1
|
Shi Z, Luo K, Deol S, Tan S. A systematic review of noninflammatory cerebrospinal fluid biomarkers for clinical outcome in neonates with perinatal hypoxic brain injury that could be biologically significant. J Neurosci Res 2022; 100:2154-2173. [PMID: 33543500 PMCID: PMC9249405 DOI: 10.1002/jnr.24801] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/12/2021] [Accepted: 01/14/2021] [Indexed: 01/07/2023]
Abstract
Neonatal encephalopathy (NE) that purportedly arises from hypoxia-ischemia is labeled hypoxic-ischemic encephalopathy (HIE). Perinatal asphyxia is a clinical syndrome involving acidosis, a low Apgar score and the need for resuscitation in the delivery room; asphyxia alerts one to the possibility of NE. In the present systematic review, we focused on the noninflammatory biomarkers in cerebrospinal fluid (CSF) that are involved in the development of possible brain injury in asphyxia or HIE. A literature search in PubMed and EMBASE for case-control studies was conducted and 17 studies were found suitable by a priori criteria. Statistical analysis used the Mantel-Haenszel model for dichotomous data. The pooled mean difference and 95% confidence intervals (CIs) were determined. We identified the best biomarkers, based on the estimation approach in evaluating the biological significance, out of hundreds in three categories: cell adhesion and proliferation, oxidants and antioxidants, and cell damage. The following subtotal-population comparisons were made: perinatal asphyxia versus no asphyxia, asphyxia with HIE versus asphyxia without HIE, asphyxia with HIE versus no asphyxia, and term versus preterm HIE newborn with asphyxia. Biological significance of the biomarkers was determined by using a modification of the estimation approach, by ranking the biomarkers according to the difference in the bounds of the CIs. The most promising CSF biomarkers for prognostication especially for the severest HIE include creatine kinase, xanthine oxidase, vascular endothelial growth factor, neuron-specific enolase, superoxide dismutase, and malondialdehyde. Future studies are recommended using such a combined test to prognosticate the most severely affected patients.
Collapse
Affiliation(s)
- Zhongjie Shi
- Department of Pediatrics, Wayne State University, Detroit, MI, USA
| | - Kehuan Luo
- Department of Pediatrics, Wayne State University, Detroit, MI, USA
| | - Saihaj Deol
- Department of Psychology, College of Liberal Arts & Sciences, Wayne State University, Detroit, MI, USA
| | - Sidhartha Tan
- Department of Pediatrics, Wayne State University, Detroit, MI, USA
| |
Collapse
|
2
|
Dawes W. Secondary Brain Injury Following Neonatal Intraventricular Hemorrhage: The Role of the Ciliated Ependyma. Front Pediatr 2022; 10:887606. [PMID: 35844746 PMCID: PMC9280684 DOI: 10.3389/fped.2022.887606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 06/07/2022] [Indexed: 11/15/2022] Open
Abstract
Intraventricular hemorrhage is recognized as a leading cause of hydrocephalus in the developed world and a key determinant of neurodevelopmental outcome following premature birth. Even in the absence of haemorrhagic infarction or posthaemorrhagic hydrocephalus, there is increasing evidence of neuropsychiatric and neurodevelopmental sequelae. The pathophysiology underlying this injury is thought to be due to a primary destructive and secondary developmental insult, but the exact mechanisms remain elusive and this has resulted in a paucity of therapeutic interventions. The presence of blood within the cerebrospinal fluid results in the loss of the delicate neurohumoral gradient within the developing brain, adversely impacting on the tightly regulated temporal and spatial control of cell proliferation and migration of the neural stem progenitor cells within the subventricular zone. In addition, haemolysis of the erythrocytes, associated with the release of clotting factors and leucocytes into the cerebrospinal (CSF), results in a toxic and inflammatory CSF microenvironment which is harmful to the periventricular tissues, resulting in damage and denudation of the multiciliated ependymal cells which line the choroid plexus and ventricular system. The ependyma plays a critical role in the developing brain and beyond, acting as both a protector and gatekeeper to the underlying parenchyma, controlling influx and efflux across the CSF to brain interstitial fluid interface. In this review I explore the hypothesis that damage and denudation of the ependymal layer at this critical juncture in the developing brain, seen following IVH, may adversely impact on the brain microenvironment, exposing the underlying periventricular tissues to toxic and inflammatory CSF, further exacerbating disordered activity within the subventricular zone (SVZ). By understanding the impact that intraventricular hemorrhage has on the microenvironment within the CSF, and the consequences that this has on the multiciliated ependymal cells which line the neuraxis, we can begin to develop and test novel therapeutic interventions to mitigate damage and reduce the associated morbidity.
Collapse
Affiliation(s)
- William Dawes
- Alder Hey Children's Hospital, Liverpool, United Kingdom.,NIHR Great Ormond Street Hospital BRC, London, United Kingdom
| |
Collapse
|
3
|
Ha SY, Sung YH. Changes of Neural Pathways after Vojta Approach in a Child with Developmental Delay. Children (Basel) 2021; 8:children8100918. [PMID: 34682183 PMCID: PMC8534406 DOI: 10.3390/children8100918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/06/2021] [Accepted: 10/13/2021] [Indexed: 11/16/2022]
Abstract
The development of motor function is related to the development of neural pathways in the white matter. Children with developmental delay (DD) and hypotonia have reduced motor function, and their neural pathways are observed differently from those of typically developed children. We investigated changes in neural pathways through diffusion tensor imaging (DTI) after utilizing the Vojta approach. The participant was a child with DD and hypotonia, and had delayed motor function. Although he had no brain damage on magnetic resonance imaging findings, damage to the neural pathway was confirmed through DTI due to cytomegalovirus infection in the mother's womb. From 11 months of age, the Vojta approach was performed for a total of 8 months. In this study, we found that in CST, the left FA and right TV increased in follow-up DTI more than in the initial DTI. In CRP, Wallerian degeneration was observed in the left FA, MD, and TV in follow-up DTI. GMFM-88 improved after intervention. The structural change of neural pathways through the Vojta approach influenced the improvement of gross motor function. Therefore, it is thought that the Vojta approach can be suggested as a meaningful intervention for children with DD and hypotonia.
Collapse
Affiliation(s)
- Sun-Young Ha
- Department of Physical Therapy, Graduate School, Kyungnam University, Changwon 51767, Korea;
| | - Yun-Hee Sung
- Department of Physical Therapy, Graduate School, Kyungnam University, Changwon 51767, Korea;
- Department of Physical Therapy, College of Health Sciences, Kyungnam University, Changwon 51767, Korea
- Correspondence: ; Tel.: +82-55-249-6334
| |
Collapse
|
4
|
Abstract
Diffusion magnetic resonance imaging (MRI) offers a wealth of information regarding the neonatal brain. Diffusion anisotropy values reflect changes in the microstructure that accompany early maturation of white and gray matter. In term neonates with neonatal encephalopathy, diffusion imaging provides a useful means of assessing brain injury during the first week of life. In preterm neonates, measures of white matter anisotropy provide information on the nature and extent of white matter disruption. Subsequently, diffusion MRI plays an important role in illuminating fundamental elements of brain development and fulfilling the clinical need to develop prognostic indicators for term and preterm infants.
Collapse
Affiliation(s)
- Jeffrey J Neil
- Department of Neurology, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8111, St Louis, MO 63110-1093, USA; Department of Pediatrics, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8116, St Louis, MO 63110-1093, USA; Department of Radiology, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8131, St Louis, MO 63110-1093, USA
| | - Christopher D Smyser
- Department of Neurology, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8111, St Louis, MO 63110-1093, USA; Department of Pediatrics, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8116, St Louis, MO 63110-1093, USA; Department of Radiology, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8131, St Louis, MO 63110-1093, USA.
| |
Collapse
|
5
|
Morales DM, Smyser CD, Han RH, Kenley JK, Shimony JS, Smyser TA, Strahle JM, Inder TE, Limbrick DD. Tract-Specific Relationships Between Cerebrospinal Fluid Biomarkers and Periventricular White Matter in Posthemorrhagic Hydrocephalus of Prematurity. Neurosurgery 2021; 88:698-706. [PMID: 33313901 PMCID: PMC7884147 DOI: 10.1093/neuros/nyaa466] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 08/12/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Posthemorrhagic hydrocephalus (PHH) is associated with neurological morbidity and complex neurosurgical care. Improved tools are needed to optimize treatments and to investigate the developmental sequelae of PHH. OBJECTIVE To examine the relationship between diffusion magnetic resonance imaging (dMRI) and cerebrospinal fluid (CSF) biomarkers of PHH. METHODS A total of 14 preterm (PT) infants with PHH and 46 controls were included. PT CSF was collected at temporizing surgery in PHH infants (PHH PT CSF) or lumbar puncture in controls. Term-equivalent age (TEA) CSF was acquired via implanted device or at permanent CSF diversion surgery in PHH (PHH-TEA-CSF) or lumbar puncture in controls. TEA dMRI scans were used to measure fractional anisotropy (FA) and mean diffusivity (MD) in the genu of corpus callosum (gCC), posterior limb of internal capsule (PLIC), and optic radiations (OPRA). Associations between dMRI measures and CSF amyloid precursor protein (APP), neural cell adhesion-1 (NCAM-1), and L1 cell adhesion molecule (L1CAM) were assessed using Pearson correlations. RESULTS APP, NCAM-1, and L1CAM were elevated over controls in PHH-PT-CSF and PHH-TEA-CSF. dMRI FA and MD differed between control and PHH infants across all tracts. PHH-PT-CSF APP levels correlated with gCC and OPRA FA and PLIC MD, while L1CAM correlated with gCC and OPRA FA. In PHH-TEA-CSF, only L1CAM correlated with OPRA MD. CONCLUSION Tract-specific associations were observed between dMRI and CSF biomarkers at the initiation of PHH treatment. dMRI and CSF biomarker analyses provide innovative complementary methods for examining PHH-related white matter injury and associated developmental sequelae.
Collapse
Affiliation(s)
- Diego M Morales
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Christopher D Smyser
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Rowland H Han
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Jeanette K Kenley
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri
| | - Joshua S Shimony
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Tara A Smyser
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Jennifer M Strahle
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Terrie E Inder
- Department of Pediatric Newborn Medicine, Brigham and Womens Hospital, Harvard Medical School, Boston, Massachusetts
| | - David D Limbrick
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| |
Collapse
|
6
|
Brunner P, Schneider J, Borradori-Tolsa C, Bickle-Graz M, Hagmann P, Macherel M, Huppi PS, Truttmann AC. Transient tone anomalies in very preterm infants: Association with term-equivalent brain magnetic resonance imaging and neurodevelopment at 18 months. Early Hum Dev 2020; 143:104998. [PMID: 32145503 DOI: 10.1016/j.earlhumdev.2020.104998] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 02/21/2020] [Accepted: 02/22/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Very preterm (VPT) infants are at risk for neurodevelopmental impairments and early clinical findings such as transient tone anomalies (TTA) might represent potential predictive indicators. AIMS The aims of this study were to assess 1) the prevalence of TTA at 6 months corrected age in a population of VPT infants, 2) the association with term-equivalent age (TEA) brain MRI and 3) the neurodevelopmental outcome at 18 months corrected age. STUDY DESIGN AND SUBJECTS A prospective case-control cohort of 103 VPT infants (<29 weeks of gestation) was followed up at 6 months and classified into TTA+ or TTA-. TTA+ was defined by the presence of ≥2 criteria among anomalies of posture, anomalies of tone and hyperreflexia. OUTCOME MEASURES Conventional and diffusion-weighted MRIs at TEA were analyzed according to a semi-quantitative MRI scoring system and apparent diffusion coefficients (ADC) and fractional anisotropy (FA) were measured in frontal, occipital white matter and posterior limb of the internal capsule (PLIC). Neurodevelopment was assessed at 18 months using Bayley-II scales (Psychomotor Developmental Index: PDI; Mental Developmental Index: MDI). RESULTS TTA+ infants represented 29.1% of the total population. They had: 1) significantly higher ADC values in 3 regions of interest (p < 0.001), 2) significant lower FA in the PLIC (p < 0.001), and 3) significant lower PDI score (p < 0.05). No differences were observed regarding MDI scores. Interaction of TTA by cerebellum score was related to lower MDI scores. CONCLUSIONS In VPT infants, TTA at 6 months and/or structural brain abnormality at TEA are associated with poorer neurodevelopmental outcome at 18 months.
