title: Diffusion tensor imaging-demonstrated differences between hemiplegic and diplegic cerebral palsy with symmetric periventricular leukomalacia.
abstract: OBJECTIVE
  Patients with cerebral palsy have variable clinical presentations such as hemiplegic, diplegic, or quadriplegic patterns though they have PVL on conventional MR images. The authors investigated whether DTT can differentiate between hemiplegic and diplegic CP in patients presenting with symmetric PVL on conventional MR images.
  
  
  METHODS
  One hundred thirteen consecutive pediatric patients with definite hemiplegic (59 patients; 30 boys, 29 girls; mean age, 34.19 months; range, 24-52 months) or diplegic (54 patients; 27 boys, 27 girls; mean age, 31.07 months; range, 24-48 months) symptoms and bilateral symmetric PVL on conventional brain MR imaging were recruited. The states of CSTs were examined by using DTT, and the asymmetries of right and left CSTs in the hemiplegic and diplegic groups were compared by using asymmetric anisotropy indexes and asymmetric mean diffusivity indexes.
  
  
  RESULTS
  All patients in the hemiplegic group with asymmetric results exhibited disrupted integrities of more affected CSTs and sparing of less affected CSTs. However, diplegic patients revealed symmetric disrupted findings of the right and left CSTs at the upper periventricular level. Asymmetric anisotropy index and asymmetric mean diffusivity index values were significantly higher in the hemiplegic group than in the diplegic group (P < .05), and these results of DTT significantly corresponded with their typical clinical manifestation.
  
  
  CONCLUSIONS
  DTT may be very useful for the detailed estimation of the CST state in patients with bilateral symmetric PVL.
authors.affiliation: Department of Physical Medicine and Rehabilitation, College of Science and Technology, College of Medicine, Yeungnam University, Taegu, Republic of Korea.
authors.forename: H K
authors.initials: HK
authors.lastname: Cho
authors.forename: S H
authors.initials: SH
authors.lastname: Jang
authors.forename: E
authors.initials: E
authors.lastname: Lee
authors.forename: S Y
authors.initials: SY
authors.lastname: Kim
authors.forename: S
authors.initials: S
authors.lastname: Kim
authors.forename: Y H
authors.initials: YH
authors.lastname: Kwon
authors.forename: S M
authors.initials: SM
authors.lastname: Son
mesh_terms: D002547:Cerebral Palsy / Q000150:complications* / Q000175:diagnosis*; D002675:Child, Preschool; D003937:Diagnosis, Differential; D056324:Diffusion Tensor Imaging / Q000379:methods*; D005260:Female; D006429:Hemiplegia / Q000175:diagnosis* / Q000473:pathology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007969:Leukomalacia, Periventricular / Q000175:diagnosis*; D008297:Male; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity