BACKGROUND: It is widely known that fluorino-18-fluorodeoxyglucose positron emission tomography (18F-FDG PET) is commonly used to evaluate and diagnose epilepsy; however, whether it is beneficial to understand functional metabolism of brain cells so as to reflect injured site and degree of brain cells or not should be studied further. OBJECTIVE: To evaluate the correlation between glucose metabolism and clinical typing as well as the correlation between active function of brain cells and degree of brain injury among children with cerebral palsy with 18F-FDG PET and MRI and compare the results of them. DESIGN: Case analysis. SETTING: Department of Pediatrics, People’s Hospital of Guangdong Province. PARTICIPANTS: A total of 31 children with cerebral palsy were selected from Out-patient Clinic and In-patient Department of People’s Hospital of Guangdong Province from July 2001 to August 2004. Based on clinical criteria of cerebral palsy, patients were classified into spasm (n =10), gradual movement (n =4), mixed type (n =13) and ataxia (n =4). There were 18 boys and 13 girls aged from 10 months to 4 years. All of them were met the diagnostic criteria of cerebral palsy and all parents of them were told the facts. Exclusion criteria: Patients who had cerebral palsy caused by genetic metabolism disease were excluded. METHODS: ① All children accepted MRI examination after hospitalization with Philips Acs NT 15T superconducting magnetic resonance scanner. ② All children were fasted for 4 hours. And then, PET image of brain was collected based on T+EID type. If obvious hypermetabolism or hypometabolism region successively occurred on two layers, the image was regarded as abnormality. ③ Different correlations of various abnormal groups of MRI and various types of cerebral palsy with PET image were compared and analyzed with Erusal-Willas rank sum test. MAIN OUTCOME MEASURES: ① Results of 18F-FDG PET; ② Results of MRI examination; ③ Correlation of variously abnormal groups of MRI and various types of cerebral palsy with PET image. RESULTS: All 31 children were involved in the final analysis. No one was dropped out in this study. ① Analytic results of glucose metabolism in brain cells: Glucose metabolism of 28 children was abnormal, and the abnormal rate was 90%. The symptoms of glucose metabolism were as the same as those of hypometabolism. A total of 13 cases had multi-focal abnormality, 8 mono-focal abnormality, 7 glucose-diffused abnormality, and 3 normality. ② Correlation between MRI examination and abnormal degree of PET imaging: Three cases had normal PET imaging but abnormal MRI examination. Among children with mono-focal abnormality of PET imaging, 2 had brain atrophy, 3 poor brain white matter, 5 encephalomalacia focus, 1 hydrocephalus, and 1 normality. Among children with multi-focal abnormality of PET imaging, 3 had brain atrophy, 4 poor brain white matter, 5 encephalomalacia focus, and 1 hydrocephalus. Among children with glucose-diffused abnormality of PET imaging, 3 had brain atrophy, 2 poor brain white matter, 1 hydrocephalus, and 1 normality. There were significant differences between various groups of MRI abnormality and abnormal degree of PET imaging (P < 0.01), and brain atrophy was the main symptom. ③ Correlation between various types of cerebral palsy and abnormal degree of PET imaging: Among 10 children with cerebral palsy, one case had normal PET imaging, 2 mono-focal abnormality, 4 multi-focal abnormality, and 3 diffused abnormality. Among 13 children with cerebral palsy of mixed type, there were 1, 4, 6 and 2 cases with normal and abnormal PET imaging, respectively. Among 4 children with cerebral palsy of gradual-movement type, there were 0, 1, 2 and 1 cases with normal and abnormal PET imaging, respectively. Among 4 children with cerebral palsy of ataxia, there was 1 and 1 case with normal and abnormal PET imaging, respectively. There were significant differences between various types of cerebral palsy and abnormal degree of PET imaging (P < 0.01), and spasm and mixed types were obvious. CONCLUSION: ① Multi-focal abnormality is the main pattern of PET abnormality among children with cerebral palsy. MRI contains various morphological abnormalities of brain, and characteristics of PET imaging of children with cerebral palsy are different. ② PET imaging can reflect functional metabolism and active function of brain cells so as to reflect injured site and degree of brain cells.
