CIPark脑瘫早期的神经成像诊断
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Purpose : To compare Brain MRI and SPECT findings in children with cerebral palsy
Subject : 60 children with cerebral palsy 1) Spastic diplegia : 44 pts 2) Spastic qudriplegia : 11 pts 3) Spastic hemiplegia : 2 pts 4) Athetoid type : 3 pts
Brain MRI : normal
Brain SPECT : severely decreased perfusion in bilateral thalamus &
left basal ganglia
1st AOCPRM
Brain MRI Findings in Cerebral Palsy (1)
1st AOCPRM
The Early Diagnosis of Cerebral Palsy -Recently advanced neuroimaging techniques-
Chang-il Park M.D., Ph.D.
Department and Research Institute of Rehabilitation Medicine Yonsei University College of Medicine, Seoul, Korea
Park et al. (1997, J Korean Acad Rehabil Med)
1st AOCPRM
Brain SPECT Findings in Cerebral Palsy
▪ Hypoperfusion in bilateral thalamus
1st AOCPRM
Brain MRI & SPECT Findings in CP spastic diplegia
Brain MRI : Loss of periventricular white matter
Brain SPECT : Markedly decreased perfusion in bilateral thalamus
1st AOCPRM
Brain MRI & SPECT Findings in CP Athetoid Type
29(48.3)
Thalamus abnormality
6(10.0)
Delayed myelination
5 ( 8.3)
Central sulcus abnormality
3( 5.0)
Basal ganglia abnormality
3( 5.0)
1st AOCPRM
Brain SPECT Findings in Cerebral Palsy (1)
1st AOCPRM
Questions ?
1. Is PVL the etiologic factor in the pathogenesis of spastic type of CP ?
2. Is the damage of the corticospinal tract caused by PVL ?
occuring in the perinatal period (commonly occuring between 24 to 34 weeks)
1st AOCPRM
Pathology of PVL
Focal necrosis in the periventricular region Diffuse reactive gliosis in the surrounding
Park et al. (1997, J Korean Acad Rehabil Med)
SPECT findings Normal Abnormal hypoperfusion
Thalamus Cerebellum Cortex except temporal ቤተ መጻሕፍቲ ባይዱobe Basal ganglia Temporal lobe Central sulcus
Park et al. (1997, J Korean Acad Rehabil Med)
(N = 60 )
MRI findings
No. of Cases(%)
Normal
15(25.0)
Abnormal
White matter abnormality
37(61.7)
Corpus callosum abnormality
3. Is the spasticity and motor dysfunction of CP caused by damaged corticospinal tract ?
1st AOCPRM
Brain MRI and SPECT Findings in Children with Cerebral Palsy
MRI Evaluation
Highly sensitive to detect gross structural abnormalities in CP
Periventricular Leukomalacia in MRI
Leading cause of chronic motor disability Damage of the immature cerebral white matter,
( N = 60 )
No. of Cases(%) 1( 1.7)
58(96.7) 27(45.0) 26(43.0) 23(38.3) 22(36.7)
3(5.0)
1st AOCPRM
white matter
1st AOCPRM
Major Interacting Factors of PVL
Incomplete development of the vascular supply to the cerebral white matter
Maturation-dependent impairment in regulation of cerebral blood flow
Subject : 60 children with cerebral palsy 1) Spastic diplegia : 44 pts 2) Spastic qudriplegia : 11 pts 3) Spastic hemiplegia : 2 pts 4) Athetoid type : 3 pts
Brain MRI : normal
Brain SPECT : severely decreased perfusion in bilateral thalamus &
left basal ganglia
1st AOCPRM
Brain MRI Findings in Cerebral Palsy (1)
1st AOCPRM
The Early Diagnosis of Cerebral Palsy -Recently advanced neuroimaging techniques-
Chang-il Park M.D., Ph.D.
Department and Research Institute of Rehabilitation Medicine Yonsei University College of Medicine, Seoul, Korea
Park et al. (1997, J Korean Acad Rehabil Med)
1st AOCPRM
Brain SPECT Findings in Cerebral Palsy
▪ Hypoperfusion in bilateral thalamus
1st AOCPRM
Brain MRI & SPECT Findings in CP spastic diplegia
Brain MRI : Loss of periventricular white matter
Brain SPECT : Markedly decreased perfusion in bilateral thalamus
1st AOCPRM
Brain MRI & SPECT Findings in CP Athetoid Type
29(48.3)
Thalamus abnormality
6(10.0)
Delayed myelination
5 ( 8.3)
Central sulcus abnormality
3( 5.0)
Basal ganglia abnormality
3( 5.0)
1st AOCPRM
Brain SPECT Findings in Cerebral Palsy (1)
1st AOCPRM
Questions ?
1. Is PVL the etiologic factor in the pathogenesis of spastic type of CP ?
2. Is the damage of the corticospinal tract caused by PVL ?
occuring in the perinatal period (commonly occuring between 24 to 34 weeks)
1st AOCPRM
Pathology of PVL
Focal necrosis in the periventricular region Diffuse reactive gliosis in the surrounding
Park et al. (1997, J Korean Acad Rehabil Med)
SPECT findings Normal Abnormal hypoperfusion
Thalamus Cerebellum Cortex except temporal ቤተ መጻሕፍቲ ባይዱobe Basal ganglia Temporal lobe Central sulcus
Park et al. (1997, J Korean Acad Rehabil Med)
(N = 60 )
MRI findings
No. of Cases(%)
Normal
15(25.0)
Abnormal
White matter abnormality
37(61.7)
Corpus callosum abnormality
3. Is the spasticity and motor dysfunction of CP caused by damaged corticospinal tract ?
1st AOCPRM
Brain MRI and SPECT Findings in Children with Cerebral Palsy
MRI Evaluation
Highly sensitive to detect gross structural abnormalities in CP
Periventricular Leukomalacia in MRI
Leading cause of chronic motor disability Damage of the immature cerebral white matter,
( N = 60 )
No. of Cases(%) 1( 1.7)
58(96.7) 27(45.0) 26(43.0) 23(38.3) 22(36.7)
3(5.0)
1st AOCPRM
white matter
1st AOCPRM
Major Interacting Factors of PVL
Incomplete development of the vascular supply to the cerebral white matter
Maturation-dependent impairment in regulation of cerebral blood flow