Correlation of white matter diffusivity and anisotropy with age during childhood and adolescence: a cross-sectional diffusion-tensor MR imaging study

Diffusion tensor MR imaging reveals persistent white matter alteration after traumatic brain injury experienced during early childhood

BACKGROUND AND PURPOSE

Diffusion tensor imaging (DTI) can noninvasively quantify white matter (WM) integrity. Although its application in adult traumatic brain injury (TBI) is common, few studies in children have been reported. The purposes of this study were to examine the alteration of fractional anisotropy (FA) in children with TBI experienced during early childhood and to quantify the association between FA and injury severity.

MATERIALS AND METHODS

FA was assessed in 9 children with TBI (age = 7.89 +/- 1.00 years; Glasgow Coma Scale [GCS] = 10.11 +/- 4.68) and a control group of 12 children with orthopedic injuries without central nervous system involvement (age = 7.51 +/- 0.95 years). All of the subjects were at minimum 12 months after injury. We examined group differences in a series of predetermined WM regions of interest with t test analysis. We subsequently conducted a voxel-wise comparison with Spearman partial correlation analysis. Correlations between FA and injury severity were also calculated on a voxel-wise basis.

RESULTS

FA values were significantly reduced in the TBI group in genu of corpus callosum (CC), posterior limb of internal capsule (PLIC), superior longitudinal fasciculus (SLF), superior fronto-occipital fasciculus (SFO), and centrum semiovale (CS). GCS scores were positively correlated with FA in several WM areas including CC, PLIC, SLF, CS, SFO, and inferior fronto-occipital fasciculus (IFO).

CONCLUSION

This DTI study provides evidence that WM integrity remains abnormal in children with moderate-to-severe TBI experienced during early childhood and that injury severity correlated strongly with FA.

Visualization of maturation of the corpus callosum during childhood and adolescence using T2 relaxometry

Previous studies have shown that maturation of the white matter in terms of its relative signal intensity changes on MRI is almost complete at 2-3 years of age. We hypothesized that quantitative analysis may show maturation of the white matter during childhood and adolescence. In the present study we performed multi-echo T2 relaxometry in 33 healthy subjects (girls, 15; boys, 18) aged 3-15 years. T2 relaxation times of the genu and splenium were measured. In healthy subjects, the T2 relaxation times were significantly correlated with age in both girls (r=0.611, p=.016) and boys (r=0.721, p=.001) in the splenium, but not in the genu (p>.05). To further confirm genu-to-splenium signal intensity ratio changes, a total of 389 brain MRIs were retrospectively selected from the patients who had normal results (189 girls/women, 200 boys/men; age range, 3-20 years). The genu-to-splenium signal intensity ratio was obtained from the T2-weighted images. In patients with normal MRI, the genu-to-splenium signal intensity ratio was significantly decreased with age (p<.001) by 16 years. The T2 relaxation times gradually increase in the splenium during childhood and adolescence, suggestive of maturation.

Characteristics of abnormal diffusivity in normal-appearing white matter investigated with diffusion tensor MR imaging in tuberous sclerosis complex

BACKGROUND AND PURPOSE

Although patients with tuberous sclerosis complex (TSC) manifest various structural abnormalities, we hypothesized that white matter (WM) structures that appear normal on conventional MR imaging may be accompanied by microstructural changes, such as gliosis and myelinization defects. Our objective was to determine in vivo whether there was evidence for WM microstructural changes by using diffusion tensor imaging (DTI).

MATERIALS AND METHODS

We used DTI to evaluate diffusivity and anisotropy in normal-appearing WM (NAWM) of 6 children with TSC and 12 age-matched control subjects. The anterior and posterior limbs of the internal capsule, the external capsule, and the genu and splenium of the corpus callosum were assessed. We hypothesized that previously reported DTI abnormalities of NAWM in patients with TSC may not be equal in all diffusion directions as measured by the major, middle, and minor eigenvalues.

RESULTS

When combining NAWM regions in patients with TSC, we observed a significant increase in mean diffusivity (P = .003) and a decrease in anisotropy (P = .03) compared with those of controls. However, the increase in diffusivity was more pronounced in directions orthogonal to the axons measured by the minor and middle eigenvalues (P = .005) than by the major eigenvalue (P = .02).

CONCLUSION

Our findings revealed a decrease in anisotropy and an increase in longitudinal and radial diffusivities in NAWM beyond the location of TSC lesions seen on conventional MR imaging. The axonal microstructural changes suggested by our study may be related to changes in myelin packing due to giant cells accompanied by gliosis and myelination defects known to occur in TSC WM.

Quantitative diffusion tensor fiber tracking of age-related changes in the limbic system

Cerebral white matter is known to undergo degradation with aging, and diffusion tensor imaging (DTI) is capable of revealing the white matter integrity. We assessed age-related changes of quantitative diffusivity parameters and fiber characteristics within the fornix and the cingulum. Thirty-eight healthy subjects aged 18-88 years were examined at 3 Tesla using a 1.9-mm isotropic DTI sequence. Quantitative fiber tracking was performed for 3D-segmentation of the fornix and the cingulum to determine fractional anisotropy (FA), mean diffusivity (MD), eigenvalues (lambda1, lambda2, and lambda3), number of fibers (NoF), and mean NoF/voxel (FpV). In the fornix, all diffusivity parameters (FA, MD, and eigenvalues) were moderately correlated with age. Strong and moderate negative correlations for NoF and FpV were found, respectively. In the cingulum, no correlation was observed between FA and age, and only weak correlations for the other quantitative parameters. Differences in correlations between the fornix and the cingulum were significant for all diffusivity parameters and for NoF, but not for FpV. The strongest relative changes per decade of age were found in the fornix: FA -2.1%, MD 4.2%, NoF -10.6%, and FpV -4.6%. Our quantitative 3D fiber tracking approach shows that the cingulum is resistant to aging while the fornix is not.

Changes in white matter microstructure during adolescence

Postmortem histological studies have demonstrated that myelination in human brain white matter (WM) continues throughout adolescence and well into adulthood. We used in vivo diffusion-weighted magnetic resonance imaging to test for age-related WM changes in 42 adolescents and 20 young adults. Tract-Based Spatial Statistics (TBSS) analysis of the adolescent data identified widespread age-related increases in fractional anisotropy (FA) that were most significant in clusters including the body of the corpus callosum and right superior corona radiata. These changes were driven by changes in perpendicular, rather than parallel, diffusivity. These WM clusters were used as seeds for probabilistic tractography, allowing us to identify the regions as belonging to callosal, corticospinal, and prefrontal tracts. We also performed voxel-based morphometry-style analysis of conventional T1-weighted images to test for age-related changes in grey matter (GM). We identified a cluster including right middle frontal and precentral gyri that showed an age-related decrease in GM density through adolescence and connected with the tracts showing age-related WM FA increases. The GM density decrease was highly significantly correlated with the WM FA increase in the connected cluster. Age-related changes in FA were much less prominent in the young adult group, but we did find a significant age-related increase in FA in the right superior longitudinal fascicle, suggesting that structural development of this pathway continues into adulthood. Our results suggest that significant microstructural changes in WM continue throughout adolescence and are associated with corresponding age-related changes in cortical GM regions.