Collapse
Affiliation(s)
- Pauline Brunner
- Clinic of Neonatology, Department of Women Mother Child, University Center Hospital and University of Lausanne, Vaud, Switzerland
| | - Juliane Schneider
- Clinic of Neonatology, Department of Women Mother Child, University Center Hospital and University of Lausanne, Vaud, Switzerland; Follow Up Unit, Department of Women Mother Child, University Center Hospital and University of Lausanne, Vaud, Switzerland
| | - Cristina Borradori-Tolsa
- Division of Development and Growth, Department of the Woman, Child and Adolescent, University Hospital Geneva, Switzerland
| | - Myriam Bickle-Graz
- Follow Up Unit, Department of Women Mother Child, University Center Hospital and University of Lausanne, Vaud, Switzerland
| | - Patric Hagmann
- Department of Radiology, University Center Hospital and University of Lausanne, Vaud, Switzerland
| | - Manon Macherel
- Clinic of Neonatology, Department of Women Mother Child, University Center Hospital and University of Lausanne, Vaud, Switzerland
| | - Petra S Huppi
- Division of Development and Growth, Department of the Woman, Child and Adolescent, University Hospital Geneva, Switzerland
| | - Anita C Truttmann
- Clinic of Neonatology, Department of Women Mother Child, University Center Hospital and University of Lausanne, Vaud, Switzerland.
| |
Collapse
|
7
|
Isaacs AM, Smyser CD, Lean RE, Alexopoulos D, Han RH, Neil JJ, Zimbalist SA, Rogers CE, Yan Y, Shimony JS, Limbrick DD. MR diffusion changes in the perimeter of the lateral ventricles demonstrate periventricular injury in post-hemorrhagic hydrocephalus of prematurity. Neuroimage Clin 2019; 24:102031. [PMID: 31795043 PMCID: PMC6909338 DOI: 10.1016/j.nicl.2019.102031] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 10/01/2019] [Accepted: 10/04/2019] [Indexed: 12/14/2022]
Abstract
Diffusion MRI demonstrates PHH is associated with LVP microstructural injury. The greatest PHH-associated disruption occurs at the frontal and occipital horns. Greater ventricular size is associated with greater disruption. dMRI may provide useful biomarkers for PHH monitoring and intervention. The region of LVP injury encompasses neuroprogenitor regions.
Objectives Injury to the preterm lateral ventricular perimeter (LVP), which contains the neural stem cells responsible for brain development, may contribute to the neurological sequelae of intraventricular hemorrhage (IVH) and post-hemorrhagic hydrocephalus of prematurity (PHH). This study utilizes diffusion MRI (dMRI) to characterize the microstructural effects of IVH/PHH on the LVP and segmented frontal-occipital horn perimeters (FOHP). Study design Prospective study of 56 full-term infants, 72 very preterm infants without brain injury (VPT), 17 VPT infants with high-grade IVH without hydrocephalus (HG-IVH), and 13 VPT infants with PHH who underwent dMRI at term equivalent. LVP and FOHP dMRI measures and ventricular size-dMRI correlations were assessed. Results In the LVP, PHH had consistently lower FA and higher MD and RD than FT and VPT (p<.050). However, while PHH FA was lower, and PHH RD was higher than their respective HG-IVH measures (p<.050), the MD and AD values did not differ. In the FOHP, PHH infants had lower FA and higher RD than FT and VPT (p<.010), and a lower FA than the HG-IVH group (p<.001). While the magnitude of AD in both the LVP and FOHP were consistently less in the PHH group on pairwise comparisons to the other groups, the differences were not significant (p>.050). Ventricular size correlated negatively with FA, and positively with MD and RD (p<.001) in both the LVP and FOHP. In the PHH group, FA was lower in the FOHP than in the LVP, which was contrary to the observed findings in the healthy infants (p<.001). Nevertheless, there were no regional differences in AD, MD, and RD in the PHH group. Conclusion HG-IVH and PHH results in aberrant LVP/FOHP microstructure, with prominent abnormalities among the PHH group, most notably in the FOHP. Larger ventricular size was associated with greater magnitude of abnormality. LVP/FOHP dMRI measures may provide valuable biomarkers for future studies directed at improving the management and neurological outcomes of IVH/PHH.
Collapse
Affiliation(s)
- Albert M Isaacs
- Department of Biology and Biomedical Sciences, Washington University in St. Louis, St. Louis, MO, United States; Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.
| | - Christopher D Smyser
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, United States; Department of Neurology, Washington University School of Medicine, St. Louis, MO, United States; Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, United States
| | - Rachel E Lean
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
| | - Dimitrios Alexopoulos
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, United States
| | - Rowland H Han
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, United States
| | - Jeffrey J Neil
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, United States
| | - Sophia A Zimbalist
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, United States
| | - Cynthia E Rogers
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, United States; Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
| | - Yan Yan
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, United States
| | - Joshua S Shimony
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, United States
| | - David D Limbrick
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, United States; Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, United States
| |
Collapse
|
8
|
Parikh NA, Hershey A, Altaye M. Early Detection of Cerebral Palsy Using Sensorimotor Tract Biomarkers in Very Preterm Infants. Pediatr Neurol 2019; 98:53-60. [PMID: 31201071 PMCID: PMC6717543 DOI: 10.1016/j.pediatrneurol.2019.05.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 04/25/2019] [Accepted: 05/02/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Our objectives were to evaluate the brain's sensorimotor network microstructure using diffusion magnetic resonance imaging (MRI) at term-corrected age and test the ability of sensorimotor microstructural parameters to accurately predict cerebral palsy in extremely-low-birth-weight infants. METHODS We enrolled a prospective pilot cohort of extremely-low-birth-weight preterm infants (birth weight ≤ 1000 g) before neonatal intensive care unit discharge and studied them with structural and diffusion MRI at term-corrected age. Six sensorimotor tracts were segmented, and microstructural parameters from these tracts were evaluated for their ability to predict later development of cerebral palsy, diagnosed at 18 to 22 months corrected age. RESULTS We found significant differences in multiple diffusion MRI parameters from five of the six sensorimotor tracts in infants who developed cerebral palsy (n = 5) versus those who did not (n = 36). When compared with structural MRI or individual diffusion MRI biomarkers, the combination of two individual biomarkers-fractional anisotropy of superior thalamic radiations (sensory component) and radial diffusivity of the corticospinal tract-exhibited the highest sensitivity (80%), specificity (97%), and positive likelihood ratio (28.0) for prediction of cerebral palsy. This combination of diffusion MRI biomarkers accurately classified 95% of the study infants. CONCLUSIONS Development of cerebral palsy in very preterm infants is preceded by early brain injury or immaturity to one or more sensorimotor tracts. A larger study is warranted to evaluate if a combination of sensorimotor microstructural biomarkers could accurately facilitate early diagnosis of cerebral palsy.
Collapse
Affiliation(s)
- Nehal A. Parikh
- Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA,Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati, OH, USA,The Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA,Corresponding author’s contact information: Nehal A. Parikh, DO, MS, Professor of Pediatrics, Cincinnati Children’s Hospital, 3333 Burnet Ave, MLC 7009, Cincinnati, OH 45229,
| | - Alexa Hershey
- The Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA
| | - Mekibib Altaye
- Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati, OH, USA,Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| |
Collapse
|
9
|
Lean RE, Han RH, Smyser TA, Kenley JK, Shimony JS, Rogers CE, Limbrick DD, Smyser CD. Altered neonatal white and gray matter microstructure is associated with neurodevelopmental impairments in very preterm infants with high-grade brain injury. Pediatr Res 2019; 86:365-374. [PMID: 31212303 PMCID: PMC6702093 DOI: 10.1038/s41390-019-0461-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 06/04/2019] [Accepted: 06/08/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND This study examines relationships between neonatal white and gray matter microstructure and neurodevelopment in very preterm (VPT) infants (≤30 weeks gestation) with high-grade brain injury (BI). METHODS Term-equivalent diffusion tensor magnetic resonance imaging data were obtained in 32 VPT infants with high-grade BI spanning grade III/IV intraventricular hemorrhage, post-hemorrhagic hydrocephalus (PHH), and cystic periventricular leukomalacia (BI group); 69 VPT infants without high-grade injury (VPT group); and 55 term-born infants. The Bayley-III assessed neurodevelopmental outcomes at age 2 years. RESULTS BI infants had lower fractional anisotropy (FA) in the posterior limb of the internal capsule (PLIC), cingulum, and corpus callosum, and higher mean diffusivity (MD) in the optic radiations and cingulum than VPT infants. PHH was associated with higher MD in the optic radiations and left PLIC, and higher FA in the right caudate. For BI infants, higher MD in the right optic radiation and lower FA in the right cingulum, PLIC, and corpus callosum were related to motor impairments. CONCLUSIONS BI infants demonstrated altered white and gray matter microstructure in regions affected by injury in a manner dependent upon injury type. PHH infants demonstrated the greatest impairments. Aberrant white matter microstructure was related to motor impairment in BI infants.
Collapse
Affiliation(s)
- Rachel E Lean
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Rowland H Han
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Tara A Smyser
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Jeanette K Kenley
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Joshua S Shimony
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Cynthia E Rogers
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - David D Limbrick
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Christopher D Smyser
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA.
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA.
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA.
| |
Collapse
|
10
|
Thomason ME, Hect J, Waller R, Manning JH, Stacks AM, Beeghly M, Boeve JL, Wong K, van den Heuvel MI, Hernandez-Andrade E, Hassan SS, Romero R. Prenatal neural origins of infant motor development: Associations between fetal brain and infant motor development. Dev Psychopathol 2018; 30:763-772. [PMID: 30068433 PMCID: PMC6261435 DOI: 10.1017/s095457941800072x] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Functional circuits of the human brain emerge and change dramatically over the second half of gestation. It is possible that variation in neural functional system connectivity in utero predicts individual differences in infant behavioral development, but this possibility has yet to be examined. The current study examines the association between fetal sensorimotor brain system functional connectivity and infant postnatal motor ability. Resting-state functional connectivity data was obtained in 96 healthy human fetuses during the second and third trimesters of pregnancy. Infant motor ability was measured 7 months after birth using the Bayley Scales of Infant Development. Increased connectivity between the emerging motor network and regions of the prefrontal cortex, temporal lobes, posterior cingulate, and supplementary motor regions was observed in infants that showed more mature motor functions. In addition, females demonstrated stronger fetal-brain to infant-behavior associations. These observations extend prior longitudinal research back into prenatal brain development and raise exciting new ideas about the advent of risk and the ontogeny of early sex differences.
Collapse
|
11
|
Teli R, Hay M, Hershey A, Kumar M, Yin H, Parikh NA. Postnatal Microstructural Developmental Trajectory of Corpus Callosum Subregions and Relationship to Clinical Factors in Very Preterm Infants. Sci Rep 2018; 8:7550. [PMID: 29765059 PMCID: PMC5954149 DOI: 10.1038/s41598-018-25245-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 04/13/2018] [Indexed: 11/30/2022] Open
Abstract
Our objectives were to define the microstructural developmental trajectory of six corpus callosum subregions and identify perinatal clinical factors that influence early development of these subregions in very preterm infants. We performed a longitudinal cohort study of very preterm infants (32 weeks gestational age or younger) (N = 36) who underwent structural MRI and diffusion tensor imaging serially at four time points - before 32, 32, 38, and 52 weeks postmenstrual age. We divided the corpus callosum into six subregions, performed probabilistic tractography, and used linear mixed effects models to evaluate the influence of antecedent clinical factors on its microstructural growth trajectory. The genu and splenium demonstrated the most rapid developmental maturation, exhibited by a steep increase in fractional anisotropy. We identified several factors that favored greater corpus callosum microstructural development, including advancing postmenstrual age, higher birth weight, and college level or higher maternal education. Bronchopulmonary dysplasia, low 5-minute Apgar scores, caffeine therapy/apnea of prematurity and male sex were associated with reduced corpus callosum microstructural integrity/development over the first six months after very preterm birth. We identified a unique postnatal microstructural growth trajectory and associated clinical factor profile for each of the six corpus callosum subregions that is consistent with the heterogeneous functional role of these white matter subregions.
