Magnetic Resonance Imaging Outcomes From a Comprehensive Magnetic Resonance Study of Children With Fetal Alcohol Spectrum Disorders
Magnetic Resonance Imaging Outcomes From a Comprehensive Magnetic Resonance Study of Children With Fetal Alcohol Spectrum Disorders
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DOI：
10.1111/j.1530-0277.2009.01004.x
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发表时间：
2009-10-01
影响因子：
3.2
通讯作者：
Richards, Todd
中科院分区：
文献类型：
--
作者：
Astley, Susan J.;Aylward, Elizabeth H.;Richards, Todd
背景：磁共振（MR）技术为体内评估神经异常提供了无创方法。方法：对患有胎儿酒精谱系障碍（FASD）的儿童进行全面的神经心理学/精神病学评估，结合磁共振成像（MRI）、磁共振光谱（MRS）和功能磁共振成像（fMRI）评估，以确定是否可以识别出整体和/或局灶性异常，并区分整个谱系的诊断亚分类。4个研究组包括：(i)胎儿酒精综合征(FAS)/部分FAS (PFAS)；静态脑病/酒精暴露（SE/AE）；（iii）被诊断患有FASD 4位代码的神经行为障碍/酒精暴露（ND/AE）；（四）没有产前酒精接触的健康同伴。这里展示的是用于比较四组大脑区域大小的MRI评估结果。神经心理/行为、MRS和fMRI结果分别报告。结果：从对照组到ND/AE，再到SE/AE，再到FAS/PFAS 4个研究组，总脑、额叶、尾状核、壳核、海马、小脑蚓部和胼胝体长度的平均绝对尺寸呈递增性显著减小。与所有其他组相比，FAS/PFAS组（唯一具有4趾FAS面部表型的组）的额叶不成比例地小。与ND/AE组和对照组相比，FAS/PFAS组和SE/AE组（中枢神经系统（CNS）功能最严重的2组）的尾状核区明显较小。FAS/PFAS组、SE/AE组和ND/AE组中有1个或更多脑区、2个或更多sd低于对照组平均大小的比例分别为78.8%、58%和43%。大脑区域的大小与产前酒精暴露水平、FAS面部表型的大小和中枢神经系统功能障碍水平之间存在显著相关性。结论：磁共振成像进一步验证了ND/AE、SE/AE和FAS/PFAS是FASD四位数编码定义的3个临床不同且越来越受影响的诊断亚分类。神经结构异常普遍存在。一旦建立了以人群为基础的人脑结构发育规范，MRI可以重要地增强FASD下的疾病诊断。
Background:Magnetic resonance (MR) technology offers noninvasive methods for in vivo assessment of neuroabnormalities.Methods:A comprehensive neuropsychological/psychiatric battery, coupled with MR imaging, (MRI), MR spectroscopy (MRS), and functional MRI (fMRI) assessments, were administered to children with fetal alcohol spectrum disorders (FASD) to determine if global and/or focal abnormalities could be identified, and distinguish diagnostic subclassifications across the spectrum. The 4 study groups included: (i) fetal alcohol syndrome (FAS)/partial FAS (PFAS); (ii) static encephalopathy/alcohol exposed (SE/AE); (iii) neurobehavioral disorder/alcohol exposed (ND/AE) as diagnosed with the FASD 4-Digit Code; and (iv) healthy peers with no prenatal alcohol exposure. Presented here are the MRI assessments that were used to compare the sizes of brain regions between the 4 groups. The neuropsychological/behavioral, MRS, and fMRI outcomes are reported separately.Results:Progressing across the 4 study groups from Controls to ND/AE to SE/AE to FAS/PFAS, the mean absolute size of the total brain, frontal lobe, caudate, putamen, hippocampus, cerebellar vermis, and corpus callosum length decreased incrementally and significantly. The FAS/PFAS group (the only group with the 4-Digit FAS facial phenotype) had disproportionately smaller frontal lobes relative to all other groups. The FAS/PFAS and SE/AE groups [the 2 groups with the most severe central nervous system (CNS) dysfunction] had disproportionately smaller caudate regions relative to the ND/AE and Control groups. The prevalence of subjects in the FAS/PFAS, SE/AE, and ND/AE groups that had 1 or more brain regions, 2 or more SDs below the mean size observed in the Control group was 78, 58, and 43%, respectively. Significant correlations were observed between size of brain regions and level of prenatal alcohol exposure, magnitude of FAS facial phenotype, and level of CNS dysfunction.Conclusions:Magnetic resonance imaging provided further validation that ND/AE, SE/AE, and FAS/PFAS as defined by the FASD 4-Digit Code are 3 clinically distinct and increasingly more affected diagnostic subclassifications under the umbrella of FASD. Neurostructural abnormalities are present across the spectrum. MRI could importantly augment diagnosis of conditions under the umbrella of FASD, once population-based norms for structural development of the human brain are established.