Specific White Matter Lesions Related to Motor Dysfunction in Spastic Cerebral Palsy: A Meta-analysis of Diffusion Tensor Imaging Studies

Background: Assessing motor impairment in spastic cerebral palsy is a key factor in the treatment and rehabilitation of patients. We intend to investigate the correlation between diffusion tensor imaging properties of sensorimotor pathways and motor function in spastic cerebral palsy using meta-analysis, and to determine specific white matter lesions that are closely related to motor dysfunction in spastic cerebral palsy. Methods: We conducted a literature search of PubMed, Embase, Scopus, and Web of Science databases to identify trials published from January 1999 to January 2019 that had evaluated the correlation between fractional anisotropy and motor function scores in spastic cerebral palsy. Correlation coefficient ( r) values were extracted for each study, and the extent of r was quantitatively explored. The r values between fractional anisotropy within different sensorimotor pathways and motor function scores were pooled respectively. Results: Nineteen studies involving 504 children with spastic cerebral palsy, were included. Fractional anisotropy in both sensory and motor pathways significantly correlated with motor function scores. However, compared with the corticospinal tract and thalamic radiation, fractional anisotropy in the posterior limb of the internal capsule correlated more strongly with gross motor function classification system and upper limb motor function ( r = –0.71, 95% confidence interval [CI] –0.80 to –0.60; r = 0.73, 95% CI 0.60-0.82, respectively; P < .05). Conclusions: Fractional anisotropy within the posterior limb of the internal capsule is more closely related to motor dysfunction and can potentially be a biomarker for evaluating the degree of motor impairment in spastic cerebral palsy.