Periventriküler Lökomalazi: Pediatrik Vakalarda Beyin MR’ında Parankimal Sinyal ve Hacim Değişikliklerinin Sağlıklı Akranlarla Karşılaştırılması

Year 2024, Volume: 34 Issue: 4, 547 - 553, 31.08.2024

Hanife Gülden Düzkalır , İrem Sarı , Fulden Cantaş Türkiş , Safiye Güneş Sağer , Emine Çalışkan , Tamer Baysal

https://doi.org/10.54005/geneltip.1471245

Abstract

Amaç: Önceki MRG çalışmaları periventriküler lökomalazide (PVL) serebrum ve serebellumun beyaz cevher (BC) ve gri cevher (GC), korpus kallozum (KK) anormalliklerini göstermiştir. Ancak MRG'de BC FLAIR sinyal oranı yeni bir radyolojik yöntem olarak tanı ve takipte kantitatif veri sağlayabilir. Talamik tutulum nöronal hasar ve hastalık şiddeti için bir biyobelirteç olabilir. Bu çalışmada PVL'de serebrum ve serebellumun BC ve GC hacim değişikliklerini, KK yüzey alanını detaylı araştırmayı, talamus L işareti ve FLAIR sinyal oranının tanısal doğruluğunu değerlendirmeyi amaçladık.
Gereç ve Yöntemler: PVL'li 30 pediatrik hastanın ve 42 sağlıklı kontrolün MRG taramaları, BC ve GC hacim değişikliklerini, FLAIR sinyal oranını, KK yüzey alanını ve talamus L işaretini incelemek için analiz edildi. Volümetrik analizler Volbrain programı ile yapıldı.
Bulgular: PVL'de subkortikal BC hacimlerinde azalma saptadık (p<0.001). FLAIR sinyal oranı ile çeşitli GC ve serebellum hacimleri arasında anlamlı pozitif korelasyon bulduk. Talamus L işareti bulgusu olan hastalarda azalmış GC hacmi ve artmış anormal sinyalli BC hacmi gözledik. PVL tanısında en önemli değişken olarak anormal sinyalli BC hacmini bulduk (p>0.001).
Sonuç: Sonuçlarımız PVL'nin saptanmasında, GC değişikliklerinin ve beyin hasarının değerlendirilmesinde MRG'nin rolünü ve hastalığın ciddiyetinin değerlendirilmesinde talamus L işaretinin ve FLAIR sinyal oranının önemini vurgulamaktadır. Bu yönde kapsamlı çalışmalar PVL'de bilişsel ve motor bozuklukları azaltmayı amaçlayan hedefe yönelik tedavi stratejilerinin geliştirilmesine katkıda bulunabilir.

Keywords

periventriküler lökomalazi, beyin hacmi, FLAIR sinyal oranı, talamus L işareti, gri madde, korpus kallozum

Periventricular Leukomalacia: Comparison of Parenchymal Signal and Volume Changes on Brain MRI in Paediatric Cases with Healthy Peers

Abstract

Background/aims: Previous MRI studies have shown white matter (WM) and gray matter (GM) of cerebrum and cerebellum, corpus callosum (CC) abnormalities in periventricular leukomalacia (PVL). But, the WM FLAIR signal ratio in MRI may provide quantitative data in the diagnosis and follow-up, as a new radiologic method. Thalamic involvement may be a biomarker for neuronal damage and disease severity. We aimed to re-investigate both WM and GM volume changes of cerebrum and cerebellum, CC surface area in PVL, and to evaluate the diagnostic accuracy of the thalamus L sign and FLAIR signal ratio.
Methods: MRI scans of 30 pediatric patients with PVL and 42 healthy controls were analyzed to examine WM and GM volume changes, FLAIR signal ratio, CC surface area, and thalamus L sign. Volumetric analyses were done with the Volbrain program.
Results: Decreased subcortical GM volumes were found in PVL (p<0.001). There was a significant positive correlation between FLAIR signal ratio, various GM and cerebellum volumes. In patients with thalamus L sign, decreased GM volume and increased abnormal signaled WM volume were observed. The most important variable in the diagnosis of PVL was abnormally signaled WM volume (p>0.001).
Conclusions: Our results emphasise the role of MRI in the detection of PVL, the evaluation of GM changes and brain damage, and the importance of thalamus L sign and FLAIR signal ratio in the evaluation of the severity of the disease. Comprehensive studies in this direction may contribute to the development of targeted treatment strategies aimed at reducing cognitive and motor impairments in PVL.

Keywords

periventricular leukomalacia, brain volume, FLAIR signal ratio, thalamus L sign, gray matter, corpus callosum

Ethical Statement

Ethical approval: This article does not contain any studies with human participants or animals performed by any of the authors. This study was approved by the local medical ethical committee (2023/514/258/25), and all data was processed anonymously, according to the privacy legislation.

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