ABSTRACT
Objective To explore the relationship between MRI findings and defecation function after laparoscopic?assisted anorectal pull?through for anorectal malformations. Methods A retrospective cohort study focused on the findings of MRI performed after laparoscopic?assisted anorectal pull?through for anorectal malformations and no spinal deformity was present in all patients who are currently older than 3 years. Forty?two patients aged from 3 to 16 years (median age was 4 years), whom accepted operation at 3 months to 13 years old(median age was 5 months), and MRI was carried out in 2 to 5 months after operation (median time was 3 months). The MRI manifestations including the relationship between the anorect and the high muscle complex(RAHMC), anorectal angle(AA); the relationship between the anorect and the low muscle complex(RALMC), the rectal maximum diameter(RMD), the fat tissue interposition(FTI) and the development of pelvic floor muscle(PFM) were reviewed and summarized. Statistically, the differences of MRI manifestations in different defecation function index, including the degree of voluntary bowel movements, soiling, constipation and Krickenbeck score were evaluated respectively with Chi?square test or rank sum test. Results statistically, There was significant differences among the groups with different degree of voluntary bowel movements, soiling and Krickenbeck score in the RAHMC (P<0.05), and AA was correlated with the degree of voluntary bowel movements, soiling, constipation and Krickenbeck score(P<0.05), but no significant differences was found among the groups with different defecation function index in the RALMC, the RMD, the FTI and the development of PFM(P>0.05). Conclusions The deviation of the anorect from the high muscle complex which showed in the postoperative MRI pictures suggested the poor prognosis, and well?developed pelvic floor muscles which indicated in the MRI was not the sufficient predictor for good outcome. Postoperative anorectal angle obtained in the MRI can be used as an objective indicator of prognosis.
ABSTRACT
Objective To detect the differences of grey matter volume between the patients with mental retardation (MR) presented clinically as operation deficit (OD) or as language deficit (LD) and the children with typical normal development using optimal VBM.The developmental connections between brain gray matter and language or operation skills were examined.Methods Magnetic resonance imaging was obtained from 9 children with mental retardation presented as OD predominantly and 11 children with mental retardation presented as LD mainly,as well as the age-matched control group (11 and 14 normal children,respectively) on a 1.5 T scanner.Voxel-based morphometry analysis with an optimization of spatial segmentation and normalization procedures was applied to compare the volume of grey matter between the two groups (OD VS.control; LD VS.control).Statistically,the total and local gray matter volumes were compared between the two groups with t test.Results The total gray matter volume of OD group was [(1.030 ± 0.078) × 106 mm3].Compared to that of controls [(0.984 ± 0.058) × 106 mm3],it was increased significantly (t =-2.6,P ＜ 0.05).And the gray matter volume in the posterior cingulated gyrus,left superior prefrontal gyrus,left cuneus,left middle prefrontal gyrus and the body of left caudate nucleus showed significantly increased.Meanwhile,the total gray matter volume of the MR children presented as LD [(1.002 ± 0.068) × 106 mm3] showed significantly increased(t =-3.0,P ＜ 0.05) compared with that of control group [(0.957 ±0.057) × 106 mm3].The gray matter volume in bilateral thalami,the left inferior temporal gyrus,the left inferior frontal gyrus,and the left cerebellum of the LD group was more than that of normal children.Conclusion As revealed by VBM,there are differences in alterations of gray matter volume between MR children presented with OD and with LD relative to control.
ABSTRACT
Objective To detect brain structural difference between children with unexplained mental retardation and children with typically normal development. Methods The high-resolution magnetic MR imaging were obtained from 21 children with unexplained mental retardation and 30 age-matched control children without intellectual disabilities. Voxel-based morphometry analysis with an optimization of spatial segmentation and normalization procedures were applied to compare differences of gray matter volume between the two groups. The total and regional gray matter volume were compared between the two groups with independent t test. Meanwhile, correlation was conducted to analyze the relationship between the total gray matter volume and intelligence quotient (IQ) with partial correlation test. Results The total gray matter volume was significantly increased in the mental retardation children [(1. 012 ±0. 079) × 106 mm3]in relative to the controls [(0. 956 ± 0. 059) × 106 mm3, t = - 2. 80, P ＜ 0. 05]. Compared to controls,children with unexplained mental retardation showed significantly increased gray matter volume in different regions, including the bilateral thalami, the bilateral superior frontal gyri, the bilateral gyri rectus, the bilateral temporal poles, the right inferior frontal gyrus, right parahippocampal gyrus and the right cerebellum. No correlation was detected between the total gray matter volume and IQ in children with mental retardation (r = 0. 078 ,P ＞ 0. 05). Conclusions VBM would detect the gray matter abnormalities that were not founded in routine MR scanning. The increase of gray matter volume in the frontal-thalamus network might indicate the delayed maturation of the brain development. This might be one of the causations of mental retardation in children.