Clinical applications of diffusion tensor imaging and tractography in children

Diffusion tensor imaging (DTI) is a relatively new addition to routine MR imaging. DTI exploits the preferential movement of water protons within the brain along the axis of the axons. This anisotropic diffusion provides information about the immature brain prior to myelination, during maturation, and in normal and disease states, information that MRI cannot provide. By virtue of sensitivity to anisotropic movement of protons, DTI allows the core of larger individual white matter tracts to be visualized as discreet anatomic structures. DTI can also provide information about the microarchitecture of white matter in the form of metrics referred to as fractional anisotropy and diffusivity. The information contained within the diffusion tensor data can be used to create 3-D mathematical renderings of white matter or tractography. This article is an introduction to DTI for pediatric radiologists interested in exploring potential applications in children.

Evidence of subcortical and cortical aging of the acoustic pathway: a diffusion tensor imaging (DTI) study

RATIONALE AND OBJECTIVES

During aging, there is evidence of microstructural changes in certain cortical and subcortical brain regions. Diffusion tensor imaging (DTI) is used to study age related microstructural changes in the acoustic pathway.

MATERIALS AND METHODS

Twenty healthy volunteers (mean age 28.5 years) and 15 healthy volunteers (mean age 61.3 years) were examined using a 1.5-T MR system with a high-resolution T1-weighted sequence and an integrated parallel imaging technique DTI Echo-planar-imaging (EPI) sequence. For reliability, 10 subjects underwent a second examination 2 days later. The fractional anisotropy (FA) and the apparent diffusion coefficient (ADC) were measured in six brain regions of the auditory pathway.

RESULTS

We found no left/right asymmetry in the selected brain structures. There were no significant differences (P < .05) in the ADC and FA in the lateral lemniscus and medial geniculate body of young and elderly subjects. However, FA was significantly increased (P < .05) in the inferior colliculus and decreased in the auditory radiation, the superficial temporal gyrus, and the transverse temporal gyrus in the elder subjects than in the younger ones. There were no significant differences in anisotropy in subsequent examinations in the younger individuals.

CONCLUSIONS

These findings suggest evidence of age-related changes in the acoustic pathway. These changes are associated with a decrease in anisotropy mainly in the cortical grey and white matter rather than in the subcortical regions. Our DTI measurements were reproducible.

Multimodality imaging of cortical and white matter abnormalities in Sturge-Weber syndrome

BACKGROUND AND PURPOSE

Impaired cortical venous outflow and abnormal deep venous collaterals are common in Sturge-Weber syndrome (SWS), but their relation to brain metabolism and function is poorly understood. In this study, advanced MR imaging techniques, such as susceptibility-weighted imaging (SWI) and diffusion tensor imaging (DTI), were applied in conjunction with positron-emission tomography (PET), to assess cortical and white matter structural abnormalities and their relation to cortical glucose metabolism and cognitive functions in children with unilateral SWS.

MATERIALS AND METHODS

Thirteen children (age, 1.5-10.3 years) with unilateral SWS underwent MR imaging with SWI and DTI, glucose metabolism PET, and comprehensive neuropsychologic assessment prospectively. The MR imaging and PET images were coregistered and cortical regions showing decreased glucose metabolism were compared with locations of SWI signal intensity abnormalities, changes in white matter water diffusion, and cognitive functions.

RESULTS

SWI detected both cortical abnormalities (n=8) and deep transmedullary veins (n=9), including those in young children with no cortical SWI signal intensity changes. These veins were often located under cortex adjacent to hypometabolic regions. DTI showed abnormal water diffusion both under hypometabolic cortex and in adjacent white matter with collateral veins. Cognitive dysfunction was associated with abnormal water diffusion in the posterior white matter.

CONCLUSIONS

Transmedullary venous collaterals can be detected early by SWI and persist in white matter adjacent to damaged cortex in children with SWS. Microstructural white matter damage extends beyond cortical abnormalities and may contribute to cognitive impairment. SWI and DTI can be incorporated into clinical MR imaging acquisitions to objectively assess microstructural abnormalities at different stages of SWS.

The contribution of neuroimaging to the study of language and aphasia

New structural and functional imaging methods continue to be developed at a rapid pace. In the last 25 years, advanced imaging techniques have provided insights into how language is represented and processed in the brain and how it can be disrupted by damage to, or dysfunction of, various parts of the brain. Imaging studies have also yielded new information regarding how individuals recover language after stroke. We briefly review the strengths and weaknesses of the various radiological methods currently used to study language and aphasia.

Quantitative diffusion tensor tractography of association and projection fibers in normally developing children and adolescents

Whole-brain diffusion tensor tractography (DTT) at high signal-to-noise ratio and angular and spatial resolutions were utilized to study the effects of age, sex differences, and lateral asymmetries of 6 white matter pathways (arcuate fasciculus [AF], inferior longitudinal fasciculus, inferior fronto-occipital fasciculus [IFOF], uncinate fasciculus [UF], corticospinal tract [CST], and somatosensory pathway [SS]) in 31 right-handed children (6-17 years). Fractional anisotropy (FA), a measure of the orientational variance in water molecular diffusivity, and the magnitude of water diffusivity (parallel, perpendicular, and mean diffusivity) along the pathways were quantified. Three major patterns of maturation were observed: 1) significant increase in FA with age, accompanied by significant decreases in all 3 diffusivities (e.g., left IFOF); 2) significant decreases in all three diffusivities with age without significant changes in FA (e.g., left CST); and 3) no significant age-related changes in FA or diffusivity (e.g., SS). Sex differences were minimal. Many pathways showed lateral asymmetries. In the right hemisphere, the frontotemporal (FT) segment of AF was not visualized in a substantial (29%) number of participants. FA was higher in the left hemisphere in the FT segment of AF, UF, and CST, whereas it was lower in the frontoparietal segment of AF. This study provides normative data essential for the interpretation of pediatric brain DTT measurements in both health and disease.

Diffusion tensor imaging: Application to the study of the developing brain

OBJECTIVE

To provide an overview of diffusion tensor imaging (DTI) and its application to the study of white matter in the developing brain in both healthy and clinical samples.

METHOD

The development of DTI and its application to brain imaging of white matter tracts is discussed. Forty-eight studies using DTI to examine diffusion properties of the developing brain are reviewed in the context of the structural magnetic resonance imaging literature. Reports of how brain diffusion properties are affected in pediatric clinical samples and how they relate to cognitive and behavioral phenotypes are reviewed.

RESULTS

DTI has been used successfully to describe white matter development in pediatric samples. Changes in white matter diffusion properties are consistent across studies, with anisotropy increasing and overall diffusion decreasing with age. Diffusion measures in relevant white matter regions correlate with behavioral measures in healthy children and in clinical pediatric samples.

CONCLUSIONS

DTI is an important tool for providing a more detailed picture of developing white matter than can be obtained with conventional magnetic resonance imaging alone.