Collapse
Affiliation(s)
- Radhika Teli
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States of America.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States of America
| | - Margaret Hay
- Center for Perinatal Research, Nationwide Children's Hospital, Columbus, Ohio, United States of America
| | - Alexa Hershey
- Center for Perinatal Research, Nationwide Children's Hospital, Columbus, Ohio, United States of America
| | - Manoj Kumar
- Center for Perinatal Research, Nationwide Children's Hospital, Columbus, Ohio, United States of America
| | - Han Yin
- Center for Perinatal Research, Nationwide Children's Hospital, Columbus, Ohio, United States of America
| | - Nehal A Parikh
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States of America. .,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States of America. .,Center for Perinatal Research, Nationwide Children's Hospital, Columbus, Ohio, United States of America.
| |
Collapse
|
12
|
George JM, Pannek K, Rose SE, Ware RS, Colditz PB, Boyd RN. Diagnostic accuracy of early magnetic resonance imaging to determine motor outcomes in infants born preterm: a systematic review and meta-analysis. Dev Med Child Neurol 2018; 60:134-146. [PMID: 29193032 DOI: 10.1111/dmcn.13611] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/15/2017] [Indexed: 01/18/2023]
Abstract
AIM To examine the diagnostic ability of early magnetic resonance imaging (MRI; <36wks postmenstrual age) to detect later adverse motor outcomes or cerebral palsy (CP) in infants born preterm. METHOD Studies of infants born preterm with MRI earlier than 36 weeks postmenstrual age and quantitative motor data or a diagnosis of CP at or beyond 1 year corrected age were identified. Study details were extracted and meta-analyses performed where possible. Quality of included studies was evaluated with the QUADAS-2 (a revised tool for the quality assessment of diagnostic accuracy studies). RESULTS Thirty-one articles met the inclusion criteria, five of which reported diagnostic accuracy and five reported data sufficient for calculation of diagnostic accuracy. Early structural MRI global scores detected a later diagnosis of CP with a pooled sensitivity of 100% (95% confidence interval [CI] 86-100) and a specificity of 93% (95% CI 59-100). Global structural MRI scores determined adverse motor outcomes with a pooled sensitivity of 89% (95% CI 44-100) and a specificity of 98% (95% CI 90-100). White matter scores determined adverse motor outcomes with a pooled sensitivity of 33% (95% CI 20-48) and a specificity of 83% (95% CI 78-88). INTERPRETATION Early structural MRI has reasonable sensitivity and specificity to determine adverse motor outcomes and CP in infants born preterm. Greater reporting of diagnostic accuracy in studies examining relationships with motor outcomes and CP is required to facilitate clinical utility of early MRI. WHAT THIS PAPER ADDS Early magnetic resonance imaging (MRI) has reasonable sensitivity and specificity to determine later adverse motor outcomes and cerebral palsy (CP). Detection of infants who progressed to CP was stronger than motor outcomes. Global MRI scores determined adverse motor outcomes more accurately than white matter scores. Few studies report diagnostic accuracy of early MRI findings. Diagnostic accuracy is required to draw clinically meaningful conclusions from early MRI studies.
Collapse
Affiliation(s)
- Joanne M George
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Centre for Children's Health Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Kerstin Pannek
- The Australian e-Health Research Centre, Health and Biosecurity, CSIRO, Brisbane, Australia
| | - Stephen E Rose
- The Australian e-Health Research Centre, Health and Biosecurity, CSIRO, Brisbane, Australia
| | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia.,Queensland Centre for Intellectual and Developmental Disability, The University of Queensland, Brisbane, Australia
| | - Paul B Colditz
- Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Perinatal Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Roslyn N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Centre for Children's Health Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| |
Collapse
|
13
|
Zhang X, Rocha-Ferreira E, Li T, Vontell R, Jabin D, Hua S, Zhou K, Nazmi A, Albertsson AM, Sobotka K, Ek J, Thornton C, Hagberg H, Mallard C, Leavenworth JW, Zhu C, Wang X. γδT cells but not αβT cells contribute to sepsis-induced white matter injury and motor abnormalities in mice. J Neuroinflammation 2017; 14:255. [PMID: 29262837 PMCID: PMC5738716 DOI: 10.1186/s12974-017-1029-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 12/08/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Infection and sepsis are associated with brain white matter injury in preterm infants and the subsequent development of cerebral palsy. METHODS In the present study, we used a neonatal mouse sepsis-induced white matter injury model to determine the contribution of different T cell subsets (αβT cells and γδT cells) to white matter injury and consequent behavioral changes. C57BL/6J wild-type (WT), T cell receptor (TCR) δ-deficient (Tcrd -/-, lacking γδT cells), and TCRα-deficient (Tcra -/-, lacking αβT cells) mice were administered with lipopolysaccharide (LPS) at postnatal day (PND) 2. Brain myelination was examined at PNDs 12, 26, and 60. Motor function and anxiety-like behavior were evaluated at PND 26 or 30 using DigiGait analysis and an elevated plus maze. RESULTS White matter development was normal in Tcrd -/- and Tcrα -/- compared to WT mice. LPS exposure induced reductions in white matter tissue volume in WT and Tcrα -/- mice, but not in the Tcrd -/- mice, compared with the saline-treated groups. Neither LPS administration nor the T cell deficiency affected anxiety behavior in these mice as determined with the elevated plus maze. DigiGait analysis revealed motor function deficiency after LPS-induced sepsis in both WT and Tcrα -/- mice, but no such effect was observed in Tcrd -/- mice. CONCLUSIONS Our results suggest that γδT cells but not αβT cells contribute to sepsis-induced white matter injury and subsequent motor function abnormalities in early life. Modulating the activity of γδT cells in the early stages of preterm white matter injury might represent a novel therapeutic strategy for the treatment of perinatal brain injury.
Collapse
Affiliation(s)
- Xiaoli Zhang
- Henan Key Laboratory of Child Brain Injury, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China.,Perinatal Center, Department of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 432, 405 30, Gothenburg, Sweden
| | - Eridan Rocha-Ferreira
- Department of Obstetrics and Gynecology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Tao Li
- Henan Key Laboratory of Child Brain Injury, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China.,Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 436, 405 30, Gothenburg, Sweden
| | - Regina Vontell
- Department of Perinatal Imaging and Health, Division of Imaging Sciences and Biomedical Engineering, King's College London, King's Health Partners, St. Thomas' Hospital, London, SE1 7EH, UK
| | - Darakhshan Jabin
- Perinatal Center, Department of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 432, 405 30, Gothenburg, Sweden
| | - Sha Hua
- Perinatal Center, Department of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 432, 405 30, Gothenburg, Sweden.,Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University Medical School, Luwan Branch, Shanghai, China
| | - Kai Zhou
- Department of Obstetrics and Gynecology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Women's and Children's Health, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden
| | - Arshed Nazmi
- Perinatal Center, Department of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 432, 405 30, Gothenburg, Sweden
| | - Anna-Maj Albertsson
- Perinatal Center, Department of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 432, 405 30, Gothenburg, Sweden
| | - Kristina Sobotka
- Perinatal Center, Department of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 432, 405 30, Gothenburg, Sweden
| | - Joakim Ek
- Perinatal Center, Department of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 432, 405 30, Gothenburg, Sweden
| | - Claire Thornton
- Department of Perinatal Imaging and Health, Division of Imaging Sciences and Biomedical Engineering, King's College London, King's Health Partners, St. Thomas' Hospital, London, SE1 7EH, UK
| | - Henrik Hagberg
- Perinatal Center, Department of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 432, 405 30, Gothenburg, Sweden.,Department of Obstetrics and Gynecology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Perinatal Imaging and Health, Division of Imaging Sciences and Biomedical Engineering, King's College London, King's Health Partners, St. Thomas' Hospital, London, SE1 7EH, UK
| | - Carina Mallard
- Perinatal Center, Department of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 432, 405 30, Gothenburg, Sweden
| | - Jianmei W Leavenworth
- Department of Neurosurgery, The University of Alabama at Birmingham, Birmingham, AL, 35233, USA.,Department of Microbiology, The University of Alabama at Birmingham, Birmingham, AL, 35233, USA
| | - Changlian Zhu
- Henan Key Laboratory of Child Brain Injury, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China. .,Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 436, 405 30, Gothenburg, Sweden.
| | - Xiaoyang Wang
- Perinatal Center, Department of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 432, 405 30, Gothenburg, Sweden. .,Department of Pediatrics, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
| |
Collapse
|
14
|
Schadl K, Vassar R, Cahill-Rowley K, Yeom KW, Stevenson DK, Rose J. Prediction of cognitive and motor development in preterm children using exhaustive feature selection and cross-validation of near-term white matter microstructure. Neuroimage Clin 2017; 17:667-679. [PMID: 29234600 PMCID: PMC5722472 DOI: 10.1016/j.nicl.2017.11.023] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Revised: 11/23/2017] [Accepted: 11/28/2017] [Indexed: 01/20/2023]
Abstract
Background Advanced neuroimaging and computational methods offer opportunities for more accurate prognosis. We hypothesized that near-term regional white matter (WM) microstructure, assessed on diffusion tensor imaging (DTI), using exhaustive feature selection with cross-validation would predict neurodevelopment in preterm children. Methods Near-term MRI and DTI obtained at 36.6 ± 1.8 weeks postmenstrual age in 66 very-low-birth-weight preterm neonates were assessed. 60/66 had follow-up neurodevelopmental evaluation with Bayley Scales of Infant-Toddler Development, 3rd-edition (BSID-III) at 18-22 months. Linear models with exhaustive feature selection and leave-one-out cross-validation computed based on DTI identified sets of three brain regions most predictive of cognitive and motor function; logistic regression models were computed to classify high-risk infants scoring one standard deviation below mean. Results Cognitive impairment was predicted (100% sensitivity, 100% specificity; AUC = 1) by near-term right middle-temporal gyrus MD, right cingulate-cingulum MD, left caudate MD. Motor impairment was predicted (90% sensitivity, 86% specificity; AUC = 0.912) by left precuneus FA, right superior occipital gyrus MD, right hippocampus FA. Cognitive score variance was explained (29.6%, cross-validated Rˆ2 = 0.296) by left posterior-limb-of-internal-capsule MD, Genu RD, right fusiform gyrus AD. Motor score variance was explained (31.7%, cross-validated Rˆ2 = 0.317) by left posterior-limb-of-internal-capsule MD, right parahippocampal gyrus AD, right middle-temporal gyrus AD. Conclusion Search in large DTI feature space more accurately identified neonatal neuroimaging correlates of neurodevelopment.
Collapse
Affiliation(s)
- Kornél Schadl
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, United States; Neonatal Neuroimaging Research Lab, Stanford University School of Medicine, Stanford, CA, United States
| | - Rachel Vassar
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, United States; Neonatal Neuroimaging Research Lab, Stanford University School of Medicine, Stanford, CA, United States
| | - Katelyn Cahill-Rowley
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, United States; Motion & Gait Analysis Lab, Lucile Packard Children's Hospital, Stanford, CA, United States
| | - Kristen W Yeom
- Department of Radiology, Lucile Packard Children's Hospital, Stanford University School of Medicine, Stanford, CA, United States
| | - David K Stevenson
- Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Jessica Rose
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, United States; Motion & Gait Analysis Lab, Lucile Packard Children's Hospital, Stanford, CA, United States; Neonatal Neuroimaging Research Lab, Stanford University School of Medicine, Stanford, CA, United States.
| |
Collapse
|
15
|
Hinojosa-Rodríguez M, Harmony T, Carrillo-Prado C, Van Horn JD, Irimia A, Torgerson C, Jacokes Z. Clinical neuroimaging in the preterm infant: Diagnosis and prognosis. Neuroimage Clin 2017; 16:355-368. [PMID: 28861337 PMCID: PMC5568883 DOI: 10.1016/j.nicl.2017.08.015] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Revised: 08/11/2017] [Accepted: 08/12/2017] [Indexed: 01/30/2023]
Abstract
Perinatal care advances emerging over the past twenty years have helped to diminish the mortality and severe neurological morbidity of extremely and very preterm neonates (e.g., cystic Periventricular Leukomalacia [c-PVL] and Germinal Matrix Hemorrhage - Intraventricular Hemorrhage [GMH-IVH grade 3-4/4]; 22 to < 32 weeks of gestational age, GA). However, motor and/or cognitive disabilities associated with mild-to-moderate white and gray matter injury are frequently present in this population (e.g., non-cystic Periventricular Leukomalacia [non-cystic PVL], neuronal-axonal injury and GMH-IVH grade 1-2/4). Brain research studies using magnetic resonance imaging (MRI) report that 50% to 80% of extremely and very preterm neonates have diffuse white matter abnormalities (WMA) which correspond to only the minimum grade of severity. Nevertheless, mild-to-moderate diffuse WMA has also been associated with significant affectations of motor and cognitive activities. Due to increased neonatal survival and the intrinsic characteristics of diffuse WMA, there is a growing need to study the brain of the premature infant using non-invasive neuroimaging techniques sensitive to microscopic and/or diffuse lesions. This emerging need has led the scientific community to try to bridge the gap between concepts or ideas from different methodologies and approaches; for instance, neuropathology, neuroimaging and clinical findings. This is evident from the combination of intense pre-clinical and clinicopathologic research along with neonatal neurology and quantitative neuroimaging research. In the following review, we explore literature relating the most frequently observed neuropathological patterns with the recent neuroimaging findings in preterm newborns and infants with perinatal brain injury. Specifically, we focus our discussions on the use of neuroimaging to aid diagnosis, measure morphometric brain damage, and track long-term neurodevelopmental outcomes.
Collapse
Affiliation(s)
- Manuel Hinojosa-Rodríguez
- Unidad de Investigación en Neurodesarrollo, Departamento de Neurobiología Conductual y Cognitiva, Instituto de Neurobiología, Universidad Nacional Autónoma de México (UNAM), Campus Juriquilla, Mexico
| | - Thalía Harmony
- Unidad de Investigación en Neurodesarrollo, Departamento de Neurobiología Conductual y Cognitiva, Instituto de Neurobiología, Universidad Nacional Autónoma de México (UNAM), Campus Juriquilla, Mexico
| | - Cristina Carrillo-Prado
- Unidad de Investigación en Neurodesarrollo, Departamento de Neurobiología Conductual y Cognitiva, Instituto de Neurobiología, Universidad Nacional Autónoma de México (UNAM), Campus Juriquilla, Mexico
| | - John Darrell Van Horn
- USC Mark and Mary Stevens Neuroimaging and Informatics Institute, 2025 Zonal Avenue, SHN, Los Angeles, California 90033, USA
| | - Andrei Irimia
- USC Mark and Mary Stevens Neuroimaging and Informatics Institute, 2025 Zonal Avenue, SHN, Los Angeles, California 90033, USA
| | - Carinna Torgerson
- USC Mark and Mary Stevens Neuroimaging and Informatics Institute, 2025 Zonal Avenue, SHN, Los Angeles, California 90033, USA
| | - Zachary Jacokes
- USC Mark and Mary Stevens Neuroimaging and Informatics Institute, 2025 Zonal Avenue, SHN, Los Angeles, California 90033, USA
| |
Collapse
|
16
|
Lenfeldt N, Johansson AM, Domellöf E, Riklund K, Rönnqvist L. Alterations in white matter microstructure are associated with goal-directed upper-limb movement segmentation in children born extremely preterm. Hum Brain Mapp 2017; 38:5051-5068. [PMID: 28685893 DOI: 10.1002/hbm.23714] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 06/19/2017] [Accepted: 06/19/2017] [Indexed: 12/14/2022] Open
Abstract
Altered white matter microstructure is commonly found in children born preterm (PT), especially those born at an extremely low gestational age (GA). These children also commonly show disturbed motor function. This study explores the relation between white matter alterations and upper-limb movement segmentation in 41 children born PT (19 girls), and 41 children born at term (18 girls) at 8 years. The PT group was subdivided into extremely PT (E-PT; GA = 25-27 weeks, N = 10), very PT (V-PT; GA = 28-32 weeks, N = 13), and moderately PT (M-PT; GA = 33-35 weeks, N = 18). Arm/hand preference (preferred/non-preferred) was determined through object interactions and the brain hemispheres were designated accordingly. White matter alterations were assessed using diffusion tensor imaging in nine areas, and movement segmentation of the body-parts head, shoulder, elbow, and wrist were registered during a unimanual goal-directed task. Increased movement segmentation was demonstrated consistently on the preferred side in the E-PT group compared with the term born group. Also compared with the term born peers, the E-PT group demonstrated reduced fractional anisotropy (FA) in the cerebral peduncle (targeting the corticospinal tract) in the hemisphere on the non-preferred side and in the splenium of corpus callosum. In contrast, in the anterior internal capsule on the preferred side, the E-PT group had increased FA. Lower FA in the cerebral peduncle, but higher FA in the anterior internal capsule, was associated with increased movement segmentation across body-parts in a contralateral manner. The results suggest that impaired development of sensorimotor tracts in E-PT children could explain a sub-optimal spatiotemporal organization of upper-limb movements. Hum Brain Mapp 38:5051-5068, 2017. © 2017 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Niklas Lenfeldt
- Department of Pharmacology and Clinical Neuroscience, Umeå University, Umeå, Sweden
| | - Anna-Maria Johansson
- Department of Psychology, , Umeå University, Umeå, Sweden.,Department of Community Medicine and Rehabilitation, Physiotheraphy, Umeå University, Umeå, Sweden
| | - Erik Domellöf
- Department of Psychology, , Umeå University, Umeå, Sweden
| | - Katrine Riklund
- Department of Radiation Sciences, Diagnostic Radiology, Umeå University, Umeå, Sweden
| | | |
Collapse
|
17
|
Kwon YM, Rose J, Kim AR, Son SM. Corticoreticular tract lesion in children with developmental delay presenting with gait dysfunction and trunk instability. Neural Regen Res 2017; 12:1465-1471. [PMID: 29089992 PMCID: PMC5649467 DOI: 10.4103/1673-5374.215258] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The corticoreticular tract (CRT) is known to be involved in walking and postural control. Using diffusion tensor tractography (DTT), we investigated the relationship between the CRT and gait dysfunction, including trunk instability, in pediatric patients. Thirty patients with delayed development and 15 age-matched, typically-developed (TD) children were recruited. Fifteen patients with gait dysfunction (bilateral trunk instability) were included in the group A, and the other 15 patients with gait dysfunction (unilateral trunk instability) were included in the group B. The Growth Motor Function Classification System, Functional Ambulation Category scale, and Functional Ambulation Category scale were used for measurement of functional state. Fractional anisotropy, apparent diffusion coefficient, fiber number, and tract integrity of the CRT and corticospinal tract were measured. Diffusion parameters or integrity of corticospinal tract were not significantly different in the three study groups. However, CRT results revealed that both CRTs were disrupted in the group A, whereas CRT disruption in the hemispheres contralateral to clinical manifestations was observed in the group B. Fractional anisotropy values and fiber numbers in both CRTs were decreased in the group A than in the group TD. The extents of decreases of fractional anisotropy values and fiber numbers on the ipsilateral side relative to those on the contralateral side were greater in the group B than in the group TD. Functional evaluation data and clinical manifestations were found to show strong correlations with CRT status, rather than with corticospinal tract status. These findings suggest that CRT status appears to be clinically important for gait function and trunk stability in pediatric patients and DTT can help assess CRT status in pediatric patients with gait dysfunction.
Collapse
Affiliation(s)
- Yong Min Kwon
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daemyungdong, Namku, Taegu, Republic of Korea
| | - Jessica Rose
- Department of Orthopedic Surgery, College of Medicine, Stanford University, Stanford, CA, USA
| | - Ae Ryoung Kim
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daemyungdong, Namku, Taegu, Republic of Korea
| | - Su Min Son
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daemyungdong, Namku, Taegu, Republic of Korea
| |
Collapse
|
18
|
Abstract
Up to 35% of very preterm infants survive with neurodevelopmental impairments (NDI) such as cognitive deficits, cerebral palsy, and attention deficit disorder. Advanced MRI quantitative tools such as brain morphometry, diffusion MRI, magnetic resonance spectroscopy, and functional MRI at term-equivalent age are ideally suited to improve current efforts to predict later development of disabilities. This would facilitate application of targeted early intervention therapies during the first few years of life when neuroplasticity is optimal. A systematic search and review identified 47 published studies of advanced MRI to predict NDI. Diffusion MRI and morphometry studies were the most commonly studied modalities. Despite several limitations, studies clearly showed that brain structural and metabolite biomarkers are promising independent predictors of NDI. Large representative multicenter studies are needed to validate these studies.
Collapse
Affiliation(s)
- Nehal A. Parikh
- Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH,Correspondence address: Cincinnati Children’s Hospital, Perinatal Institute, 3333 Burnet Ave., MLC 7009, Cincinnati, OH.
| |
Collapse
|
19
|
Kim DY, Park HK, Kim NS, Hwang SJ, Lee HJ. Neonatal diffusion tensor brain imaging predicts later motor outcome in preterm neonates with white matter abnormalities. Ital J Pediatr 2016; 42:104. [PMID: 27906083 PMCID: PMC5134238 DOI: 10.1186/s13052-016-0309-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 11/12/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND White matter (WM) abnormalities associated with prematurity are one of the most important causes of neurological disability that involves spastic motor deficits in preterm newborns. This study aimed to evaluate regional microstructural changes in diffusion tensor imaging (DTI) associated with WM abnormalities. METHODS We prospectively studied extremely low birth weight (ELBW; <1000 g) preterm infants who were admitted to the Neonatal Intensive Care Unit of Hanyang University Hospital between February 2011 and February 2014. WM abnormalities were assessed with conventional magnetic resonance (MR) imaging and DTI near term-equivalent age before discharge. Region-of-interests (ROIs) measurements were performed to examine the regional distribution of fractional anisotropy (FA) values. RESULTS Thirty-two out of 72 ELBW infants underwent conventional MR imaging and DTI at term-equivalent age. Ten of these infants developed WM abnormalities associated with prematurity. Five of ten of those with WM abnormalities developed cerebral palsy (CP). DTI in the WM abnormalities with CP showed a significant reduction of mean FA in the genu of the corpus callosum (p = 0.022), the ipsilateral posterior limb of the internal capsule (p = 0.019), and the ipsilateral centrum semiovale (p = 0.012) compared to normal WM and WM abnormalities without CP. In infants having WM abnormalities with CP, early FA values in neonatal DTI revealed abnormalities of the WM regions prior to the manifestation of hemiparesis. CONCLUSIONS DTI performed at term equivalent age shows different FA values in WM regions among infants with or without WM abnormalities associated with prematurity and/or CP. Low FA values of ROIs in DTI are related with later development of spastic CP in preterm infants with WM abnormalities.
Collapse
Affiliation(s)
- Do-Yeon Kim
- Department of Pediatrics, Hanyang University College of Medicine, Seoul, South Korea
| | - Hyun-Kyung Park
- Department of Pediatrics, Hanyang University College of Medicine, Seoul, South Korea
| | - Nam-Su Kim
- Department of Pediatrics, Hanyang University College of Medicine, Seoul, South Korea
| | - Se-Jin Hwang
- Division of Neuroanatomy, Department of Anatomy and Histology, Hanyang University College of Medicine, Seoul, South Korea
| | - Hyun Ju Lee
- Department of Pediatrics, Hanyang University College of Medicine, Seoul, South Korea.
| |
Collapse
|
20
|
Chang MC, Jang SH, Seo JP, Lee E, Kim S, Won YH, Son SM. Degenerative changes of the corticospinal tract in pediatric patients showing deteriorated motor function: A diffusion tensor tractography study. Dev Neurorehabil 2016; 18:290-5. [PMID: 23957254 DOI: 10.3109/17518423.2013.821538] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE We attempted to demonstrate the corresponding degenerative changes of the affected corticospinal tract (CST) in pediatric patients with deteriorated motor function using diffusion tensor tractography (DTT). METHODS We recruited three pediatric patients (corrected age: 2, 6 and 47 months, respectively) who showed impaired motor function. RESULTS DTT in each patient showed interruption of the CSTs of the hemisphere contralateral to the side of motor impairment. Despite motor impairment and abnormal DTT findings, none of the three patients received rehabilitative therapy. The patients (corrected age: 9, 53 and 59 months, respectively) and their parents visited our clinic again due to deterioration of motor functions. Follow-up DTT of all evaluated patients showed significant degenerative changes in the affected CSTs in accordance with the aggravation of motor impairment. CONCLUSION We presented degenerative changes of the affected CSTs in pediatric patients according to the deterioration of motor function.
Collapse
Affiliation(s)
- Min Cheol Chang
- a Department of Physical Medicine and Rehabilitation , College of Medicine, Yeungnam University , Taegu , Republic of Korea
| | - Sung Ho Jang
- a Department of Physical Medicine and Rehabilitation , College of Medicine, Yeungnam University , Taegu , Republic of Korea
| | - Jeong Pyo Seo
- a Department of Physical Medicine and Rehabilitation , College of Medicine, Yeungnam University , Taegu , Republic of Korea
| | - Eusil Lee
- b Department of Pediatrics , College of Medicine, Yeungnam University , Taegu , Republic of Korea , and
| | - Saeyoon Kim
- b Department of Pediatrics , College of Medicine, Yeungnam University , Taegu , Republic of Korea , and
| | - Yu Hui Won
- c Department of Physical Medicine and Rehabilitation , College of Medicine, Ewha Womans University , Seoul , Republic of Korea
| | - Su Min Son
- a Department of Physical Medicine and Rehabilitation , College of Medicine, Yeungnam University , Taegu , Republic of Korea
| |
Collapse
|
21
|
Kim JH, Son SM. Activation of less affected corticospinal tract and poor motor outcome in hemiplegic pediatric patients: a diffusion tensor tractography imaging study. Neural Regen Res 2016; 10:2054-9. [PMID: 26889198 PMCID: PMC4730834 DOI: 10.4103/1673-5374.172326] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The less affected hemisphere is important in motor recovery in mature brains. However, in terms of motor outcome in immature brains, no study has been reported on the less affected corticospinal tract in hemiplegic pediatric patients. Therefore, we examined the relationship between the condition of the less affected corticospinal tract and motor function in hemiplegic pediatric patients. Forty patients with hemiplegia due to perinatal or prenatal injury (13.7 ± 3.0 months) and 40 age-matched typically developing controls were recruited. These patients were divided into two age-matched groups, the high functioning group (20 patients) and the low functioning group (20 patients) using functional level of hemiplegia scale. Diffusion tensor tractography images showed that compared with the control group, the patient group of the less affected corticospinal tract showed significantly increased fiber number and significantly decreased fractional anisotropy value. Significantly increased fiber number and significantly decreased fractional anisotropy value in the low functioning group were observed than in the high functioning group. These findings suggest that activation of the less affected hemisphere presenting as increased fiber number and decreased fractional anisotropy value is related to poor motor function in pediatric hemiplegic patients.
Collapse
Affiliation(s)
- Jin Hyun Kim
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daemyungdong, Namku, Daegu, Republic of Korea
| | - Su Min Son
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daemyungdong, Namku, Daegu, Republic of Korea
| |
Collapse
|
22
|
Kim JH, Kwon YM, Son SM. Motor function outcomes of pediatric patients with hemiplegic cerebral palsy after rehabilitation treatment: a diffusion tensor imaging study. Neural Regen Res 2015; 10:624-30. [PMID: 26170825 PMCID: PMC4424757 DOI: 10.4103/1673-5374.155438] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2015] [Indexed: 11/09/2022] Open
Abstract
Previous diffusion tensor imaging (DTI) studies regarding pediatric patients with motor dysfunction have confirmed the correlation between DTI parameters of the injured corticospinal tract and the severity of motor dysfunction. There is also evidence that DTI parameters can help predict the prognosis of motor function of patients with cerebral palsy. But few studies are reported on the DTI parameters that can reflect the motor function outcomes of pediatric patients with hemiplegic cerebral palsy after rehabilitation treatment. In the present study, 36 pediatric patients with hemiplegic cerebral palsy were included. Before and after rehabilitation treatment, DTI was used to measure the fiber number (FN), fractional anisotropy (FA) and apparent diffusion coefficient (ADC) of bilateral corticospinal tracts. Functional Level of Hemiplegia scale (FxL) was used to assess the therapeutic effect of rehabilitative therapy on clinical hemiplegia. Correlation analysis was performed to assess the statistical interrelationship between the change amount of DTI parameters and FxL. DTI findings obtained at the initial and follow-up evaluations demonstrated that more affected corticospinal tract yielded significantly decreased FN and FA values and significantly increased ADC value compared to the less affected corticospinal tract. Correlation analysis results showed that the change amount of FxL was positively correlated to FN and FA values, and the correlation to FN was stronger than the correlation to FA. The results suggest that FN and FA values can be used to evaluate the motor function outcomes of pediatric patients with hemiplegic cerebral palsy after rehabilitation treatment and FN is of more significance for evaluation.
Collapse
Affiliation(s)
- Jin Hyun Kim
- Department of Physical Medicine and Rehabilitation, School of Medicine, Yeungnam University, 317-1, Daemyungdong, Namku, Daegu, 705-717, Republic of Korea
| | - Yong Min Kwon
- Department of Physical Medicine and Rehabilitation, School of Medicine, Yeungnam University, 317-1, Daemyungdong, Namku, Daegu, 705-717, Republic of Korea
| | - Su Min Son
- Department of Physical Medicine and Rehabilitation, School of Medicine, Yeungnam University, 317-1, Daemyungdong, Namku, Daegu, 705-717, Republic of Korea
| |
Collapse
|
23
|
Abstract
Very preterm children are at a high risk for neurodevelopmental impairments, but there is variability in the pattern and severity of outcome. Neonatal magnetic resonance imaging (MRI) enhances the capacity to detect brain injury and altered brain development and assists in the prediction of high-risk children who warrant surveillance and early intervention. This review describes the application of conventional and advanced MRI with very preterm neonates, specifically focusing on the relationship between neonatal MRI findings and later neurodevelopmental outcome. Research demonstrates that conventional MRI is strongly associated with neurodevelopmental outcome in childhood. Further studies are needed to examine the role of advanced MRI techniques in predicting outcome in very preterm children, but early research findings are promising. In conclusion, neonatal MRI is predictive of later neurodevelopment but is dependent on appropriately trained specialists and should be interpreted in conjunction with other clinical and social information.
Collapse
Affiliation(s)
- Peter J Anderson
- Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Australia.
| | - Jeanie L Y Cheong
- Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Australia; Neonatal Services, Royal Women׳s Hospital, Melbourne, Australia; Department of Obstetrics & Gynaecology, University of Melbourne, Melbourne, Australia
| | - Deanne K Thompson
- Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| |
Collapse
|
24
|
Pieterman K, Plaisier A, Govaert P, Leemans A, Lequin MH, Dudink J. Data quality in diffusion tensor imaging studies of the preterm brain: a systematic review. Pediatr Radiol 2015; 45:1372-81. [PMID: 25820411 PMCID: PMC4526590 DOI: 10.1007/s00247-015-3307-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 01/15/2015] [Accepted: 02/05/2015] [Indexed: 01/31/2023]
Abstract
BACKGROUND To study early neurodevelopment in preterm infants, evaluation of brain maturation and injury is increasingly performed using diffusion tensor imaging, for which the reliability of underlying data is paramount. OBJECTIVE To review the literature to evaluate acquisition and processing methodology in diffusion tensor imaging studies of preterm infants. MATERIALS AND METHODS We searched the Embase, Medline, Web of Science and Cochrane databases for relevant papers published between 2003 and 2013. The following keywords were included in our search: prematurity, neuroimaging, brain, and diffusion tensor imaging. RESULTS We found 74 diffusion tensor imaging studies in preterm infants meeting our inclusion criteria. There was wide variation in acquisition and processing methodology, and we found incomplete reporting of these settings. Nineteen studies (26%) reported the use of neonatal hardware. Data quality assessment was not reported in 13 (18%) studies. Artefacts-correction and data-exclusion was not reported in 33 (45%) and 18 (24%) studies, respectively. Tensor estimation algorithms were reported in 56 (76%) studies but were often suboptimal. CONCLUSION Diffusion tensor imaging acquisition and processing settings are incompletely described in current literature, vary considerably, and frequently do not meet the highest standards.
Collapse
Affiliation(s)
- Kay Pieterman
- Division of Neonatology, Department of Pediatrics, Erasmus Medical Center - Sophia, dr. Molewaterplein 60, 3015, GJ, Rotterdam, The Netherlands,
| | - Annemarie Plaisier
- Division of Neonatology, Department of Pediatrics, Erasmus Medical Center – Sophia, dr. Molewaterplein 60, 3015 GJ Rotterdam, The Netherlands ,Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Paul Govaert
- Division of Neonatology, Department of Pediatrics, Erasmus Medical Center – Sophia, dr. Molewaterplein 60, 3015 GJ Rotterdam, The Netherlands ,Department of Pediatrics, Koningin Paola Children’s Hospital, Antwerp, Belgium
| | - Alexander Leemans
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Maarten H. Lequin
- Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jeroen Dudink
- Division of Neonatology, Department of Pediatrics, Erasmus Medical Center – Sophia, dr. Molewaterplein 60, 3015 GJ Rotterdam, The Netherlands ,Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
25
|
Laukka JJ, Makki MI, Lafleur T, Stanley J, Kamholz J, Garbern JY. Diffusion tensor imaging of patients with proteolipid protein 1 gene mutations. J Neurosci Res 2014; 92:1723-32. [PMID: 25156430 DOI: 10.1002/jnr.23458] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 06/10/2014] [Accepted: 07/05/2014] [Indexed: 11/08/2022]
Abstract
Pelizaeus-Merzbacher disease (PMD) is an X-linked disorder of the central nervous system (CNS) caused by a wide variety of mutations affecting proteolipid protein 1 (PLP1). We assessed the effects of PLP1 mutations on water diffusion in CNS white matter by using diffusion tensor imaging. Twelve patients with different PLP1 point mutations encompassing a range of clinical phenotypes were analyzed, and the results were compared with a group of 12 age-matched controls. The parallel (λ// ), perpendicular (λ⊥ ), and apparent diffusion coefficients (ADC) and fractional anisotropy were measured in both limbs of the internal capsule, the genu and splenium of corpus callosum, the base of the pons, and the cerebral peduncles. The mean ADC and λ⊥ in the PMD patient group were both significantly increased in all selected structures, except for the base of the pons, compared with controls. PMD patients with the most severe disease, however, had a significant increase of both λ// and λ⊥ . In contrast, more mildly affected patients had much smaller changes in λ// and λ⊥ . These data suggest that myelin, the structure responsible in part for the λ⊥ barrier, is the major site of disease pathogenesis in this heterogeneous group of patients. Axons, in contrast, the structures mainly responsible for λ// , are much less affected, except within the subgroup of patients with the most severe disease. Clinical disability in patients with PLP1 point mutation is thus likely determined by the extent of pathological involvement of both myelin and axons, with alterations of both structures causing the most severe disease. © 2014 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Jeremy J Laukka
- Department of Neuroscience, University of Toledo, Toledo, Ohio; Center of Molecular Medicine and Genetics, Wayne State University, Detroit, Michigan
| | | | | | | | | | | |
Collapse
|
26
|
Skiöld B, Alexandrou G, Padilla N, Blennow M, Vollmer B, Adén U. Sex differences in outcome and associations with neonatal brain morphology in extremely preterm children. J Pediatr 2014; 164:1012-8. [PMID: 24530122 DOI: 10.1016/j.jpeds.2013.12.051] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Revised: 11/18/2013] [Accepted: 12/27/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate sex differences in neurologic and developmental outcomes in extremely preterm (EPT) children and explore associations with neonatal brain morphology. STUDY DESIGN A population-based cohort of infants born at <27 weeks gestation underwent magnetic resonance imaging (MRI) at term equivalent age (n = 107). Voxel-based morphometry (n = 27) and tract-based spatial statistics (n = 29) were performed in infants with normal MRI findings. Neurologic and developmental assessment (using the Bayley Scales of Infant and Toddler Development-Third Edition [BSITD-III]) was performed at 30 months corrected age (n = 91). RESULTS EPT boys had lower mean cognitive composite scores (P = .03) and lower mean language composite scores (P = .04) compared with EPT girls. Rates of cerebral palsy were similar in the 2 sexes. No perinatal factor explained the variance in outcomes. Visual inspection of T1- and T2-weighted MRI images found that delayed myelination was found more frequently in boys, whereas cerebellar abnormalities were more common in girls. In the subgroup of children with normal MRI findings (n = 27), boys had poorer cognitive function (P = .015) and language function (P = .008), despite larger volumes of cerebellar tissue (P = .029). In boys, cerebellar volume was positively correlated with BSITD-III cognitive and motor scores (P = .04 for both). In girls, white matter volume (P = .02) and cortical gray matter volume (P = .03) were positively correlated with BSITD-III language score. At the regional level, significant correlations with outcomes were found only in girls. CONCLUSION Cognitive and language outcomes at age 30 months were poorer in boys. Sex-related differences were observed on neonatal structural MRI, including differences in the patterns of correlations between brain volumes and developmental scores at both global and regional levels.
Collapse
Affiliation(s)
- Béatrice Skiöld
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; Department of Neonatology, Karolinska Institutet, Stockholm, Sweden.
| | - Georgios Alexandrou
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Nelly Padilla
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Mats Blennow
- Department of Neonatology, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Sciences, Intervention, and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Brigitte Vollmer
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Ulrika Adén
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; Department of Neonatology, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
27
|
Drobyshevsky A, Jiang R, Lin L, Derrick M, Luo K, Back SA, Tan S. Unmyelinated axon loss with postnatal hypertonia after fetal hypoxia. Ann Neurol 2014; 75:533-41. [PMID: 24633673 PMCID: PMC5975649 DOI: 10.1002/ana.24115] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2013] [Revised: 01/31/2014] [Accepted: 02/03/2014] [Indexed: 12/28/2022]
Abstract
OBJECTIVE White matter (WM) injury due to myelination defects is believed to be responsible for the motor deficits seen in cerebral palsy. We tested the hypothesis that the predominant injury is to functional electrical connectivity in unmyelinated WM fibers by conducting a longitudinal study of central WM tracts in newborn rabbit kits with hypertonia in our model of cerebral palsy. METHODS Pregnant rabbits at 70% gestation underwent 40-minute uterine ischemia. Motor deficits in newborn kits, including muscle hypertonia, were assessed by neurobehavioral testing. Major central WM tracts, including internal capsule, corpus callosum, anterior commissure, and fimbria hippocampi, were investigated for structural and functional injury using diffusion tensor magnetic resonance imaging (MRI), electrophysiological recordings of fiber conductivity in perfused brain slices, electron microscopy, and immunohistochemistry of oligodendrocyte lineage. RESULTS Motor deficits were observed on postnatal day 1 (P1) when WM tracts were unmyelinated. Myelination occurred later and was obvious by P18. Hypertonia was associated with microstructural WM injury and unmyelinated axon loss at P1, diagnosed by diffusion tensor MRI and electron microscopy. Axonal conductivity from electrophysiological recordings in hypertonic P18 kits decreased only in unmyelinated fibers, despite a loss in both myelinated and unmyelinated axons. INTERPRETATION Motor deficits in cerebral palsy were associated with loss of unmyelinated WM tracts. The contribution of injury to myelinated fibers that was observed at P18 is probably a secondary etiological factor in the motor and sensory deficits in the rabbit model of cerebral palsy.
