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Juhász C, Behen ME, Gjolaj N, Luat AF, Xuan Y, Jeong JW. Feasibility and Potential Diagnostic Value of Noncontrast Brain MRI in Nonsedated Children With Sturge-Weber Syndrome and Healthy Siblings. J Child Neurol 2024:8830738241272064. [PMID: 39175387 DOI: 10.1177/08830738241272064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/24/2024]
Abstract
BACKGROUND Postcontrast magnetic resonance imaging (MRI), obtained under anesthesia, is often used to evaluate brain parenchymal and vascular abnormalities in young children, including those with Sturge-Weber syndrome. However, anesthesia and contrast administration may carry risks. We explored the feasibility and potential diagnostic value of a noncontrast, nonsedate MRI acquisition in Sturge-Weber syndrome children and their siblings with a wide range of cognitive and behavioral functioning. METHODS Twenty children (10 with Sturge-Weber syndrome and 10 healthy siblings; age: 0.7-13.5 years) underwent nonsedate 3-tesla (T) brain MRI acquisition with noncontrast sequences (including susceptibility-weighted imaging) prospectively along with neuropsychology assessment. All images were evaluated for quality, and MRI abnormalities identified in the Sturge-Weber syndrome group were compared to those identified on previous clinical pre- and postcontrast MRI. RESULTS Nineteen participants (95%) completed the MRI with good (n = 18) or adequate (n = 1) quality, including all children with Sturge-Weber syndrome and all 5 children ≤5 years of age. The Sturge-Weber syndrome group had lower cognitive functions than the controls, and both groups had several children with behavioral issues, without an apparent effect on the success and quality of the MR images. Susceptibility-weighted imaging detected key venous vascular abnormalities and calcifications and, along with the other noncontrast sequences, provided diagnostic information comparable to previous clinical MRI performed with contrast administration under anesthesia. CONCLUSION This study demonstrates the feasibility and the potential diagnostic value of a nonsedate, noncontrast MRI acquisition protocol in young children including those with cognitive impairment and/or behavioral concerns. This approach can facilitate clinical trials in children where safe serial MRI is warranted.
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Affiliation(s)
- Csaba Juhász
- Department of Pediatrics, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit, MI, USA
- Department of Neurology, Wayne State University School of Medicine, Detroit, MI, USA
- Translational Imaging, University Health Center, Detroit, MI, USA
| | - Michael E Behen
- Department of Pediatrics, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit, MI, USA
- Department of Neurology, Wayne State University School of Medicine, Detroit, MI, USA
- Translational Imaging, University Health Center, Detroit, MI, USA
| | - Nore Gjolaj
- Department of Pediatrics, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit, MI, USA
- Translational Imaging, University Health Center, Detroit, MI, USA
| | - Aimee F Luat
- Department of Pediatrics, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit, MI, USA
- Department of Pediatrics, Central Michigan University, Detroit, MI, USA
| | - Yang Xuan
- Department of Radiology, Wayne State University School of Medicine, Detroit, MI, USA
- MR Core Research Facility, Wayne State University, Harper University Hospital, Detroit, MI, USA
| | - Jeong-Won Jeong
- Department of Pediatrics, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit, MI, USA
- Department of Neurology, Wayne State University School of Medicine, Detroit, MI, USA
- Translational Imaging, University Health Center, Detroit, MI, USA
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Jeong JW, Lee MH, Luat AF, Xuan Y, Haacke EM, Juhász C. Quantification of enlarged deep medullary vein volumes in Sturge-Weber syndrome. Quant Imaging Med Surg 2024; 14:1916-1929. [PMID: 38415136 PMCID: PMC10895099 DOI: 10.21037/qims-23-1271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 12/05/2023] [Indexed: 02/29/2024]
Abstract
Background Enlarged deep medullary veins (EDMVs) in patients with Sturge-Weber syndrome (SWS) may channel venous blood from the surface to the deep vein system in brain regions affected by the leptomeningeal venous malformation. Thus, the quantification of EDMV volume may provide an objective imaging marker for this vascular compensatory process. The present study proposes a novel analytical method to quantify enlarged EDMV volumes in the affected hemisphere of patients with unilateral SWS. Methods Twenty young subjects, including 10 patients with unilateral SWS and 10 healthy siblings (age 14.5±6.7 and 16.0±7.0 years, respectively) underwent 3T brain MRI scanning using susceptibility-weighted imaging (SWI) and volumetric T1-weighted sequences. The proposed image analytic steps segmented EDMVs in white matter regions, defined on the volumetric T1-weighted images, by statistically associating the likelihood of intensity, location, and tubular shape on SWI. The volumes of the segmented EDMVs, calculated in each hemisphere, were compared between affected and unaffected hemispheres. EDMV volumes were also correlated with visually assessed EDMV scores, hemispheric white matter volumes, and cortical surface areas. Parametric tests including Pearson's correlation, unpaired and paired t-tests, were used. A P value <0.05 was considered statistically significant. Results It was found that EDMVs were identified well in SWS-affected hemispheres while calcified regions were excluded. Mean EDMV volumes in the SWS-affected hemispheres were 10-12-fold greater than in the unaffected or healthy control hemispheres; while white matter volumes and cortical surface areas were lower. EDMV volumes in the SWS-affected hemispheres showed a strong positive correlation with the visual EDMV scores (r=0.88, P=0.001) and an inverse correlation with cortical surface area ratios (r=-0.65, P=0.04) but no correlation with white matter volume ratios. Conclusions EDMVs were detected in the SWS-affected atrophic hemispheres reliably while avoiding calcified regions. The approach can be used to quantify enlarged deep cerebral veins in the human brain, which may provide a potential marker of cerebral venous remodeling.
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Affiliation(s)
- Jeong-Won Jeong
- Department of Pediatrics, Wayne State University School of Medicine, University Health Center, Detroit, MI, USA
- Department of Neurology, Wayne State University School of Medicine, Detroit, MI, USA
- Translational Imaging Laboratory, University Health Center, Detroit, MI, USA
| | - Min-Hee Lee
- Department of Pediatrics, Wayne State University School of Medicine, University Health Center, Detroit, MI, USA
- Translational Imaging Laboratory, University Health Center, Detroit, MI, USA
| | - Aimee F. Luat
- Department of Pediatrics, Wayne State University School of Medicine, University Health Center, Detroit, MI, USA
- Department of Pediatrics, Central Michigan University, Mount Pleasant, MI, USA
| | - Yang Xuan
- Department of Radiology, Wayne State University School of Medicine, Detroit, MI, USA
| | - E. Mark Haacke
- Department of Neurology, Wayne State University School of Medicine, Detroit, MI, USA
- Department of Radiology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Csaba Juhász
- Department of Pediatrics, Wayne State University School of Medicine, University Health Center, Detroit, MI, USA
- Department of Neurology, Wayne State University School of Medicine, Detroit, MI, USA
- Translational Imaging Laboratory, University Health Center, Detroit, MI, USA
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Juhász C, Luat AF, Behen ME, Gjolaj N, Jeong JW, Chugani HT, Kumar A. Deep Venous Remodeling in Unilateral Sturge-Weber Syndrome: Robust Hemispheric Differences and Clinical Correlates. Pediatr Neurol 2023; 139:49-58. [PMID: 36521316 PMCID: PMC9840672 DOI: 10.1016/j.pediatrneurol.2022.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 08/01/2022] [Accepted: 11/20/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Enlarged deep medullary veins (EDMVs) in patients with Sturge-Weber syndrome (SWS) may provide compensatory venous drainage for brain regions affected by the leptomeningeal venous malformation (LVM). We evaluated the prevalence, extent, hemispheric differences, and clinical correlates of EDMVs in SWS. METHODS Fifty children (median age: 4.5 years) with unilateral SWS underwent brain magnetic resonance imaging prospectively including susceptibility-weighted imaging (SWI); children aged 2.5 years or older also had a formal neurocognitive evaluation. The extent of EDMVs was assessed on SWI by using an EDMV hemispheric score, which was compared between patients with right and left SWS and correlated with clinical variables. RESULTS EDMVs were present in 89% (24 of 27) of right and 78% (18 of 23) of left SWS brains. Extensive EDMVs (score >6) were more frequent in right (33%) than in left SWS (9%; P = 0.046) and commonly occurred in young children with right SWS. Patients with EDMV scores >4 had rare (less than monthly) seizures, whereas 35% (11 of 31) of patients with EDMV scores ≤4 had monthly or more frequent seizures (P = 0.003). In patients with right SWS and at least two LVM-affected lobes, higher EDMV scores were associated with higher intelligence quotient (P < 0.05). CONCLUSIONS Enlarged deep medullary veins are common in unilateral SWS, but extensive EDMVs appear to develop more commonly and earlier in right hemispheric SWS. Deep venous remodeling may be a compensatory mechanism contributing to better clinical outcomes in some patients with SWS.