White matter development during late adolescence in healthy males: a cross-sectional diffusion tensor imaging study

BACKGROUND

Previous MRI studies of healthy children have reported age-related white matter (WM) changes in language and motor areas of the brain. The authors investigated WM development in healthy adolescent males through age-associated changes in fractional anisotropy (FA), radial (lambda( perpendicular)) and axial (lambda(||)) diffusivity.

METHODS

Twenty-four healthy adolescent males (mean age=16.6, SD=2.5 years) were divided into two groups with an age split of 16.9 years and underwent a whole-brain voxelwise analysis.

RESULTS

At a threshold of p<0.001 and extent threshold of 100 contiguous voxels, several clusters with increased FA and axial diffusivity and no differences in radial diffusivity were observed in older adolescents compared to the younger adolescents in the left arcuate fasciculus, bilateral posterior internal capsule/thalamic radiation, bilateral prefrontal gyrus, right superior temporal gyrus, and posterior corpus callosum. Increased FA and lambda(||) of several clusters along the arcuate fasciculus significantly correlated with a test of language and semantic memory.

CONCLUSIONS

These results suggest ongoing maturational changes especially in the arcuate fasiculus during late adolescence. Increased FA and lambda(||) with no changes in radial diffusivity may reflect a developmental pattern of reduced tortuousity toward more straightened fibers and/or increased axonal fiber organization during late adolescence.

The NIH MRI study of normal brain development (Objective-2): newborns, infants, toddlers, and preschoolers

The Magn. Reson. Imaging (MRI) study of normal brain development currently conducted by the Brain Development Cooperative Group represents the most extensive MRI study of brain and behavioral development from birth through young adulthood ever conducted. This multi-center project, sponsored by four Institutes of the National Institutes of Health, uses a combined longitudinal and cross-sectional design to characterize normal, healthy brain and behavioral development. Children, ages newborn through 18-plus years of age, receive comprehensive behavioral, neurological and multimodal MRI evaluations via Objective-2 (birth through 4-years 5-months of age) and Objective-1 (4-years 6-months through 18 years of age and older). This report presents methods (e.g., neurobehavioral assessment, brain scan) and representative preliminary results (e.g., growth, behavior, brain development) for children from newborn through 4-years 5-months of age. To date, 75 participants from birth through 4-years 5-months have been successfully brain scanned during natural sleep (i.e., without sedation); most with multiple longitudinal scans (i.e., 45 children completing at least three scans, 22 completing four or more scans). Results from this younger age range will increase our knowledge and understanding of healthy brain and neurobehavioral development throughout an important, dynamic, and rapid growth period within the human life span; determine developmental associations among measures of brain, other physical characteristics, and behavior; and facilitate the development of automated, quantitative MR image analyses for neonates, infants and young children. The correlated brain MRI and neurobehavioral database will be released for use by the research and clinical communities at a future date.

Sex differences in the development of neuroanatomical functional connectivity underlying intelligence found using Bayesian connectivity analysis

A Bayesian method for functional connectivity analysis was adapted to investigate between-group differences. This method was applied in a large cohort of almost 300 children to investigate differences in boys and girls in the relationship between intelligence and functional connectivity for the task of narrative comprehension. For boys, a greater association was shown between intelligence and the functional connectivity linking Broca's area to auditory processing areas, including Wernicke's areas and the right posterior superior temporal gyrus. For girls, a greater association was shown between intelligence and the functional connectivity linking the left posterior superior temporal gyrus to Wernicke's areas bilaterally. A developmental effect was also seen, with girls displaying a positive correlation with age in the association between intelligence and the functional connectivity linking the right posterior superior temporal gyrus to Wernicke's areas bilaterally. Our results demonstrate a sexual dimorphism in the relationship of functional connectivity to intelligence in children and an increasing reliance on inter-hemispheric connectivity in girls with age.

A developmental study of the structural integrity of white matter in autism

Diffusion tensor imaging was used to examine developmental changes in the organization of white matter in a large sample of male participants with autism and controls between the ages of 10 and 35 years. Participants with autism had lower fractional anisotropy in areas within and near the corpus callosum and in the right retrolenticular portion of the internal capsule. Only one area, in the posterior limb of the right internal capsule, showed an interaction between age and group. The findings suggest that reductions in the structural integrity of white matter in autism persist into adulthood. These reductions may underlie the behavioral pattern observed in autism, as well as findings of reduced functional connectivity in functional magnetic resonance imaging signal between activating cortical areas.

Diffusion tensor anisotropy in adolescents and adults

We acquired diffusion tensor images on 33 normal adults aged 22-64 and 15 adolescents aged 14-21. We assessed relative anisotropy in stereotaxically located regions of interest in the internal capsule, corpus callosum, anterior thalamic radiations, frontal anterior fasciculus, fronto-occipital fasciculus, temporal lobe white matter, cingulum bundle, frontal inferior longitudinal fasciculus, frontal superior longitudinal fasciculus, and optic radiations. All of these structures except the optic radiations, corpus callosum, and frontal inferior longitudinal fasciculus exhibited differences in anisotropy between adolescents and adults. Areas with anisotropy increasing with age included the anterior limb of the internal capsule, superior levels of the frontal superior longitudinal fasciculus and the inferior portion of the temporal white matter. Areas with anisotropy decreasing with age included the posterior limb of the internal capsule, anterior thalamic radiations, fronto-occipital fasciculus, anterior portion of the frontal anterior fasciculus, inferior portion of the frontal superior longitudinal fasciculus, cingulum bundle and superior portion of the temporal axis. Sex differences were found in the majority of areas but were most marked in the cingulum bundle and internal capsule. These results suggest continuing white matter development between adolescence and adulthood.

Diffusion tensor imaging in children with fetal alcohol spectrum disorders

BACKGROUND

Prenatal alcohol exposure, which is associated with macrostructural brain abnormalities, neurocognitive deficits, and behavioral disturbances, is characterized as fetal alcohol syndrome (FAS) in severe cases. The only published study thus far using diffusion tensor imaging (DTI) showed microstructural abnormalities in patients with FAS. The current study investigated whether similar abnormalities are present in less severely affected, prenatally exposed patients who did not display all of the typical FAS physical stigmata.

METHODS

Subjects included 14 children, ages 10 to 13, with fetal alcohol spectrum disorders (FASD) and 13 matched controls. Cases with full-criteria FAS, mental retardation, or microcephaly were excluded. Subjects underwent MRI scans including DTI.

RESULTS

Although cases with microcephaly were excluded, there was a trend toward smaller total cerebral volume in the FASD group (p=0.057, Cohen's d effect size =0.73). Subjects with FASD had greater mean diffusivity (MD) in the isthmus of the corpus callosum than controls (p=0.013, effect size =1.05), suggesting microstructural abnormalities in this region. There were no group differences in 5 other regions of the corpus callosum. Correlations between MD in the isthmus and facial dysmorphology were nonsignificant.

CONCLUSIONS

These results suggest that even relatively mild forms of fetal alcohol exposure may be associated with microstructural abnormalities in the posterior corpus callosum that are detectable with DTI.