Collapse
Affiliation(s)
- Alexander Drobyshevsky
- Department of Pediatrics, NorthShore University HealthSystem Research Institute, Evanston, IL
| | | | | | | | | | | | | |
Collapse
|
28
|
de Kieviet JF, Pouwels PJW, Lafeber HN, Vermeulen RJ, van Elburg RM, Oosterlaan J. A crucial role of altered fractional anisotropy in motor problems of very preterm children. Eur J Paediatr Neurol 2014; 18:126-33. [PMID: 24119780 DOI: 10.1016/j.ejpn.2013.09.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Revised: 08/22/2013] [Accepted: 09/14/2013] [Indexed: 11/24/2022]
Abstract
BACKGROUND Very preterm children (<32 weeks of gestation) are characterized by impaired white matter development as measured by fractional anisotropy (FA). This study investigates whether altered FA values underpin the widespread motor impairments and higher incidence of developmental coordination disorder (DCD) in very preterm children at school-age. METHODS Thirty very preterm born children (mean (SD) age of 8.6 (0.3) years) and 47 term born controls (mean [SD] age 8.7 [0.5] years) participated. Motor development was measured using the Movement Assessment Battery for Children. A score below the 15th percentile was used as a research diagnosis of DCD. FA values, as measure of white matter abnormalities, were determined for 18 major white matter tracts, obtained using probabilistic diffusion tensor tractography. RESULTS Large-sized reductions in FA of the cingulum hippocampal tract right (d = 0.75, p = .003) and left (d = 0.76, p = .001), corticospinal tract right (d = 0.56, p = .02) and left (d = 0.65, p = .009), forceps major (d = 1.04, p < .001) and minor (d = 0.54, p = .02) were present in very preterms, in particular with a research diagnosis of DCD. Reduced FA values moderately to strongly related to motor impairments. A ROC curve for average FA, as calculated from tracts that significantly discriminated between very preterm children with and without a research diagnosis of DCD, showed an area under curve of 0.87 (95% CI 0.74-1.00, p = .001). CONCLUSIONS This study provides clear evidence that reduced FA values are strongly underpinning motor impairment and DCD in very preterm children at school-age. In addition, outcomes demonstrate that altered white matter FA values can potentially be used to discriminate between very preterm children at risk for motor impairments, although future studies are warranted.
Collapse
Affiliation(s)
- Jorrit F de Kieviet
- VU University Amsterdam, Department of Clinical Neuropsychology, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands.
| | - Petra J W Pouwels
- VU University Medical Center, Department of Physics and Medical Technology, Amsterdam, The Netherlands
| | - Harrie N Lafeber
- VU University Medical Center, Department of Paediatrics, Amsterdam, The Netherlands
| | - R Jeroen Vermeulen
- VU University Medical Center, Department of Paediatric Neurology, Neuroscience Campus Amsterdam, Amsterdam, The Netherlands
| | - Ruurd M van Elburg
- VU University Medical Center, Department of Paediatrics, Amsterdam, The Netherlands; Danone Research Centre for Specialized Nutrition, Wageningen, The Netherlands
| | - Jaap Oosterlaan
- VU University Amsterdam, Department of Clinical Neuropsychology, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands
| |
Collapse
|
29
|
Abstract
Magnetic resonance imaging (MRI) is a safe and high-resolution neuroimaging modality that is increasingly used in the neonatal population to assess brain injury and its consequences on brain development. It is superior to cranial ultrasound for the definition of patterns of both white and gray matter maturation and injury and therefore has the potential to provide prognostic information on the neurodevelopmental outcomes of the preterm population. Furthermore, the development of sophisticated MRI strategies, including diffusion tensor imaging, resting state functional connectivity, and magnetic resonance spectroscopy, may increase the prognostic value, helping to guide parental counseling and allocate early intervention services.
Collapse
|
30
|
Thompson DK, Lee KJ, Egan GF, Warfield SK, Doyle LW, Anderson PJ, Inder TE. Regional white matter microstructure in very preterm infants: predictors and 7 year outcomes. Cortex 2013; 52:60-74. [PMID: 24405815 DOI: 10.1016/j.cortex.2013.11.010] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Revised: 10/18/2013] [Accepted: 11/27/2013] [Indexed: 02/01/2023]
Abstract
The aims of this study were to investigate regional white matter microstructural differences between very preterm (VPT) (<30 weeks' gestational age and/or <1250 g) and full term (FT) (≥37 weeks' gestational age) infants at term corrected age with diffusion tensor imaging, and to explore perinatal predictors of diffusion measures, and the relationship between regional diffusion measures and neurodevelopmental outcomes at age 7 years in VPT children. Mean (MD) (p = .003), axial (AD) (p = .008), and radial diffusivity (RD) (p = .003) in total white matter were increased in VPT compared with FT infants, with similar fractional anisotropy (FA) in the two groups. There was little evidence that group-wise differences were specific to any of the 8 regions studied for each hemisphere. Perinatal white matter abnormality and intraventricular hemorrhage (grade III or IV) were associated with increased diffusivity in the white matter of VPT infants. Higher white matter diffusivity measures of the inferior occipital and cerebellar region at term-equivalent age were associated with increased risk of impairments in motor and executive function at 7 years in VPT children, but there was little evidence for associations with IQ or memory impairment. In conclusion, myelination is likely disrupted or delayed in VPT infants, especially those with perinatal brain abnormality (BA). Altered diffusivity at term-equivalent age helps explain impaired functioning at 7 years. This study defines the nature of microstructural alterations in VPT infant white matter, assists in understanding the associated risk factors, and is the first study to reveal an important link between inferior occipital and cerebellar white matter disorganization in infancy, and executive and motor functioning 7 years later.
Collapse
Affiliation(s)
- Deanne K Thompson
- Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Vic, Australia; Florey Institute of Neuroscience and Mental Health, University of Melbourne, Carlton, Vic, Australia.
| | - Katherine J Lee
- Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Vic, Australia; Department of Paediatrics, University of Melbourne, Carlton, Vic, Australia
| | - Gary F Egan
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Carlton, Vic, Australia; Monash Biomedical Imaging, Monash University, Clayton, Vic, Australia
| | - Simon K Warfield
- Department of Radiology, Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Lex W Doyle
- Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Vic, Australia; Department of Obstetrics and Gynecology, Royal Women's Hospital, The University of Melbourne, Carlton, Vic, Australia
| | - Peter J Anderson
- Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Vic, Australia; Department of Paediatrics, University of Melbourne, Carlton, Vic, Australia
| | - Terrie E Inder
- Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Vic, Australia; Department of Pediatrics, St Louis Children's Hospital, Washington University in St Louis, St Louis, MO, USA
| |
Collapse
|
31
|
Tu TW, Kim JH, Yin FQ, Jakeman LB, Song SK. The impact of myelination on axon sparing and locomotor function recovery in spinal cord injury assessed using diffusion tensor imaging. NMR Biomed 2013; 26:1484-1495. [PMID: 23775778 PMCID: PMC3800477 DOI: 10.1002/nbm.2981] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Revised: 04/24/2013] [Accepted: 05/10/2013] [Indexed: 05/31/2023]
Abstract
The dysmyelinated axons of shiverer mice exhibit impaired conduction characteristics, similar to early postnatal axons before myelination, whereas the patterns of neuronal activity and connectivity are relatively comparable with those of wild-type myelinated axons. This unique dysmyelination pattern is exploited in the present study to determine the role of compact myelin in the loss and recovery of function following traumatic spinal cord injury (SCI). We applied in vivo diffusion tensor imaging (DTI) and post-mortem immunohistochemistry analysis to examine changes in myelin and axonal integrity, and evaluated these changes in concert with the analysis of locomotor function from 1 to 4 weeks following a mid-thoracic contusion injury in homozygous shiverer and heterozygous littermate mice. The DTI biomarkers, axial and radial diffusivities, are noninvasive indicators of axon and myelin integrity in response to SCI of both myelinated and dysmyelinated spinal cord. We show that myelin is critical for normal hind limb function in open field locomotion. However, when the functional outcome is limited during chronic SCI, the extent of recovery is associated with residual axonal integrity and independent of the extent of intact myelin at the lesion epicenter.
Collapse
Affiliation(s)
- Tsang-Wei Tu
- Radiology and Imaging Sciences, Clinical Center, National Institute of Health, MD, USA
| | - Joong H. Kim
- Department of Radiology, Washington University in St. Louis, MO, USA
| | - Feng Qin Yin
- Department of Physiology & Cell Biology and Center for Brain and Spinal Cord Repair, Ohio State University, Columbus, OH, USA
| | - Lyn B. Jakeman
- Department of Physiology & Cell Biology and Center for Brain and Spinal Cord Repair, Ohio State University, Columbus, OH, USA
| | - Sheng-Kwei Song
- Department of Radiology, Washington University in St. Louis, MO, USA
| |
Collapse
|
32
|
Baek SO, Jang SH, Lee E, Kim S, Hah JO, Park YH, Lee JM, Son SM. CST recovery in pediatric hemiplegic patients: Diffusion tensor tractography study. Neurosci Lett 2013; 557 Pt B:79-83. [PMID: 24176879 DOI: 10.1016/j.neulet.2013.10.047] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Revised: 10/03/2013] [Accepted: 10/21/2013] [Indexed: 11/25/2022]
Abstract
Many diffusion tensor imaging (DTI) studies have reported an association between corticospinal tract (CST) injury and motor dysfunction. In this study, we investigated CST recovery in 29 pediatric patients with clinical hemiplegia using DTI. We measured the fractional anisotropy (FA), apparent diffusion coefficient (ADC), and asymmetric anisotropy (AA) of both CSTs. The patients were classified into three groups according to severity of CST disruption of the more affected hemisphere. DTI was followed up for 9.34 ± 2.07 months after initial evaluation. The FA value of the more affected CST showed a significant decrease compared to the opposite side at initial and follow up evaluation, respectively (p<0.05). The FA value of both CSTs showed a significant increase at follow up compared to the initial evaluation, while more changes were observed on the more affected side, compared with the less affected side (p<0.05). AA showed a significant decrease at follow up, and showed significant correlation with interval change of FA value of the more affected side, not with that of the less affected side (r=0.543, p<0.05). 19 patients showed change of CST integrity. In the current study, the results of DTI showed recovery of the CST and provided radiologic evidence for a scientific basis of brain plasticity in pediatric patients.
Collapse
Affiliation(s)
- Seung Ok Baek
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Republic of Korea
| | | | | | | | | | | | | | | |
Collapse
|
33
|
Smyser CD, Snyder AZ, Shimony JS, Blazey TM, Inder TE, Neil JJ. Effects of white matter injury on resting state fMRI measures in prematurely born infants. PLoS One 2013; 8:e68098. [PMID: 23874510 PMCID: PMC3706620 DOI: 10.1371/journal.pone.0068098] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Accepted: 05/24/2013] [Indexed: 01/16/2023] Open
Abstract
The cerebral white matter is vulnerable to injury in very preterm infants (born prior to 30 weeks gestation), resulting in a spectrum of lesions. These range from severe forms, including cystic periventricular leukomalacia and periventricular hemorrhagic infarction, to minor focal punctate lesions. Moderate to severe white matter injury in preterm infants has been shown to predict later neurodevelopmental disability, although outcomes can vary widely in infants with qualitatively comparable lesions. Resting state functional connectivity magnetic resonance imaging has been increasingly utilized in neurodevelopmental investigations and may provide complementary information regarding the impact of white matter injury on the developing brain. We performed resting state functional connectivity magnetic resonance imaging at term equivalent postmenstrual age in fourteen preterm infants with moderate to severe white matter injury secondary to periventricular hemorrhagic infarction. In these subjects, resting state networks were identifiable throughout the brain. Patterns of aberrant functional connectivity were observed and depended upon injury severity. Comparisons were performed against data obtained from prematurely-born infants with mild white matter injury and healthy, term-born infants and demonstrated group differences. These results reveal structural-functional correlates of preterm white matter injury and carry implications for future investigations of neurodevelopmental disability.
