 편마비 뇌성마비의 진단과 치료에 매우 유용한 검사로 사용될 수 있다고 생각된다. 그러나 향후 검사법의 표준화 등 보완을 요하는 연구가 더 필요하다고 생각된다.

Purpose : Magnetic resonance diffusion tensor imaging-based three-dimensional fiber tractography (DTI-FT) is a new method which demonstrates the orientation and integrity of white matter fibers in vivo. However, clinical application on children with cerebral palsy is still under investigation. We present various abnormal patterns of DTI-FT findings and accordance rate with clinical findings in children with hemiplegic cerebral palsy, to recognize the use fulness of DTI-FT. Methods : The thirteen children with hemiplegic cerebral palsy evaluated at Yeungnam University hospital from March, 2003 to August, 2007 were enrolled in this study and underwent magnetic resonance DTI-FT of the corticospinal tracts. Two regions of interest (ROI) were applied and the termination criteria were fractional anisotropy ${\geq}0.3$, angle ${\leq}70^{\circ}$. Results : The patterns and distribution of abnormal DTI-based corticospinal tractographic findings were interruption(10 cases, 76.9%), reduction of fiber volume (8 cases, 61.5%), agenesis of corticospinal tract (3 cases, 23.1%), transcallosal fiber (2 cases, 15.4%) and, aberrant corticospinal tracts (4 cases, 30.8%). Abnormal DTI-based corticospinal tractographic findings were in accordance with the clinical findings of cerebral palsy in 84.6% of the enrolled patients. Conclusion : Our results suggest that DTI-FT would be a use ful modality in the assessment of the corticospinal tract abnormalities in children with hemiplegic cerebral palsy.

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참고문헌

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