1
|
Shi H, Prayer F, Kienast P, Khalaveh F, Nasel C, Binder J, Watzenboeck ML, Weber M, Prayer D, Kasprian G. Multiparametric prenatal imaging characterization of fetal brain edema in Chiari II malformation might help to select candidates for fetal surgery. Eur Radiol 2024:10.1007/s00330-024-10729-0. [PMID: 38656710 DOI: 10.1007/s00330-024-10729-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 02/29/2024] [Accepted: 03/07/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVE To identify brain edema in fetuses with Chiari II malformation using a multiparametric approach including structural T2-weighted, diffusion tensor imaging (DTI) metrics, and MRI-based radiomics. METHODS A single-center retrospective review of MRI scans obtained in fetuses with Chiari II was performed. Brain edema cases were radiologically identified using the following MR criteria: brain parenchymal T2 prolongation, blurring of lamination, and effacement of external CSF spaces. Fractional anisotropy (FA) values were calculated from regions of interest (ROI), including hemispheric parenchyma, internal capsule, and corticospinal tract, and compared group-wise. After 1:1 age matching and manual single-slice 2D segmentation of the fetal brain parenchyma using ITK-Snap, radiomics features were extracted using pyradiomics. Areas under the curve (AUCs) of the features regarding discriminating subgroups were calculated. RESULTS Ninety-one fetuses with Chiari II underwent a total of 101 MRI scans at a median gestational age of 24.4 weeks and were included. Fifty scans were visually classified as Chiari II with brain edema group and showed significantly reduced external CSF spaces compared to the nonedema group (9.8 vs. 18.3 mm, p < 0.001). FA values of all used ROIs were elevated in the edema group (p < 0.001 for all ROIs). The 10 most important radiomics features showed an AUC of 0.81 (95%CI: 0.71, 0.91) for discriminating between Chiari II fetuses with and without edema. CONCLUSIONS Brain edema in fetuses with Chiari II is common and radiologically detectable on T2-weighted fetal MRI sequences, and DTI-based FA values and radiomics features provide further evidence of microstructure differences between subgroups with and without edema. CLINICAL RELEVANCE STATEMENT A more severe phenotype of fetuses with Chiari II malformation is characterized by prenatal brain edema and more postnatal clinical morbidity and disability. Fetal brain edema is a promising prenatal MR imaging biomarker candidate for optimizing the risk-benefit evaluation of selection for fetal surgery. KEY POINTS Brain edema of fetuses prenatally diagnosed with Chiari II malformation is a common, so far unknown, association. DTI metrics and radiomics confirm microstructural differences between the brains of Chiari II fetuses with and without edema. Fetal brain edema may explain worse motor outcomes in this Chiari II subgroup, who may substantially benefit from fetal surgery.
Collapse
Affiliation(s)
- Hui Shi
- Department of Radiology, Zhujiang Hospital, Southern Medical University, No. 253, Industrial Road, Guangzhou, China
| | - Florian Prayer
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Patric Kienast
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Farjad Khalaveh
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Christian Nasel
- Department of Radiology (Diagnostic and Interventional) (C.N.), University Hospital Tulln - Karl Landsteiner Private University of Health Sciences, Alter Ziegelweg 10, 3430, Tulln, Austria
| | - Julia Binder
- Department of Obstetrics and Feto-maternal Medicine, Medical University of Vienna, Vienna, Austria
| | - Martin L Watzenboeck
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Michael Weber
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Daniela Prayer
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Gregor Kasprian
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| |
Collapse
|
2
|
Yiğit H, Güler H, Yılmaz H, Gümü ÜÖ, Karaman ZF, Güneş T. Effect of cervical and lumbosacral spina bifida cystica on volumes of intracranial structures in children. Childs Nerv Syst 2024; 40:527-535. [PMID: 37698650 DOI: 10.1007/s00381-023-06153-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 09/06/2023] [Indexed: 09/13/2023]
Abstract
PURPOSE Spina bifida is a major disorder that occurs when the membranes of the spinal cord and medulla fail to close during the embryonic period and affects the individual for the rest of life. Some physical, mental, and social difficulties can be observed in the lives of children with spina bifida after surgery. The aim of this study is to determine what kind of volumetric changes occur in the brain when spina bifida occurs in different regions of the cord. METHODS The volume of intracranial structures of 14 children aged 1 to 9 years (7 cervical, 7 lumbosacral) with different levels of spina bifida compared with vol2Brain. RESULTS Spina bifida occurring in the cervical region was found to cause a greater volumetric reduction in subcortical structures, cortex and gyrus than spina bifida occurring in the lumbosacral region. CONCLUSION We believe that our study will help clinicians involved in the management of this disorder.
Collapse
Affiliation(s)
- Hüseyin Yiğit
- Cappadocia Vocational School, Department of Medical Services and Techniques, Cappadocia University, Nevsehir, Turkey.