Collapse
Affiliation(s)
- Christopher D Smyser
- Department of Neurology, Washington University, Saint Louis, Missouri, United States of America.
| | | | | | | | | | | |
Collapse
|
34
|
Rocca MA, Turconi AC, Strazzer S, Absinta M, Valsasina P, Beretta E, Copetti M, Cazzagon M, Falini A, Filippi M. MRI predicts efficacy of constraint-induced movement therapy in children with brain injury. Neurotherapeutics 2013; 10:511-9. [PMID: 23605556 PMCID: PMC3701764 DOI: 10.1007/s13311-013-0189-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Using resting state (RS) functional magnetic resonance imaging (fMRI) and diffusion tensor imaging (DTI), we identified the predictors of clinical improvement following constraint-induced movement therapy (CIMT) in pediatric patients with chronic hemiplegia.From 14 children with congenital or acquired brain injury and 10 sex- and age-matched healthy controls, brain dual-echo, DTI and RS fMRI sequences were acquired before CIMT. The Quality of Upper Extremities Skills Test and the Gross Motor Function Measure (GMFM) were administered at baseline, at the end of CIMT (10 weeks), and after 6 months. Mean diffusivity and fractional anisotropy (FA) were measured in the lesion responsible for the clinical symptomatology, the affected and unaffected corticospinal tract (CST), motor transcallosal fibers, and uncinate fasciculus (as an internal control). Independent component analysis was used to identify the sensorimotor RS network. The ability of baseline MRI variables to predict clinical changes over time was assessed using multivariate linear models. At baseline, patients had increased mean diffusivity in the symptomatic lesion and decreased FA in the symptomatic lesion, affected corticospinal tract, and motor transcallosal fibers. A reduced RS functional connectivity was found in the bilateral cerebellum, left precentral gyrus, and right secondary sensorimotor cortex. At follow up, Quality of Upper Extremities Skills Test and GMFM scales improved significantly. Baseline average lesion FA predicted clinical improvement at week 10, and baseline functional connectivity of the right secondary sensorimotor cortex and cerebellum predicted GMFM improvement at month 6. DTI and RS fMRI offer promising and objective markers to predict clinical outcomes following CIMT in pediatric patients with congenital or acquired hemiplegia.
Collapse
Affiliation(s)
- Maria A. Rocca
- />Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, and Department of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Anna C. Turconi
- />IRCCS Eugenio Medea, La Nostra Famiglia, Bosisio Parini, Lecco Italy
| | - Sandra Strazzer
- />IRCCS Eugenio Medea, La Nostra Famiglia, Bosisio Parini, Lecco Italy
| | - Martina Absinta
- />Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, and Department of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Paola Valsasina
- />Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, and Department of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Elena Beretta
- />IRCCS Eugenio Medea, La Nostra Famiglia, Bosisio Parini, Lecco Italy
| | - Massimiliano Copetti
- />Biostatistics Unit, IRCCS-Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia Italy
| | - Monica Cazzagon
- />IRCCS Eugenio Medea, La Nostra Famiglia, Pasian di Prato, Udine Italy
| | - Andrea Falini
- />Department of Neuroradiology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Filippi
- />Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, and Department of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| |
Collapse
|
35
|
Plaisier A, Govaert P, Lequin MH, Dudink J. Optimal timing of cerebral MRI in preterm infants to predict long-term neurodevelopmental outcome: a systematic review. AJNR Am J Neuroradiol 2013; 35:841-7. [PMID: 23639558 DOI: 10.3174/ajnr.a3513] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
SUMMARY Advances in neonatal neuroimaging have improved detection of preterm brain injury responsible for abnormal neuromotor and cognitive development. Increasingly sophisticated MR imaging setups allow scanning during early preterm life. In this review, we investigated how brain MR imaging in preterm infants should be timed to best predict long-term outcome. Given the strong evidence that structural brain abnormalities are related to long-term neurodevelopment, MR imaging should preferably be performed at term-equivalent age. Early MR imaging is promising because it can guide early intervention studies and is indispensable in research on preterm brain injury.
Collapse
Affiliation(s)
- A Plaisier
- From the Division of Neonatology (A.P., P.G., J.D.)Department of Pediatrics, and Division of Pediatric Radiology (A.P., M.H.L., J.D.), Department of Radiology, Erasmus Medical Center-Sophia, Rotterdam, the Netherlands
| | - P Govaert
- From the Division of Neonatology (A.P., P.G., J.D.)Department of Pediatrics (P.G.), Koningin Paola Children's Hospital, Antwerp, Belgium
| | - M H Lequin
- Department of Pediatrics, and Division of Pediatric Radiology (A.P., M.H.L., J.D.), Department of Radiology, Erasmus Medical Center-Sophia, Rotterdam, the Netherlands
| | - J Dudink
- From the Division of Neonatology (A.P., P.G., J.D.)Department of Pediatrics, and Division of Pediatric Radiology (A.P., M.H.L., J.D.), Department of Radiology, Erasmus Medical Center-Sophia, Rotterdam, the Netherlands
| |
Collapse
|
36
|
Heemskerk AM, Leemans A, Plaisier A, Pieterman K, Lequin MH, Dudink J. Acquisition guidelines and quality assessment tools for analyzing neonatal diffusion tensor MRI data. AJNR Am J Neuroradiol 2013; 34:1496-505. [PMID: 23518355 DOI: 10.3174/ajnr.a3465] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Diffusion tensor imaging is a valuable measure in clinical settings to assess diagnosis and prognosis of neonatal brain development. However, obtaining reliable images is not straightforward because of the tissue characteristics of the neonatal brain and the high likelihood of motion artifacts. In this review, we present guidelines on how to acquire DTI data of the neonatal brain and recommend high-quality data acquisition and processing as an essential means to obtain accurate and robust parametric maps. Sudden head movements are problematic for DTI in neonates, and these may lead to incorrect values. We describe strategies to minimize the corrupting effects both in terms of acquisition (eg, more gradient directions) and postprocessing (eg, tensor estimation methods). In addition, tools are described that can help assess whether a dataset is of sufficient quality for further assessment.
Collapse
Affiliation(s)
- A M Heemskerk
- Division of Neonatology, Department of Pediatrics, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | | | | | | | | |
Collapse
|
37
|
Abstract
Diffusion imaging has made significant inroads into the clinical diagnosis of a variety of diseases by inferring changes in microstructure, namely cell membranes, myelin sheath and other structures that inhibit water diffusion. This review discusses recent progress in the use of diffusion parameters in predicting functional outcome. Studies in the literature using only scalar parameters from diffusion measurements, such as apparent diffusion coefficient (ADC) and fractional anisotropy (FA), are summarized. Other more complex mathematical models and post-processing uses are also discussed briefly.
Collapse
Affiliation(s)
- Duan Xu
- Department of Radiology and Biomedical Imaging, University of California-San Francisco, 1 Irving St, AC112, Box 2512, San Francisco, CA 94143, USA.
| | - Pratik Mukherjee
- Department of Radiology and Biomedical Imaging, University of California
– San Francisco
| | - A James Barkovich
- Department of Radiology and Biomedical Imaging, University of California
– San Francisco
| |
Collapse
|
38
|
Pitcher JB, Schneider LA, Burns NR, Drysdale JL, Higgins RD, Ridding MC, Nettelbeck TJ, Haslam RR, Robinson JS. Reduced corticomotor excitability and motor skills development in children born preterm. J Physiol 2012; 590:5827-44. [PMID: 22966161 DOI: 10.1113/jphysiol.2012.239269] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The mechanisms underlying the altered neurodevelopment commonly experienced by children born preterm, but without brain lesions, remain unknown. While individuals born the earliest are at most risk, late preterm children also experience significant motor, cognitive and behavioural dysfunction from school age, and reduced income and educational attainment in adulthood. We used transcranial magnetic stimulation and functional assessments to examine corticomotor development in 151 children without cerebral palsy, aged 10-13 years and born after gestations of 25-41 completed weeks. We hypothesized that motor cortex and corticospinal development are altered in preterm children, which underpins at least some of their motor dysfunction. We report for the first time that every week of reduced gestation is associated with a reduction in corticomotor excitability that remains evident in late childhood. This reduced excitability was associated with poorer motor skill development, particularly manual dexterity. However, child adiposity, sex and socio-economic factors regarding the child's home environment soon after birth were also powerful influences on development of motor skills. Preterm birth was also associated with reduced left hemisphere lateralization, but without increasing the likelihood of being left handed per se. These corticomotor findings have implications for normal motor development, but also raise questions regarding possible longer term consequences of preterm birth on motor function.
Collapse
Affiliation(s)
- Julia B Pitcher
- Research Centre for Early Origins of Health and Disease, Robinson Institute, School of Paediatrics & Reproductive Health, University of Adelaide, SA 5005, Australia.
| | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Lepomäki V, Paavilainen T, Matomäki J, Hurme S, Haataja L, Lapinleimu H, Liisa Lehtonen L, Komu M, Parkkola R. Effect of antenatal growth and prematurity on brain white matter: diffusion tensor study. Pediatr Radiol 2012; 42:692-8. [PMID: 22421990 DOI: 10.1007/s00247-012-2352-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2011] [Revised: 11/30/2011] [Accepted: 12/04/2011] [Indexed: 11/25/2022]
Abstract
BACKGROUND White matter maturation is characterised by increasing fractional anisotropy (FA) and decreasing mean diffusivity (MD). Contradictory results have been published on the effect of premature birth on white matter maturation at term-equivalent age. OBJECTIVE To assess the association of gestational age and low birth-weight-for-gestational-age (z-score) with white matter maturation. MATERIALS AND METHODS Infants (n = 76, 53 males) born at different gestational ages were imaged at term-equivalent age. Gestational age and birth weight z-score were used as continuous variables and the effect on diffusion parameters was assessed. Brain maturation was studied using regions-of-interest analysis in several white matter areas. RESULTS Gestational age showed no significant effect on white matter maturation at term-equivalent age. Children with low birth weight z-score had lower FA in the genu and splenium of the corpus callosum (regression, P = 0.012 and P = 0.032; correlation, P = 0.009 and P = 0.006, respectively), and higher MD in the splenium of the corpus callosum (regression, P = 0.002; correlation, P = 0.0004) compared to children whose birth weight was appropriate for gestational age. CONCLUSION Children with low birth weight relative to gestational age show delay and/or anomaly in white matter maturation at term-equivalent age.
Collapse
Affiliation(s)
- V Lepomäki
- Medical Imaging Centre of Southwest Finland, Turku University Central Hospital, Turku, Finland.
| | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Abstract
With the wider use of magnetic resonance imaging, the recognition of different patterns of injury has become established. These patterns vary in relation to the level of immaturity of the infant. This review will outline the major patterns of abnormality that are found in the term born and preterm infant.
Collapse
|
41
|
Chang MC, Jang SH, Yoe SS, Lee E, Kim S, Lee DG, Son SM. Diffusion tensor imaging demonstrated radiologic differences between diplegic and quadriplegic cerebral palsy. Neurosci Lett 2012; 512:53-8. [PMID: 22330748 DOI: 10.1016/j.neulet.2012.01.065] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2011] [Revised: 01/25/2012] [Accepted: 01/27/2012] [Indexed: 10/14/2022]
|
42
|
Lepomäki VK, Paavilainen TP, Hurme SAM, Komu ME, Parkkola RK. Fractional anisotropy and mean diffusivity parameters of the brain white matter tracts in preterm infants: reproducibility of region-of-interest measurements. Pediatr Radiol 2012; 42:175-82. [PMID: 22006530 DOI: 10.1007/s00247-011-2234-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2011] [Revised: 06/06/2011] [Accepted: 06/26/2011] [Indexed: 11/25/2022]
Abstract
BACKGROUND Diffusion tensor parameters can be analysed by fitting regions of interest (ROIs) to selected brain structures. The clinical usefulness of these measurements is influenced by their reproducibility and validity. OBJECTIVE To investigate the reproducibility of fractional anisotropy (FA) and mean diffusivity (MD) measurements. MATERIAL AND METHODS Seventy-six infants were imaged once at term-equivalent age. We measured several brain regions. Reproducibility was assessed using intraclass correlation coefficient and Bland-Altman method. RESULTS Intra-observer reproducibility was excellent for FA in the calcarine cortex (right) and frontal white matter (left), and for MD in the corpus callosum (anterior), internal capsule, corona radiata, putamen, frontal white matter, optic radiation (left), thalamus (right) and calcarine cortex (right). Inter-observer reproducibility was excellent for FA in the corpus callosum (posterior) and for MD in the internal capsule and corona radiata (right). Inter-observer reproducibility was poor for FA in frontal and posterior white matter (right) and for MD in the inferior colliculus (right). Reproducibility was fair to good in other areas. The Bland-Altman plots showed no considerable bias, and variance was independent of the mean value. CONCLUSION Reproducibility of ROI measurement was fair to good for both FA and MD.