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Affiliation(s)
- Csaba Juhász
- Department of Pediatrics, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit, Michigan; Department of Neurology, Wayne State University School of Medicine, Detroit, Michigan; Translational Imaging Laboratory, Children's Hospital of Michigan, Detroit, Michigan.
| | - Aimee F Luat
- Department of Pediatrics, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit, Michigan; Department of Pediatrics, Central Michigan University, Mt Pleasant, Michigan
| | - Michael E Behen
- Department of Pediatrics, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit, Michigan; Translational Imaging Laboratory, Children's Hospital of Michigan, Detroit, Michigan
| | - Nore Gjolaj
- Department of Pediatrics, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit, Michigan; Translational Imaging Laboratory, Children's Hospital of Michigan, Detroit, Michigan
| | - Jeong-Won Jeong
- Department of Pediatrics, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit, Michigan; Department of Neurology, Wayne State University School of Medicine, Detroit, Michigan; Translational Imaging Laboratory, Children's Hospital of Michigan, Detroit, Michigan
| | - Harry T Chugani
- Department of Pediatrics, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit, Michigan; Department of Neurology, Wayne State University School of Medicine, Detroit, Michigan; Translational Imaging Laboratory, Children's Hospital of Michigan, Detroit, Michigan; Department of Neurology, NYU Langone School of Medicine, New York, New York
| | - Ajay Kumar
- Department of Pediatrics, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit, Michigan; Translational Imaging Laboratory, Children's Hospital of Michigan, Detroit, Michigan; Department of Radiology, Wayne State University School of Medicine, Detroit, Michigan; Division of Neuroradiology, Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, Baltimore, Maryland
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Vedmurthy P, Pinto ALR, Lin DDM, Comi AM, Ou Y. Study protocol: retrospectively mining multisite clinical data to presymptomatically predict seizure onset for individual patients with Sturge-Weber. BMJ Open 2022; 12:e053103. [PMID: 35121603 PMCID: PMC8819809 DOI: 10.1136/bmjopen-2021-053103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 01/13/2022] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Secondary analysis of hospital-hosted clinical data can save time and cost compared with prospective clinical trials for neuroimaging biomarker development. We present such a study for Sturge-Weber syndrome (SWS), a rare neurovascular disorder that affects 1 in 20 000-50 000 newborns. Children with SWS are at risk for developing neurocognitive deficit by school age. A critical period for early intervention is before 2 years of age, but early diagnostic and prognostic biomarkers are lacking. We aim to retrospectively mine clinical data for SWS at two national centres to develop presymptomatic biomarkers. METHODS AND ANALYSIS We will retrospectively collect clinical, MRI and neurocognitive outcome data for patients with SWS who underwent brain MRI before 2 years of age at two national SWS care centres. Expert review of clinical records and MRI quality control will be used to refine the cohort. The merged multisite data will be used to develop algorithms for abnormality detection, lesion-symptom mapping to identify neural substrate and machine learning to predict individual outcomes (presence or absence of seizures) by 2 years of age. Presymptomatic treatment in 0-2 years and before seizure onset may delay or prevent the onset of seizures by 2 years of age, and thereby improve neurocognitive outcomes. The proposed work, if successful, will be one of the largest and most comprehensive multisite databases for the presymptomatic phase of this rare disease. ETHICS AND DISSEMINATION This study involves human participants and was approved by Boston Children's Hospital Institutional Review Board: IRB-P00014482 and IRB-P00025916 Johns Hopkins School of Medicine Institutional Review Board: NA_00043846. Participants gave informed consent to participate in the study before taking part. The Institutional Review Boards at Kennedy Krieger Institute and Boston Children's Hospital approval have been obtained at each site to retrospectively study this data. Results will be disseminated by presentations, publication and sharing of algorithms generated.