Hand preference and sex shape the architecture of language networks

In right-handed subjects, language processing relies predominantly on left hemisphere networks, more so in men than in women, and in right- versus left-handers. Using DT-MRI tractography, we have shown that right-handed men are massively interconnected between the left-hemisphere language areas, whereas the homologous in the right hemisphere are sparse; interhemispheric connections between the language areas and their contralateral homologues are relatively strong. Women and left-handed men have equally strong intrahemispheric connections in both hemispheres, but women have a higher density of interhemispheric connections.

Age-related changes in prefrontal white matter volume across adolescence

Past research has suggested that white matter volume increases from childhood to adulthood; however, during adolescence, there is somewhat limited data to support this finding. In the present study, 65 typically developing adolescents underwent structural magnetic resonance imaging. Using magnetic resonance imaging, prefrontal white matter volumes were examined in relation to adolescent age and sex. Surprisingly, results suggested that prefrontal white matter volume decreased during late adolescence, particularly among the female sex. These findings are inconsistent with past research and suggest that perhaps some developmental processes in late adolescence are not yet fully explained. Possible methodological contributions and implications for the current findings are discussed.

Diffusion tensor imaging in children and adolescents: reproducibility, hemispheric, and age-related differences

We evaluated intra-rater, inter-rater, and between-scan reproducibility, hemispheric differences, and the effect of age on apparent diffusion coefficient (ADC) and fractional anisotropy (FA) in healthy children (age range 5.5-19.1 years) examined with a clinical diffusion tensor imaging (DTI) protocol at 1.5 T, using a region of interest (ROI) methodology. Measures of reliability and precision were assessed in six ROIs using two different ROI shapes (polygonal and ellipsoidal).

RESULTS

Highly reproducible values of ADC and FA were obtained with the polygonal method on intra-rater (coefficients of variation<or=2.7%) and inter-rater (coefficients of variation<or=4.8%) reproducibility. For between-scan reproducibility, the coefficients of variation were <or=5.0%. Mean asymmetry indices were in the range from -4% to 9% for FA and from -6% to 3% for ADC. ADC showed significant negative correlation with age in 13 of 15 examined fiber tracts and FA increased significantly in three fiber tracts. Our results show that the evaluated DTI protocol is suitable for clinical application in pediatric population.

Diffusion tensor imaging of frontal white matter and executive functioning in cocaine-exposed children

BACKGROUND

Although animal studies have demonstrated frontal white matter and behavioral changes resulting from prenatal cocaine exposure, no human studies have associated neuropsychological deficits in attention and inhibition with brain structure. We used diffusion tensor imaging to investigate frontal white matter integrity and executive functioning in cocaine-exposed children.

METHODS

Six direction diffusion tensor images were acquired using a Siemens 3T scanner with a spin-echo echo-planar imaging pulse sequence on right-handed cocaine-exposed (n = 28) and sociodemographically similar non-exposed children (n = 25; mean age: 10.6 years) drawn from a prospective, longitudinal study. Average diffusion and fractional anisotropy were measured in the left and right frontal callosal and frontal projection fibers. Executive functioning was assessed using two well-validated neuropsychological tests (Stroop color-word test and Trail Making Test).

RESULTS

Cocaine-exposed children showed significantly higher average diffusion in the left frontal callosal and right frontal projection fibers. Cocaine-exposed children were also significantly slower on a visual-motor set-shifting task with a trend toward lower scores on a verbal inhibition task. Controlling for gender and intelligence, average diffusion in the left frontal callosal fibers was related to prenatal exposure to alcohol and marijuana and an interaction between cocaine and marijuana exposure. Performance on the visual-motor set-shifting task was related to prenatal cocaine exposure and an interaction between cocaine and tobacco exposure. Significant correlations were found between test performance and fractional anisotropy in areas of the frontal white matter.

CONCLUSIONS

Prenatal cocaine exposure, alone and in combination with exposure to other drugs, is associated with slightly poorer executive functioning and subtle microstructural changes suggesting less mature development of frontal white matter pathways. The relative contribution of postnatal environmental factors, including characteristics of the caregiving environment and stressors associated with poverty and out-of-home placement, on brain development and behavioral functioning in polydrug-exposed children awaits further research.

Microstructural development of human brain assessed in utero by diffusion tensor imaging

BACKGROUND

Diffusion-weighted MR imaging (DWI) has been shown to be a great tool to assess white matter development in normal infants. Comparison of cerebral diffusion properties between preterm infants and fetuses of corresponding ages should assist in determining the impact of premature ex utero life on brain maturation.

OBJECTIVE

To assess in utero maturation-dependent microstructural changes of fetal cerebral white matter using diffusion tensor MR imaging.

MATERIALS AND METHODS

An echoplanar sequence with diffusion gradient (b=700 s/mm(2)) applied in six non-colinear directions was performed between 31 and 37(+3) weeks of gestation in 24 fetuses without cerebral abnormality on T1- and T2-weighted images. Apparent diffusion coefficient (ADC) and fractional anisotropy (FA) were measured in the white matter.

RESULTS

Mean ADC values were 1.8 microm(2)/ms in the centrum semiovale, 1.2 microm(2)/ms in the splenium of the corpus callosum and 1.1 microm(2)/ms in the pyramidal tract. The paired Wilcoxon rank test showed significant differences in ADC between these three white matter regions. Mean FA values were 1.1%, 3.8% and 4.7%, respectively, in the centrum semiovale, corpus callosum and pyramidal tract. A significant age-related decrease in ADC and an increase in FA towards term were demonstrated in the pyramidal tract and corpus callosum.

CONCLUSION

Diffusion tensor imaging in utero can provide a quantitative assessment of the microstructural development of fetal white matter. Anisotropic parameters of the diffusion tensor should improve with technical advances.

Voxel based versus region of interest analysis in diffusion tensor imaging of neurodevelopment

There are two main methods of quantitative analysis in diffusion tensor imaging (DTI) studies: manual region of interest (ROI) and automated voxel based. The purpose of this study is to compare the results of each of these methods applied to the same data set. Linear correlative analysis was performed for mean diffusivity (Trace/3 ADC) and for fractional anisotropy (FA) versus age within 8-12 years (N = 32) and within 21-27 years (N = 28), as well as a group comparison. SPM analysis identified more structures changing with age, partly due to the limited regions measured with ROI analysis. In general, ROI and voxel-based analysis methods produced comparable results for widespread reductions of Trace/3 ADC and increases of FA with age, particularly for group comparison. The discrepancies (i.e., missed regions) were likely related to problems of spatial normalization for SPM analysis, and masking localized changes by averaging all the voxels within a region of interest for ROI analysis. These two analysis methods for DTI offer complementary results, but neither one yields the complete story of neurodevelopment.