Collapse
Affiliation(s)
- Virva K Lepomäki
- Department of Radiology, Turku University Hospital, Turku, Finland.
| | | | | | | | | |
Collapse
|
43
|
Griffith JL, Shimony JS, Cousins SA, Rees SE, McCurnin DC, Inder TE, Neil JJ. MR imaging correlates of white-matter pathology in a preterm baboon model. Pediatr Res 2012; 71:185-91. [PMID: 22258130 DOI: 10.1038/pr.2011.33] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Cerebral white-matter (WM) abnormalities on magnetic resonance imaging (MRI) correlate with neurodevelopmental disability in infants born prematurely. RESULTS Quantitative histological measures of WM and ventricular volumes correlated with qualitative MRI scores of WM volume loss and ventriculomegaly. Diffuse astrocytosis was associated with signal abnormality on T(2)-weighted imaging and higher apparent diffusion coefficient in WM. Loss of oligodendrocytes was associated with lower relative anisotropy characterized by higher radial diffusivity values. The relationship between histopathology and MRI abnormalities was more pronounced in animals in the 28 d model, equivalent to the term human infant. DISCUSSION MRI reflects microstructural and anatomical abnormalities that are characteristic of WM injury in the preterm brain, and these changes are more evident on MRI at term-equivalent postmenstrual age. METHODS We assessed the histopathological correlates of MRI abnormalities in a baboon model of premature birth. Baboons were delivered at 125 d of gestation (dg, term ~185 dg) and maintained in an animal intensive care unit for 14 (n = 26) or 28 d (n = 17). Gestational control animals were delivered at 140 dg (n = 9) or 153 dg (n = 4). Cerebral WM in fixed brains was evaluated using MRI, diffusion tensor imaging (DTI), and histopathology.
Collapse
|
44
|
Abstract
The study of the links and interactions between development and motor learning has noticeable implications for the understanding and management of neurodevelopmental disorders. This is particularly relevant for the cerebellum which is critical for sensorimotor learning. The olivocerebellar pathway is a key pathway contributing to learning of motor skills. Its developmental maturation and remodeling are being unraveled. Advances in genetics have led to major improvements in our appraisal of the genes involved in cerebellar development, especially studies in mutant mice. Cerebellar neurogenesis is compartmentalized in relationship with neurotransmitter fate. The Engrailed-2 gene is a major actor of the specification of cerebellar cell types and late embryogenic morphogenesis. Math1, expressed by the rhombic lip, is required for the genesis of glutamatergic neurons. Mutants deficient for the transcription factor Ptf1a display a lack of Purkinje cells and gabaergic interneurons. Rora gene contributes to the developmental signaling between granule cells and Purkinje neurons. The expression profile of sonic hedgehog in postnatal stages determines the final size/shape of the cerebellum. Genes affecting the development impact upon the physiological properties of the cerebellar circuits. For instance, receptors are developmentally regulated and their action interferes directly with developmental processes. Another field of research which is expanding relates to very preterm neonates. They are at risk for cerebellar lesions, which may themselves impair the developmental events. Very preterm neonates often show sensori-motor deficits, highlighting another major link between impaired developments and learning deficiencies. Pathways playing a critical role in cerebellar development are likely to become therapeutical targets for several neurodevelopmental disorders.
Collapse
Affiliation(s)
- Mario U Manto
- FNRS, Neurologie, Unité d'Etude du Mouvement, Hôpital Erasme-ULB Bruxelles, Belgium
| | | |
Collapse
|
45
|
van Kooij BJM, van Pul C, Benders MJNL, van Haastert IC, de Vries LS, Groenendaal F. Fiber tracking at term displays gender differences regarding cognitive and motor outcome at 2 years of age in preterm infants. Pediatr Res 2011; 70:626-32. [PMID: 21857376 DOI: 10.1203/pdr.0b013e318232a963] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
White matter microstructural changes can be detected with diffusion tensor imaging. It was hypothesized that diffusion parameters in the posterior limb of the internal capsule (PLIC) and corpus callosum (CC) bundles in preterm infants at term equivalent age (TEA) were associated with neurodevelopment at 2 y corrected age. In 67 preterm infants, fiber tracking was performed at TEA for the CC and both PLIC bundles. Volume, length, fractional anisotropy (FA), mean diffusivity, axial diffusivity, and radial diffusivity were determined for the three bundles. These parameters were assessed in relation to outcome on the Bayley Scales of Infant and Toddler Development III. In girls, volume and length of the CC bundle and right PLIC bundle volume were associated with cognition. In boys, volume, FA, mean and radial diffusivity, and length of the left PLIC were associated with fine motor scores. Correction for GA, birth weight, intraventricular hemorrhage, white matter injury, and maternal education did not change the results. Fiber tracking parameters in the PLIC and CC bundles in preterm infants at TEA revealed different associations with neurodevelopment between boys and girls. This study suggested that fiber tracking is a useful method to predict neurodevelopment in preterm infants.
Collapse
Affiliation(s)
- Britt J M van Kooij
- Neonatology Unit, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht 3584 EA, The Netherlands
| | | | | | | | | | | |
Collapse
|
46
|
Affiliation(s)
- Izlem Izbudak
- Neuroradiology Division, Department of Radiology and Radiological Science, Johns Hopkins University, 600 North Wolfe Street, Phipps B-126-B, Baltimore, MD 21287-0842, USA.
| | | |
Collapse
|
47
|
Mullen KM, Vohr BR, Katz KH, Schneider KC, Lacadie C, Hampson M, Makuch RW, Reiss AL, Constable RT, Ment LR. Preterm birth results in alterations in neural connectivity at age 16 years. Neuroimage 2010; 54:2563-70. [PMID: 21073965 DOI: 10.1016/j.neuroimage.2010.11.019] [Citation(s) in RCA: 136] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Revised: 10/28/2010] [Accepted: 11/03/2010] [Indexed: 10/18/2022] Open
Abstract
Very low birth weight preterm (PT) children are at high risk for brain injury. Employing diffusion tensor imaging (DTI), we tested the hypothesis that PT adolescents would demonstrate microstructural white matter disorganization relative to term controls at 16 years of age. Forty-four PT subjects (600-1250 g birth weight) without neonatal brain injury and 41 term controls were evaluated at age 16 years with DTI, the Wechsler Intelligence Scale for Children-III (WISC), the Peabody Picture Vocabulary Test-Revised (PPVT), and the Comprehensive Test of Phonological Processing (CTOPP). PT subjects scored lower than term subjects on WISC full scale (p=0.003), verbal (p=0.043), and performance IQ tests (p=0.001), as well as CTOPP phonological awareness (p=0.004), but scored comparably to term subjects on PPVT and CTOPP Rapid Naming tests. PT subjects had lower fractional anisotropy (FA) values in multiple regions including bilateral uncinate fasciculi (left: p=0.01; right: p=0.004), bilateral external capsules (left: p<0.001; right: p<0.001), the splenium of the corpus callosum (p=0.008), and white matter serving the inferior frontal gyrus bilaterally (left: p<0.001; right: p=0.011). FA values in both the left and right uncinate fasciculi correlated with PPVT scores (a semantic language task) in the PT subjects (left: r=0.314, p=0.038; right: r=0.336, p=0.026). FA values in the left and right arcuate fasciculi correlated with CTOPP Rapid Naming scores (a phonologic task) in the PT subjects (left: r=0.424, p=0.004; right: r=0.301, p=0.047). These data support for the first time that dual pathways underlying language function are present in PT adolescents. The striking bilateral dorsal correlations for the PT group suggest that prematurely born subjects rely more heavily on the right hemisphere than typically developing adults for performance of phonological language tasks. These findings may represent either a delay in maturation or the engagement of alternative neural pathways for language in the developing PT brain.
Collapse
Affiliation(s)
- Katherine M Mullen
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT 06511, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Bonifacio SL, Glass HC, Chau V, Berman JI, Xu D, Brant R, Barkovich AJ, Poskitt KJ, Miller SP, Ferriero DM. Extreme premature birth is not associated with impaired development of brain microstructure. J Pediatr 2010; 157:726-32.e1. [PMID: 20598316 DOI: 10.1016/j.jpeds.2010.05.026] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2009] [Revised: 04/15/2010] [Accepted: 05/11/2010] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To assess whether birth at <26 weeks gestation is an important predictor of brain microstructure maturation as determined by using diffusion tensor imaging. STUDY DESIGN We performed serial magnetic resonance imaging and diffusion tensor imaging in 176 infants born at <33 weeks gestation. Diffusion parameters were calculated for white and gray matter regions. Linear regression for repeated measures was used to assess the effect of extremely premature birth on brain maturation. RESULTS In white matter, fractional anisotropy increased by 0.008 per week (95% CI, 0.007-0.009; P < .0001) and mean diffusivity decreased by 0.021 mm(2)/sec per week, (95% CI, -0.24-0.018; P < .0001). Birth at <26 weeks was associated with lower white matter fractional anisotropy (-0.01; 95% CI, -0.018-0.003; P = .008), but this effect was eliminated when co-morbid conditions were added to the model. Moderate-severe brain injury was associated with decreased mean white matter fractional anisotropy (-0.012; 95% CI, -0.02-0.004; P = .002). CONCLUSION Brain microstructure maturation as measured serially in premature infants is independent of extremely premature birth. Brain injury and co-morbid conditions may be the important determinants of microstructure maturation.
Collapse
|
49
|
Glass HC, Berman JI, Norcia AM, Rogers EE, Henry RG, Hou C, Barkovich AJ, Good WV. Quantitative fiber tracking of the optic radiation is correlated with visual-evoked potential amplitude in preterm infants. AJNR Am J Neuroradiol 2010; 31:1424-9. [PMID: 20448011 DOI: 10.3174/ajnr.a2110] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Children born preterm are at risk for adverse outcome, including visual impairment. We examined the relationship between neonatal DTI and sVEP in children born preterm to determine whether visual outcomes are related to early measurements of brain microstructure. MATERIALS AND METHODS Subjects were born at <34 weeks gestation and imaged before term-equivalent age. DTI fiber tracking was used to delineate the optic radiations and measure tract-specific average FA, D(av), and parallel and transverse diffusivity. Visual-evoked response amplitudes were measured as a function of spatial frequency, contrast, and vernier offset size with sVEP at 6-20 months after birth. The association between DTI and sVEP was assessed by using the Spearman correlation coefficient and linear regression for repeated measures. RESULTS Nine children with 15 scans were included. The peak response amplitudes for spatial frequency sweeps were associated with increasing FA and decreasing D(av) and transverse diffusivity (P ≤ .006) but not with parallel diffusivity (P = 1). There was only modest association with the swept contrast condition and no detectable association with the vernier offset sweeps. CONCLUSIONS Microstructure of the optic radiations measured shortly after birth is associated with quantitatively measured responses elicited by moderate-to-high contrast spatiotemporal gratings in infancy. These findings are in keeping with studies showing a relationship between brain microstructure and function. While the clinical impact is not known, quantitative neuroimaging of white matter may ultimately be important for predicting outcome in preterm neonates.
Collapse
Affiliation(s)
- H C Glass
- Department of Pediatrics, University ofCalifornia, San Francisco, San Francisco, CA, USA.
| | | | | | | | | | | | | | | |
Collapse
|
50
|
Mathur AM, Neil JJ, Inder TE. Understanding brain injury and neurodevelopmental disabilities in the preterm infant: the evolving role of advanced magnetic resonance imaging. Semin Perinatol 2010; 34:57-66. [PMID: 20109973 PMCID: PMC2864915 DOI: 10.1053/j.semperi.2009.10.006] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The high incidence of neurodevelopmental disability in premature infants requires continued efforts at understanding the underlying microstructural changes in the brain that cause this perturbation in normal development. Magnetic resonance imaging (MRI) methods offer great potential to fulfill this need. Serial MR imaging and the application of newer analysis techniques, such as diffusion tensor imaging (DTI), volumetric MR analysis, cortical surface analysis, functional connectivity MRI (fcMRI) and diffusion tractography, provide important insights into the trajectory of brain development in the premature infant and the impact of injury on this developmental trajectory. While some of these imaging techniques are currently available in the research setting only, other measures, such as DTI and brain metric measures can be used clinically. MR imaging also has an enormous potential to be used as a surrogate, short-term outcome measure in clinical studies evaluating new therapeutic interventions of neuroprotection of the developing brain. In this article, we review the current status of these advanced MR imaging techniques.
Collapse
|