This study was planned to evaluate the Magnetic Resonance Imaging(MRI) findings in assessment of the CP patients with periventricular leukomalacia(PVL) on brain MRI and to analyze the neurodevelopmental outcome in those patients in comparison with the extent of PVL on brain MRI findings. Brain MRI study was performed in 50 children with CP evaluated at Department of Rehabilitation Medicine, St. Mary's Hospital, Catholic University Medical College, between March 1991 and July 1994. Of the 50 children, 20 children showed PVL on brain MRI. Besides brain MRI, evaluation consisted of patients; ① medical, developmental, family and pregnancy histories, ② physical examination including assessment of spontaneous motility from the standardized tests by Vojta and Bobath, primitive reflexes and Vojta's Postural Reactions, ③ developmental assessment (MFED: Münchener Functionelle Entwichlungs Diagnostik). Motor age and motor quotient(M.Q.) was estimated from the standardized test by Vojta and Bobath. Developmental quotient(D.Q.) was also estimated from MFED in perceptual, speech, social and selfhelp areas. And the mean of D.Q. in above 4 areas was also estimated. To analyze the brain MRI findings of PVL, abnormalities on the MRI were divided into 4 categories: ① distribution of highsignalintensity areas on T2 images within the cerebral white matter, ② degree of ventriculomegaly, ③ degree of brain atrophy, ④ extent of myelination. From the distribution of high-signal-intensity areas on T2 images within the cerebral white matter, localized or extensive PVL was defined. Localized PVL refers to lesions involving 1 lobe or 2 lobes and extensive PVL refers to lesions involving 3 lobes. Range and mean±standard deviation(S.D.) of M.Q. and D.Q. were obtained in localized and extensive PVL lesions. The results were as follows: 1) The number of the distribution of high-signal intensity areas on T2 images within the cerebral white matter was 19 cases(46.3%) in occipital lobe, 10 cases(24.4%) in frontal lobe, 8 cases(19.5%) in parietal lobe, 4 cases(9.8%) in temporal lobe. 2) The number of the cases was 11 cases(55%) in localized PVL lesion, and 9 cases(45%) in extensive PVL lesion. 3) The number of the cases was 9 cases(45%) in no dilatation of ventricle, 11 cases(55%) in mild to moderate dilatation of ventricle. 4) The number of the cases was 7 cases(35%) in no brain atrophy, 9 cases(45%) in mild brain atrophy, 3 cases(15%) in moderate brain atrophy, 1 cases(5%) in severe brain atrophy. 5) The number of the cases was 12 cases(60%) in no delay in myelination, and 8 cases(40%) in delayed myelination. 6) Range and mean±S.D. of M.Q. were 11 80(43.2±21.1) in localized PVL and 10~67(35.5±16.0) in extensive PVL. 7) Range and mean±S.D. of the mean of D.Q. in perceptual, speech and social areas by MFED for 1-year-old children were 59~87(78.1±11.0) in localized PVL and 30~93(60.5±25.7) in extensive PVL. Range and mean±S.D. of the mean of D.Q. in perceptual, speech, social and self-help areas by MFED for 2-year-old children were 76~102(83±9.5) in localized PVL and 65~87(77.4±11.6) in extensive PVL. In summary, the data obtained in this study would be helpful for estimating neurodevelopmental prognosis of the CP patients with PVL on brain MRI. |