Global and local development of gray and white matter volume in normal children and adolescents

Over the last decade, non-invasive, high-resolution magnetic resonance imaging has allowed investigating normal brain development. However, much is still not known in this context, especially with regard to regional differences in brain morphology between genders. We conducted a large-scale study utilizing fully automated analysis-approaches, using high-resolution MR-imaging data from 200 normal children and aimed at providing reference data for future neuroimaging studies. Global and local aspects of normal development of gray and white matter volume were investigated as a function of age and gender while covarying for known nuisance variables. Global developmental patterns were apparent in both gray and white matter, with gray matter decreasing and white matter increasing significantly with age. Gray matter loss was most pronounced in the parietal lobes and least in the cingulate and in posterior temporal regions. White matter volume gains with age were almost uniform, with an accentuation of the pyramidal tract. Gender influences were detectable for both gray and white matter. Voxel-based analyses confirmed significant differences in brain morphology between genders, like a larger amygdala in boys or a larger caudate in girls. We could demonstrate profound influences of both age and gender on normal brain morphology, confirming and extending earlier studies. The knowledge of such influence allows for the consideration of age- and gender-effects in future pediatric neuroimaging studies and advances our understanding of normal and abnormal brain development.

White matter growth as a mechanism of cognitive development in children

We examined the functional role of white matter growth in cognitive development. Specifically, we used hierarchical regression analyses to test the unique contributions of age versus white matter integrity in accounting for the development of information processing speed. Diffusion tensor imaging was acquired for 17 children and adolescents (age range 6-17 years), with apparent diffusion coefficient (ADC) and fractional anisotropy (FA) calculated for 10 anatomically defined fiber pathways and 12 regions of hemispheric white matter. Measures of speeded visual-spatial searching, rapid picture naming, reaction time in a sustained attention task, and intelligence were administered. Age-related increases were evident across tasks, as well as for white matter integrity in hemispheric white matter. ADC was related to few measures. FA within multiple hemispheric compartments predicted rapid picture naming and standard error of reaction time in sustained attention, though it did not contribute significantly to the models after controlling for age. Independent of intelligence, visual-spatial searching was related to FA in a number of hemispheric regions. A novel finding was that only right frontal-parietal regions contributed uniquely beyond the effect of age in accounting for performance: age did not contribute to visual-spatial searching when FA within these regions was first included in the models. Considering we found that both FA in right frontal-parietal regions and speed of visual-spatial searching increased with age, our findings are consistent with the growth of regional white matter organization as playing an important role in increased speed of visual searching with age.

Advances in white matter imaging: a review of in vivo magnetic resonance methodologies and their applicability to the study of development and aging

Several newer magnetic resonance imaging (MRI) techniques are increasingly being applied to the study of white matter development and pathology across the lifespan. These techniques go beyond traditional macrostructural volumetric methods and provide valuable information about underlying tissue integrity and organization at the microstructural and biochemical levels. We first provide an overview of white matter development and discuss the role of white matter and myelin in cognitive function. We also review available studies of development that have employed traditional volumetric measures. Then, we discuss the contributions of four newer imaging paradigms to our understanding of brain development and aging. These paradigms are Diffusion Tensor Imaging (DTI), Magnetization Transfer Imaging (MTI), T2-Relaxography, and Magnetic Resonance Spectroscopy (MRS). Studies examining brain development during childhood and adulthood as well as studies of the effects of aging are discussed.

Brain developmental abnormalities in Prader-Willi syndrome detected by diffusion tensor imaging

OBJECTIVE

The purpose of this work was to detect brain developmental abnormalities in Prader-Willi syndrome by using diffusion tensor imaging based on a high-field MRI system.

METHODS

Eight patients with Prader-Willi syndrome and 8 age- and gender-matched normal control subjects were examined using a high-field (3.0 T) MRI system. Trace value and fractional anisotropy were assessed simultaneously in multiple representative brain regions: the deep gray matter (putamen, caudate head, and dorsomedial thalamus) and the white matter structures (frontal and parietal white matter, posterior limb of internal capsule, and corpus callosum).

RESULTS

In Prader-Willi syndrome patients, trace value was found to be significantly higher in the left frontal white matter and the left dorsomedial thalamus, whereas fractional anisotropy was significantly reduced in the posterior limb of the internal capsule bilaterally, the right frontal white matter, and the splenium of the corpus callosum. The observed diffusivity characteristics indicate developmental abnormalities in these areas, which are highly consistent with the clinical features of Prader-Willi syndrome.

CONCLUSIONS

The study provides the first objective evidence that Prader-Willi syndrome patients indeed have developmental abnormalities in specific areas of the brain, providing a new window toward understanding the pathophysiology of Prader-Willi syndrome.

Selective alterations of white matter associated with visuospatial and sensorimotor dysfunction in turner syndrome

Turner syndrome (TS) is a neurogenetic disorder characterized by impaired spatial, numerical, and motor functioning but relatively spared verbal ability. Results from previous neuroimaging studies suggest that gray matter alterations in parietal and frontal regions may contribute to atypical visuospatial and executive functioning in TS. Recent findings in TS also indicate variations in the shape of parietal gyri and white matter microstructural anomalies of the temporal lobe. Diffusion tensor imaging and structural imaging methods were used to determine whether 10 females with TS and 10 age- and gender-matched control subjects exhibited differences in fractional anisotropy, white matter density, and local brain shape. Relative to controls, females with TS had lower fractional anisotropy (FA) values in the deep white matter of the left parietal-occipital region extending anteriorly along the superior longitudinal fasciculus into the deep white matter of the frontal lobe. In addition, decreased FA values were located bilaterally in the internal capsule extending into the globus pallidus and in the right prefrontal region. Voxel-based morphometry (VBM) analysis showed corresponding white matter density differences in the internal capsules and left centrum semiovale. Tensor-based morphometry analysis indicated that the FA and VBM results were not attributable to differences in the local shape of brain structures. Compared with controls, females with TS had increases in FA values and white matter density in language-related areas of the inferior parietal and temporal lobes. These complementary analyses provide evidence for alterations in white matter pathways that subserve affected and preserved cognitive functions in TS.

Changes in white matter diffusion anisotropy in adolescents born prematurely

Being born with very low birth weight (VLBW, birth weight<or=1500 g) or small for gestational age (SGA) carries an increased risk of cerebral white matter damage. The reduced cognitive and motor skills these two groups exhibit suggest that the early injuries to white matter persist into adolescence. White matter integrity was assessed using voxel-wise statistical analysis of fractional anisotropy (FA) maps between three groups of adolescents at age 15; the VLBW group (n=34), the SGA group (n=42) and a control group with normal birth weight (n=47). The FA maps were normalized to a study specific template and group differences were assessed using an analysis of covariance with gender as a confounder (FDR-corrected P<0.05). The main finding is that the VLBW group has significantly reduced FA values in several white matter regions, including the corpus callosum, internal capsule and superior fasciculus compared to the control group. Some of the observed reduction in anisotropy, particularly that observed in the corpus callosum, may have been caused by inaccurate spatial normalization, but this can only explain 30% of the area with reduced anisotropy. Analysis of the eigenvalues of the diffusion tensor show that the reduced FA values in the VLBW group is primarily due to an increase in the two lowest eigenvalues of the diffusion tensor. We speculate that this may be caused by reduced myelination. For the SGA group, we find no statistically significant differences in anisotropy compared to the control group.

