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Zhang JJ, Yang YL, Hu J, Zhao CF, He XH, Yang QY, Qi XS, Lu H, He C, Liu H. Development and validation of a novel model based on hand knob score and white matter injury on MRI to predict hand function in children with cerebral palsy. ANNALS OF TRANSLATIONAL MEDICINE 2022; 10:1102. [PMID: 36388818 PMCID: PMC9652546 DOI: 10.21037/atm-22-4112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 09/30/2022] [Indexed: 08/30/2023]
Abstract
BACKGROUND Childhood hand function is considered to be one of the strongest predictors of the ability to participate in daily activities as children with cerebral palsy (CP) reach adulthood. The manual ability classification system (MACS) is currently the most widely used for grading hand function in children with CP. However, the MACS method is subjective and may be affected by the raters' experience. Hand knob is an important control center for hand movement. Therefor this study aimed to develop and validate an objective model for hand function estimation in children with CP and visualize it as a nomogram. METHODS A total of 70 Children (2-12 years old) with CP underwent magnetic resonance imaging (MRI) scanning, MACS assessment. According to MACS, children with CP were divided into mild impairment group (grade I-III) and severe impairment group (grade IV-V). Hand function prediction models based on (I) hand knob score, (II) clinical features, and (III) the combination of clinical features and hand knob score were developed and validated separately. The models were subjected to stepwise regression according to the maximum likelihood method, and the Akaike information criterion was used to select the best model. Model discrimination was assessed using receiver operating characteristic (ROC) and calibration curves. The nomogram was finally built according to the best model. RESULTS The area under the curve (AUC) of the hand knob score model in the training set was 0.752, the clinical features model was 0.819, and the hand knob score and clinical features combined model was 0.880. The AUC of the hand knob score model in the validation set was 0.765, the clinical features model was 0.782, and the combined model was 0.894. The best model was the hand knob score-clinical features combined model, and the nomogram finally incorporated two assessment items: the hand knob score and white matter injury. The estimated probability of hand function injury degree of the combined model displayed good agreement with the actual occurrence probability. CONCLUSIONS The hand knob score-clinical features combined model can be used to preliminarily assess the degree of hand impairment in children with CP, with good calibration.
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Affiliation(s)
- Jing-Jing Zhang
- Department of Radiology, The Affiliated Hospital of Zunyi Medical University, Zunyi, China
- Department of Radiology, Mianyang Hospital of T.C.M, Mianyang, China
| | - Yan-Li Yang
- Department of Radiology, The Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Jie Hu
- Department of Radiology, The Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Chun-Feng Zhao
- Department of Radiology, The Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Xing-Hong He
- Department of Radiology, The Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Qian-Yu Yang
- Department of Radiology, The Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Xiao-Shan Qi
- Department of Radiology, The Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Hong Lu
- Department of Radiology, The Seventh People’s Hospital of Chongqing, The Central Hospital Affiliated to Chongqing University of Technology, Chongqing, China
| | - Cheng He
- Medical Imaging Department, Chongqing University Central Hospital, Chongqing, China
| | - Heng Liu
- Department of Radiology, The Affiliated Hospital of Zunyi Medical University, Zunyi, China
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Wu F, Zhao H, Zhang Y, Wang M, Liu C, Wang X, Cheng Y, Jin C, Yang J, Li X. Morphologic Variants of the Hand Motor Cortex in Developing Brains from Neonates through Childhood Assessed by MR Imaging. AJNR Am J Neuroradiol 2022; 43:292-298. [PMID: 34992126 PMCID: PMC8985685 DOI: 10.3174/ajnr.a7386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 10/20/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND PURPOSE Knowledge of anatomic markers of the hand motor cortex is essential in the evaluation and treatment of motor neurologic diseases for both adults and developing populations. However, hand motor cortex variants in developing brains remain to be investigated. Our objective was to observe morphologic variants of the hand motor cortex in developing brains from neonates through childhood. MATERIALS AND METHODS In this study, 542 participants (0∼15 years of age) were retrospectively enrolled and divided into different age groups. The hand motor cortex morphology was evaluated on the basis of 3D T1WI. Variations in hand motor cortex variants were compared among different age groups. Inter-gender and interhemispheric differences of hand motor cortex variants were also evaluated. RESULTS Various hand motor cortex variants could be observed in developing brains, even in the neonatal period. One new morphologic shape, "immature Ω," was found in neonates and infants. The proportion of this new shape decreased dramatically during the first year after birth, then disappeared after 1 year of age. It persisted for a longer time in the right hemisphere and in males. However, sex or hemispheric effects on the distribution of the proportion of variants were not statistically significant. Furthermore, the proportion of concordance of the bilateral hand motor cortex showed an increasing trend with age (P = .006), higher in females than males. CONCLUSIONS Various hand motor cortex variants already existed at birth. The distribution of proportions of different variants developmentally varied during the first year after birth and became stable after 1 year of age. The concordance of the bilateral hand motor cortex could be influenced by age and sex.
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Affiliation(s)
- F. Wu
- From the Department of Radiology (F.W., H.Z., Y.Z., M.W., C.L., X.W., Y.C., C.J., J.Y., X.L.), the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China,Department of Radiology (F.W.), Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
| | - H. Zhao
- From the Department of Radiology (F.W., H.Z., Y.Z., M.W., C.L., X.W., Y.C., C.J., J.Y., X.L.), the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Y. Zhang
- From the Department of Radiology (F.W., H.Z., Y.Z., M.W., C.L., X.W., Y.C., C.J., J.Y., X.L.), the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - M. Wang
- From the Department of Radiology (F.W., H.Z., Y.Z., M.W., C.L., X.W., Y.C., C.J., J.Y., X.L.), the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - C. Liu
- From the Department of Radiology (F.W., H.Z., Y.Z., M.W., C.L., X.W., Y.C., C.J., J.Y., X.L.), the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - X. Wang
- From the Department of Radiology (F.W., H.Z., Y.Z., M.W., C.L., X.W., Y.C., C.J., J.Y., X.L.), the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Y. Cheng
- From the Department of Radiology (F.W., H.Z., Y.Z., M.W., C.L., X.W., Y.C., C.J., J.Y., X.L.), the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - C. Jin
- From the Department of Radiology (F.W., H.Z., Y.Z., M.W., C.L., X.W., Y.C., C.J., J.Y., X.L.), the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - J. Yang
- From the Department of Radiology (F.W., H.Z., Y.Z., M.W., C.L., X.W., Y.C., C.J., J.Y., X.L.), the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - X. Li
- From the Department of Radiology (F.W., H.Z., Y.Z., M.W., C.L., X.W., Y.C., C.J., J.Y., X.L.), the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
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