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Affiliation(s)
- Pooja Vedmurthy
- Department of Neurology and Developmental Medicine, Hugo Moser Research Institute, Baltimore, Maryland, USA
- Department of Neurology and Pediatrics, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Anna L R Pinto
- Department of Neurology, Division of Epilepsy, Harvard Medical School, Boston, Massachusetts, USA
| | - Doris D M Lin
- Neuroradiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Anne M Comi
- Department of Neurology and Developmental Medicine, Hugo Moser Research Institute, Baltimore, Maryland, USA
- Department of Neurology and Pediatrics, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Neurology and Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Yangming Ou
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Boston, Massachusetts, USA
- Computational Health Informatics Program, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Radiology, Boston Children's Hospital; Harvard Medical School, Boston, MA, USA
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Sabeti S, Ball KL, Bhattacharya SK, Bitrian E, Blieden LS, Brandt JD, Burkhart C, Chugani HT, Falchek SJ, Jain BG, Juhasz C, Loeb JA, Luat A, Pinto A, Segal E, Salvin J, Kelly KM. Consensus Statement for the Management and Treatment of Sturge-Weber Syndrome: Neurology, Neuroimaging, and Ophthalmology Recommendations. Pediatr Neurol 2021; 121:59-66. [PMID: 34153815 PMCID: PMC9107097 DOI: 10.1016/j.pediatrneurol.2021.04.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/20/2021] [Accepted: 04/21/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND Sturge-Weber syndrome (SWS) is a sporadic, neurocutaneous syndrome involving the skin, brain, and eyes. Because of the variability of the clinical manifestations and the lack of prospective studies, consensus recommendations for management and treatment of SWS have not been published. OBJECTIVE This article consolidates the current literature with expert opinion to make recommendations to guide the neuroimaging evaluation and the management of the neurological and ophthalmologic features of SWS. METHODS Thirteen national peer-recognized experts in neurology, radiology, and ophthalmology with experience treating patients with SWS were assembled. Key topics and questions were formulated for each group and included (1) risk stratification, (2) indications for referral, and (3) optimum treatment strategies. An extensive PubMed search was performed of English language articles published in 2008 to 2018, as well as recent studies identified by the expert panel. The panel made clinical practice recommendations. CONCLUSIONS Children with a high-risk facial port-wine birthmark (PWB) should be referred to a pediatric neurologist and a pediatric ophthalmologist for baseline evaluation and periodic follow-up. In newborns and infants with a high-risk PWB and no history of seizures or neurological symptoms, routine screening for brain involvement is not recommended, but brain imaging can be performed in select cases. Routine follow-up neuroimaging is not recommended in children with SWS and stable neurocognitive symptoms. The treatment of ophthalmologic complications, such as glaucoma, differs based on the age and clinical presentation of the patient. These recommendations will help facilitate coordinated care for patients with SWS and may improve patient outcomes.
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Affiliation(s)
- Sara Sabeti
- Department of Dermatology, University of California, Irvine School of Medicine, Irvine, California
| | | | | | - Elena Bitrian
- Department of Ophthalmology & Bascom Palmer Eye Institute, University of Miami, Miami
| | - Lauren S. Blieden
- Department of Ophthalmology & Cullen Eye Institute, Baylor College of Medicine, Houston, Texas
| | - James D. Brandt
- Department of Ophthalmology, University of California, Davis, Sacramento, California
| | - Craig Burkhart
- Department of Dermatology, University of North Carolina, Chapel Hill, North Carolina
| | - Harry T. Chugani
- Department of Neurology, NYU School of Medicine, New York, New York
| | - Stephen J. Falchek
- Department of Neurology, Nemours duPont Hospital for Children, Wilmington, Delaware
| | - Badal G. Jain
- Department of Neurology, Nemours duPont Hospital for Children, Wilmington, Delaware
| | - Csaba Juhasz
- Departments of Pediatrics and Neurology, Wayne State University School of Medicine, Children’s Hospital of Michigan, Detroit, Michigan
| | - Jeffrey A. Loeb
- Department of Neurology and Rehabilitation Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Aimee Luat
- Departments of Pediatrics and Neurology, Wayne State University School of Medicine, Children’s Hospital of Michigan, Detroit, Michigan,Department of Pediatrics, Central Michigan University, College of Medicine, Mt. Pleasant, Michigan
| | - Anna Pinto
- Department of Neurology, Boston Children’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Eric Segal
- Hackensack University Medical Center, Hackensack Meridian School of Medicine and Northeast Regional Epilepsy Group, Hackensack, New Jersey
| | - Jonathan Salvin
- Previous affiliation Division of Pediatric Ophthalmology, Nemours duPont Hospital for Children, Wilmington, Delaware
| | - Kristen M. Kelly
- Department of Dermatology, University of California, Irvine School of Medicine, Irvine, California
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Andica C, Hagiwara A, Hori M, Haruyama T, Fujita S, Maekawa T, Kamagata K, Yoshida MT, Suzuki M, Sugano H, Arai H, Aoki S. Aberrant myelination in patients with Sturge-Weber syndrome analyzed using synthetic quantitative magnetic resonance imaging. Neuroradiology 2019; 61:1055-1066. [DOI: 10.1007/s00234-019-02250-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 06/19/2019] [Indexed: 12/16/2022]
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