Functional MRI evidence for disparate developmental processes underlying intelligence in boys and girls

Previous research has shown evidence for sex differences in the neuroanatomical bases for intelligence in adults. Possible differences in the neuroanatomical correlates of intelligence and their developmental trajectories between boys and girls were investigated using functional MRI (fMRI). A large cohort of over 300 children, ages 5-18, performed the semantic processing task of silent verb generation. Regions were found in the left hemisphere exhibiting positive correlations of blood-oxygenation-level-dependent (BOLD) activation with IQ, including the middle temporal gyrus, prefrontal cortex (Broca's area), medial frontal gyrus, precuneus, and cingulate gyrus, while the superior temporal gyrus in the right hemisphere displayed a negative correlation of BOLD activation with IQ. Significant sex-X-IQ and sex-X-IQ-X-age interaction effects were also seen in the left middle temporal gyrus and left inferior frontal gyrus. Using a data-driven analysis procedure, a sex-X-IQ-X-age interaction was also demonstrated in the functional connectivity between regions in the left hemisphere, parameterized as a weighted sum of pairwise covariances between fMRI time courses. While young girls (<13 years) exhibited no correlation of connectivity with intelligence, older girls (>13 years) demonstrated a positive association of functional connectivity with intelligence. Boys, however, demonstrated the opposite developmental trajectory, from a positive association of connectivity with intelligence in young boys (ages <9 years), to a negative association in older boys (ages >13 years). Our results provide evidence for disparate neuroanatomical trajectories underlying intelligence in boys and girls.

White matter volume and concentration reductions in adolescents with history of very preterm birth: a voxel-based morphometry study

Very preterm birth (VPTB) is an important risk factor for white matter (WM) damage. We used voxel-based morphometry (VBM) to examine regional WM brain abnormalities in 50 adolescents with antecedents of very preterm birth (VPTB) without evidence of WM damage on T2-weighted MRI. This group was compared with a group of 50 subjects born at term and matched for age, handedness and socio-cultural status. We also examined the relationship between WM changes and gestational age (GA) and weight (GW) at birth in VPTB subjects. Both modulated and unmodulated VBM analyses showed significant abnormalities in several WM brain regions in the VPTB group, involving all the cerebral lobes. However, density analyses (unmodulated data) mainly identified periventricular damage and the involvement of the longitudinal fascicles while volume analyses (modulated data) detected WM decreases in regions distant from the ventricular system, located at the origin and end of the long fascicles. A significant correlation was found between WM decreases and both GA and GW in various brain regions: the lower the GA and GW, the lower the WM integrity. This study supports the current view that widespread white matter impairment is associated with immature birth.

A longitudinal functional magnetic resonance imaging study of language development in children 5 to 11 years old

OBJECTIVE

Language skills continue to develop rapidly in children during the school-age years, and the "snapshot" view of the neural substrates of language provided by current neuroimaging studies cannot capture the dynamic changes associated with brain development. The aim of this study was to conduct a 5-year longitudinal investigation of language development using functional magnetic resonance imaging in healthy children.

METHODS

Thirty subjects enrolled at ages 5, 6, or 7 were examined annually for 5 years using a 3-Tesla magnetic resonance imaging scanner and a verb generation task. Data analysis was conducted based on a general linear model that was modified to investigate developmental changes whereas minimizing the potential for missing data.

RESULTS

With increasing age, there is progressive participation in language processing by the inferior/middle frontal, middle temporal, and angular gyri of the left hemisphere and the lingual and inferior temporal gyri of the right hemisphere and regression of participation of the left posterior insula/extrastriate cortex, left superior frontal and right anterior cingulate gyri, and left thalamus.

CONCLUSION

The age-related changes observed in this study provide evidence of increased neuroplasticity of language in this age group and may have implications for further investigations of normal and aberrant language development.

Sex differences in the relationship between white matter microstructure and impulsivity in adolescents

Rapid maturational brain changes occur during adolescence--a time associated with risk-taking behaviors and improvements in cognition. The present study examined the relationship between white matter (WM) microstructure, impulsive behavior and response inhibition in female and male adolescents. Twenty-one healthy adolescents underwent diffusion tensor imaging using a 3.0-T magnetic resonance imaging system. Impulse control was assessed using the Bar-On Emotional Quotient Inventory, Youth Version. Response inhibition was assessed using the Stroop Color-Word Interference Test. Fractional anisotropy (FA), a measure of WM coherence, and trace, a measure of overall diffusivity, were determined from voxels manually placed in the midline and in the left and right forward-projecting arms of the genu and the splenium of the corpus callosum. Sex-specific differences were observed for the relationship between FA and impulsive behavior in the right anterior callosum for males and in the splenium for females. Males, compared to females, displayed significantly higher FA in the left WM region. Although trace was not associated with impulse control, trace in the genu (for females) and splenium (males and females) was associated with Stroop performance. Regional differences in trace also were evident, with lower values in the splenium observed than in all other regions. Although the latter significantly improved with age, no sex differences in impulse control or in Stroop performance were detected. The present findings provide supporting evidence for sex-related differences in the development of WM microstructure during adolescence. These data further suggest a neurobiological mechanism underlying some of the emotional and cognitive changes commonly observed in males versus females during the adolescent period.

Assessment of the early organization and maturation of infants' cerebral white matter fiber bundles: A feasibility study using quantitative diffusion tensor imaging and tractography

The human infant is particularly immature at birth and brain maturation, with the myelination of white matter fibers, is protracted until adulthood. Diffusion tensor imaging offers the possibility to describe non invasively the fascicles spatial organization at an early stage and to follow the cerebral maturation with quantitative parameters that might be correlated with behavioral development. Here, we assessed the feasibility to study the organization and maturation of major white matter bundles in eighteen 1- to 4-month-old healthy infants, using a specific acquisition protocol customized to the immature brain (with 15 orientations of the diffusion gradients and a 700 s mm(-2)b factor). We were able to track most of the main fascicles described at later ages despite the low anisotropy of the infant white matter, using the FACT algorithm. This mapping allows us to propose a new method of quantification based on reconstructed tracts, split between specific regions, which should be more sensitive to specific changes in a bundle than the conventional approach, based on regions-of-interest. We observed variations in fractional anisotropy and mean diffusivity over the considered developmental period in most bundles (corpus callosum, cerebellar peduncles, cortico-spinal tract, spino-thalamic tract, capsules, radiations, longitudinal and uncinate fascicles, cingulum). The results are in good agreement with the known stages of white matter maturation and myelination, and the proposed approach might provide important insights on brain development.

fMRI study of language lateralization in children and adults

Language lateralization in the brain is dependent on family history of handedness, personal handedness, pathology, and other factors. The influence of age on language lateralization is not completely understood. Increasing left lateralization of language with age has been observed in children, while the reverse has been noted in healthy young adults. It is not known whether the trend of decreasing language lateralization with age continues in the late decades of life and at what age the inflection in language lateralization trend as a function of age occurs. In this study, we examined the effect of age on language lateralization in 170 healthy right-handed children and adults ages 5-67 using functional MRI (fMRI) and a verb generation task. Our findings indicate that language lateralization to the dominant hemisphere increases between the ages 5 and 20 years, plateaus between 20 and 25 years, and slowly decreases between 25 and 70 years.

Mild-onset presentation of Canavan's disease associated with novel G212A point mutation in aspartoacylase gene

We describe two sisters with a mild-onset variant of Canavan's disease who presented at age 50 and 19 months with developmental delay but without macrocephaly, hypotonia, spasticity, or seizures. Remarkably, both patients had age-appropriate head control, gross motor development, and muscle tone. There were very mild deficits in fine motor skills, coordination, and gait. Both sisters had a history of strabismus, but otherwise vision was normal. The older child showed evidence of mild cognitive and social impairment, whereas language and behavior were normal for age in the infant. Both patients were found to be compound heterozygotes for C914A (A305E) and G212A (R71H) mutations in ASPA. Like all other known ASPA mutations, this previously unknown G212A mutation appears to have low absolute enzyme activity. Nevertheless, it is associated in these patients with an extremely benign phenotype that is highly atypical of Canavan's disease. Biochemical and clinical data were evaluated using a generalized linear mixed model generated from 25 other subjects with Canavan's disease. There were statistically significant differences in brain chemistry and clinical evaluations, supporting a distinct variant of Canavan's disease. Future studies of ASPA enzyme structure and gene regulation in these subjects could lead to a better understanding of Canavan's pathophysiology and improvements in ASPA gene therapy.

Mapping anatomical correlations across cerebral cortex (MACACC) using cortical thickness from MRI

We introduce MACACC-Mapping Anatomical Correlations Across Cerebral Cortex-to study correlated changes within and across different cortical networks. The principal topic of investigation is whether the thickness of one area of the cortex changes in a statistically correlated fashion with changes in thickness of other cortical regions. We further extend these methods by introducing techniques to test whether different population groupings exhibit significantly varying MACACC patterns. The methods are described in detail and applied to a normal childhood development population (n = 292), and show that association cortices have the highest correlation strengths. Taking Brodmann Area (BA) 44 as a seed region revealed MACACC patterns strikingly similar to tractography maps obtained from diffusion tensor imaging. Furthermore, the MACACC map of BA 44 changed with age, older subjects featuring tighter correlations with BA 44 in the anterior portions of the superior temporal gyri. Lastly, IQ-dependent MACACC differences were investigated, revealing steeper correlations between BA 44 and multiple frontal and parietal regions for the higher IQ group, most significantly (t = 4.0) in the anterior cingulate.

Quantitative diffusion tensor MR imaging of the brain: field strength related variance of apparent diffusion coefficient (ADC) and fractional anisotropy (FA) scalars

The objectives were to study the "impact" of the magnetic field strength on diffusion tensor imaging (DTI) metrics and also to determine whether magnetic-field-related differences in T2-relaxation times of brain tissue influence DTI measurements. DTI was performed on 12 healthy volunteers at 1.5 and 3.0 Tesla (within 2 h) using identical DTI scan parameters. Apparent diffusion coefficient (ADC) and fractional anisotropy (FA) values were measured at multiple gray and white matter locations. ADC and FA values were compared and analyzed for statistically significant differences. In addition, DTI measurements were performed at different echo times (TE) for both field strengths. ADC values for gray and white matter were statistically significantly lower at 3.0 Tesla compared with 1.5 Tesla (% change between -1.94% and -9.79%). FA values were statistically significantly higher at 3.0 Tesla compared with 1.5 Tesla (% change between +4.04 and 11.15%). ADC and FA values are not significantly different for TE=91 ms and TE=125 ms. Thus, ADC and FA values vary with the used field strength. Comparative clinical studies using ADC or FA values should consequently compare ADC or FA results with normative ADC or FA values that have been determined for the field strength used.

Left lateralized white matter microstructure accounts for individual differences in reading ability and disability

Diffusion tensor imaging (DTI) was used to investigate the association between variation in white matter microstructure and individual differences in reading skill within children. Unlike previous DTI studies of reading, our sample examined children in both the average reading range as well as several children in the performance range of reading disability (RD). Results replicate previous findings of a strong correlation between fractional anisotropy (FA) values in a left temporo-parietal white matter region and standardized reading scores of typically developing children. Furthermore, FA values in this same region accounted for differences between children scoring in the average range and children scoring in the RD range, suggesting that the role of white matter tract microstructure is best characterized as an extreme range on a continuum of typical variation. Furthermore, significant correlations between working memory and frontal white matter tract regions were present in this same population, yet were demonstrated to be independent of the relationships found between reading and more posterior regions. Results form a "correlational double dissociation" that demonstrates domain specificity in the influence of white matter tract structures to individual differences in cognitive performance.

Brain Injury from Cardiac Arrest in Children

This article reviews the important differences between children and adults suffering brain injury following cardiac arrest. The differences in etiology, pathophysiology, neuronal vulnerability, and repair in the context of the developing brain are reviewed. The available clinical data are reviewed, and selected treatment priori-ties are declared. The article includes a discussion of knowledge gaps and future directions.

Diffusion Tensor Imaging and Tractography of Human Brain Development

Over the past decade, diffusion tensor imaging (DTI) has offered researchers and clinicians a new noninvasive window into the developing human brain, from preterm infants through adolescents and young adults. DTI improves on conventional MR imaging, such as T1-weighted and T2-weighted sequences, through its sensitivity to many microstructural features of neural organization. This has enabled visualization of the early cerebral laminar architecture in premature infants, of developing white matter before myelination, and of the microarchitecture of the cerebral cortex during preterm maturation. DTI provides reproducible quantitative measures, such as mean diffusivity and fractional anisotropy, that reflect the underlying tissue properties of gray matter and white matter and may therefore become useful as developmental milestones for the improved assessment of abnormal brain maturation. Furthermore, three-dimensional fiber tractography based on DTI can reveal the developing axonal connectivity of the human brain as well as aberrant connectivity in structural brain malformations. In this article, applications of DTI and fiber tractography to the study of human brain development are reviewed. The new insights into brain maturation afforded by DTI promise to improve the diagnostic evaluation of an array of congenital, metabolic, and neurodevelopmental disorders.

Hippocampal and Thalamic Diffusion Abnormalities in Children with Temporal Lobe Epilepsy

PURPOSE

Previous studies using diffusion MRI in patients with temporal lobe epilepsy have shown abnormal water diffusion in the hippocampus. Because thalamus and lentiform nuclei are considered important for the regulation of cortical excitability and seizure propagation, we analyzed diffusion tensor imaging (DTI) abnormalities in these subcortical structures and in hippocampus of children with partial epilepsy with and without secondary generalization.

METHODS

Fourteen children with partial epilepsy involving the temporal lobe underwent MRI including a DTI sequence. Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values were obtained in the hippocampus, thalamus, and lentiform nucleus, and compared with DTI data of 14 control children with no epilepsy, as well as glucose positron emission tomography (PET) findings.

RESULTS

Decreased FA (p < 0.001) and increased ADC (p = 0.003) values were found in the hippocampi ipsilateral to the seizure focus. Significant FA decreases (p = 0.002) also were seen in the contralateral hippocampi, despite unilateral seizure onset and excellent surgical outcome in patients who underwent surgery. ADC values showed a trend for increase in the thalami ipsilateral to the epileptic focus in the seven children with secondarily generalized seizures (p = 0.09). No group differences of ADC or FA were found in the lentiform nuclei. The DTI variables did not correlate with regional glucose metabolism in any of the structures analyzed.

CONCLUSIONS

Increased ADC values in hippocampus can assist in lateralizing the seizure focus, but decreased FA in the contralateral hippocampus suggests that it too may be dysfunctional despite unilateral seizure onset. Less-robust thalamic abnormalities of water diffusion in patients with secondarily generalized seizures suggest secondary involvement of the thalamus, perhaps due to recruitment of this structure into the epileptic network; however, this must be confirmed in a larger population. DTI appears to be a sensitive method for detection abnormalities in children with partial epilepsy, even in structures without apparent changes on conventional MRI.

Development of a superior frontal–intraparietal network for visuo-spatial working memory

Working memory capacity increases throughout childhood and adolescence, which is important for the development of a wide range of cognitive abilities, including complex reasoning. The spatial-span task, in which subjects retain information about the order and position of a number of objects, is a sensitive task to measure development of spatial working memory. This review considers results from previous neuroimaging studies investigating the neural correlates of this development. Older children and adolescents, with higher capacity, have been found to have higher brain activity in the intraparietal cortex and in the posterior part of the superior frontal sulcus, during the performance of working memory tasks. The structural maturation of white matter has been investigated by diffusion tensor magnetic resonance imaging (DTI). This has revealed several regions in the frontal lobes in which white matter maturation is correlated with the development of working memory. Among these is a superior fronto-parietal white matter region, located close to the grey matter regions that are implicated in the development of working memory. Furthermore, the degree of white matter maturation is positively correlated with the degree of cortical activation in the frontal and parietal regions. This suggests that during childhood and adolescence, there is development of networks related to specific cognitive functions, such as visuo-spatial working memory. These networks not only consist of cortical areas but also the white matter tracts connecting them. For visuo-spatial working memory, this network could consist of the superior frontal and intraparietal cortex.

Arithmetic ability and parietal alterations: A diffusion tensor imaging study in Velocardiofacial syndrome

Velocardiofacial syndrome (VCFS) is a congenital anomaly that causes somatic as well as cognitive and psychiatric impairments. Previous studies have found specific deficits in arithmetic abilities in subjects with VCFS. In this study, we investigated whether abnormalities in white matter pathways are correlated with reduced arithmetic ability. Nineteen individuals with VCFS aged 7-19 years received diffusion-weighted magnetic resonance imaging (MRI) scans. A linear regression model was used to correlate fractional anisotropy (FA) values with scores of the arithmetic subscale on the WISC/WAIS on a voxel-by-voxel basis, after covarying for any IQ- and age-related effects. There was a statistically significant positive correlation between the arithmetic score on the WISC/WAIS and FA values in white matter tracts adjacent to the left supramarginal and angular gyri, as well as along the left intraparietal sulcus. Inferior parietal lobe white matter structural aberrations may contribute to reduced arithmetic ability in VCFS.

Cognitive functions correlate with white matter architecture in a normal pediatric population: a diffusion tensor MRI study

A possible relationship between cognitive abilities and white matter structure as assessed by magnetic resonance diffusion tensor imaging (DTI) was investigated in the pediatric population. DTI was performed on 47 normal children ages 5-18. Using a voxelwise analysis technique, the fractional anisotropy (FA) and mean diffusivity (MD) were tested for significant correlations with Wechsler full-scale IQ scores, with subject age and gender used as covariates. Regions displaying significant positive correlations of IQ scores with FA were found bilaterally in white matter association areas, including frontal and occipito-parietal areas. No regions were found exhibiting correlations of IQ with MD except for one frontal area significantly overlapping a region containing a significant correlation with FA. The positive direction of the correlation with FA is the same as that found previously with age, and indicates a positive relationship between fiber organization and/or density with cognitive function. The results are consistent with the hypothesis that regionally specific increased fiber organization is a mechanism responsible for the normal development of white matter tracts.

White matter abnormalities in early-onset schizophrenia: a voxel-based diffusion tensor imaging study

OBJECTIVE

To investigate abnormalities in the structural integrity of brain white matter as suggested by diffusion tensor imaging in adolescents with early-onset schizophrenia (onset of psychosis by age 18).

METHOD

Twenty-six patients with schizophrenia and 34 age- and gender-matched healthy volunteers received diffusion tensor imaging and structural magnetic resonance imaging examinations. Fractional anisotropy maps were compared between groups in the white matter using a voxelwise analysis after intersubject registration to Talairach space.

RESULTS

Compared with healthy volunteers, patients demonstrated lower fractional anisotropy values in the left anterior cingulate region in close proximity to the caudate nucleus (95% confidence interval of schizophrenic-healthy: -66 to -20). Using regression analysis, the rate of change in fractional anisotropy differed significantly between groups in this region across the age span examined (10-20 years), after adjusting for group differences in premorbid intellectual capacity and parental socioeconomic status. There were no areas of significantly higher fractional anisotropy in patients compared with healthy volunteers.

CONCLUSIONS

These data suggest that early-onset schizophrenia is associated with a disruption in the structural integrity of white matter tracts in the anterior cingulate region. These structural abnormalities may contribute to the deficits in motivation, attention, memory, and higher executive functions in adolescents with schizophrenia.

Semilobar holoprosencephaly seen with diffusion tensor imaging and fiber tracking

A neonate with semilobar holoprosencephaly was studied with diffusion tensor imaging and fiber tracking. Fiber tracking showed that the frontooccipital fasciculi were in continuity across the ventral midline, interposed between fused caudate and dysplastic fornices. Tractography of the posterior limbs of the internal capsules showed fibers arching ventrally toward the expected location of the motor cortex; some fibers also coursed dorsally, presumably to the sensory cortex. There was a posterior commissural white matter bundle representing a callosal splenium. Diffusion tensor imaging and fiber tracking revealed white matter structures not apparent on routine imaging sequences, which are in agreement with pathologic descriptions of the holoprosencephalic brain.

Diffusion tensor imaging of neurodevelopment in children and young adults

Diffusion tensor magnetic resonance imaging (DTI) was used to study regional changes in the brain's development from childhood (8-12 years, mean 11.1 +/- 1.3, N = 32) to young adulthood (21-27 years, mean 24.4 +/- 1.8, N = 28). Mean diffusivity (Trace/3 apparent diffusion coefficient, ADC) and fractional anisotropy (FA) were measured in 30 regions of interest (ROIs) in 13 distinct brain structures. Correlational analysis was performed to detect changes within 8-12 years and within 21-27 years, and group analysis to compare childhood diffusion properties with young adult values. Increases of fractional anisotropy were seen in the genu of the corpus callosum, splenium of the corpus callosum, corona radiata, putamen, and head of the caudate nucleus within 8-12 years, and also between childhood and young adulthood. Reductions in Trace/3 ADC were observed in 9 of 13 structures within 8-12 years and into young adulthood as well. DTI demonstrates more widespread changes in the brain's microstructure with maturation than previous reports using conventional T1-weighted MRI scans. These findings suggest a continuation of the brain's microstructural development through adolescence.