| | - Hatice Güler
- Department of Anatomy, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Halil Yılmaz
- Department of Anatomy, Faculty of Medicine, Ordu University, Ordu, Turkey
| | - Ümmügülsüm Özgül Gümü
- Department of Pediatric Radiology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Zehra Filiz Karaman
- Department of Pediatric Radiology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Tamer Güneş
- Department of Child Health and Diseases, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| |
Collapse
|
3
|
Ji H, Payette K, Speckert A, Tuura R, Grehten P, Kottke R, Ochseinbein-Kölble N, Hagmann C, Mazzone L, Meuli M, Padden B, Hackenberg A, Wille DA, Moehrlen U, Latal B, SPINA BIFIDA STUDY GROUP ZURICH, Jakab A. Thalamic connectivity topography in newborns with spina bifida: association with neurological functional level but not developmental outcome at 2 years. Cereb Cortex 2024; 34:bhad438. [PMID: 37991274 PMCID: PMC10793566 DOI: 10.1093/cercor/bhad438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/11/2023] [Accepted: 10/11/2023] [Indexed: 11/23/2023] Open
Abstract
Spina bifida affects spinal cord and cerebral development, leading to motor and cognitive delay. We investigated whether there are associations between thalamocortical connectivity topography, neurological function, and developmental outcomes in open spina bifida. Diffusion tensor MRI was used to assess thalamocortical connectivity in 44 newborns with open spina bifida who underwent prenatal surgical repair. We quantified the volume of clusters formed based on the strongest probabilistic connectivity to the frontal, parietal, and temporal cortex. Developmental outcomes were assessed using the Bayley III Scales, while the functional level of the lesion was assessed by neurological examination at 2 years of age. Higher functional level was associated with smaller thalamo-parietal, while lower functional level was associated with smaller thalamo-temporal connectivity clusters (Bonferroni-corrected P < 0.05). Lower functional levels were associated with weaker thalamic temporal connectivity, particularly in the ventrolateral and ventral anterior nuclei. No associations were found between thalamocortical connectivity and developmental outcomes. Our findings suggest that altered thalamocortical circuitry development in open spina bifida may contribute to impaired lower extremity function, impacting motor function and independent ambulation. We hypothesize that the neurologic function might not merely be caused by the spinal cord lesion, but further impacted by the disruption of cerebral neuronal circuitry.
Collapse
Affiliation(s)
- Hui Ji
- Center for MR Research, University Children’s Hospital Zurich, Zurich 8032, Switzerland
- Neuroscience Center Zurich, University of Zurich, Zurich 8006, Switzerland
- Children’s Research Center, University Children’s Hospital Zurich, Zurich 8032, Switzerland
| | - Kelly Payette
- Center for MR Research, University Children’s Hospital Zurich, Zurich 8032, Switzerland
- Neuroscience Center Zurich, University of Zurich, Zurich 8006, Switzerland
- Children’s Research Center, University Children’s Hospital Zurich, Zurich 8032, Switzerland
| | - Anna Speckert
- Center for MR Research, University Children’s Hospital Zurich, Zurich 8032, Switzerland
- Neuroscience Center Zurich, University of Zurich, Zurich 8006, Switzerland
- Children’s Research Center, University Children’s Hospital Zurich, Zurich 8032, Switzerland
- University Research Priority Program (URPP), Adaptive Brain Circuits in Development and Learning (AdaBD), University of Zurich, Zurich 8006, Switzerland
| | - Ruth Tuura
- Center for MR Research, University Children’s Hospital Zurich, Zurich 8032, Switzerland
- Children’s Research Center, University Children’s Hospital Zurich, Zurich 8032, Switzerland
| | - Patrice Grehten
- Children’s Research Center, University Children’s Hospital Zurich, Zurich 8032, Switzerland
- Department of Diagnostic Imaging, University Children’s Hospital Zurich, Zurich 8032, Switzerland
- Zurich Center for Fetal Diagnosis and Therapy, Zurich 8032, Switzerland
- Zurich Center for Spina Bifida, University Children’s Hospital Zurich, Zurich 8032, Switzerland
| | - Raimund Kottke
- Children’s Research Center, University Children’s Hospital Zurich, Zurich 8032, Switzerland
- Department of Diagnostic Imaging, University Children’s Hospital Zurich, Zurich 8032, Switzerland
- Zurich Center for Fetal Diagnosis and Therapy, Zurich 8032, Switzerland
- Zurich Center for Spina Bifida, University Children’s Hospital Zurich, Zurich 8032, Switzerland
| | - Nicole Ochseinbein-Kölble
- Zurich Center for Fetal Diagnosis and Therapy, Zurich 8032, Switzerland
- Department of Obstetrics, University Hospital of Zurich, Zurich 8032, Switzerland
- University of Zurich, Zurich 8006, Switzerland
| | - Cornelia Hagmann
- Children’s Research Center, University Children’s Hospital Zurich, Zurich 8032, Switzerland
- Zurich Center for Spina Bifida, University Children’s Hospital Zurich, Zurich 8032, Switzerland
- Department of Neonatology, University Children's Hospital Zurich, Zurich 8032, Switzerland
| | - Luca Mazzone
- Children’s Research Center, University Children’s Hospital Zurich, Zurich 8032, Switzerland
- Zurich Center for Fetal Diagnosis and Therapy, Zurich 8032, Switzerland
- Zurich Center for Spina Bifida, University Children’s Hospital Zurich, Zurich 8032, Switzerland
- Department of Pediatric Surgery, University Children's Hospital Zurich, Zurich 8032, Switzerland
| | - Martin Meuli
- Zurich Center for Spina Bifida, University Children’s Hospital Zurich, Zurich 8032, Switzerland
- University of Zurich, Zurich 8006, Switzerland
| | - Beth Padden
- Children’s Research Center, University Children’s Hospital Zurich, Zurich 8032, Switzerland
- Zurich Center for Spina Bifida, University Children’s Hospital Zurich, Zurich 8032, Switzerland
- Division of Pediatric Rehabilitation, University Children’s Hospital Zurich, Zurich 8032, Switzerland
| | - Annette Hackenberg
- Children’s Research Center, University Children’s Hospital Zurich, Zurich 8032, Switzerland
- Zurich Center for Spina Bifida, University Children’s Hospital Zurich, Zurich 8032, Switzerland
- University of Zurich, Zurich 8006, Switzerland
- Department of Pediatric Neurology, University Children’s Hospital Zurich, Zurich 8032, Switzerland
| | - David-Alexander Wille
- Department of Pediatric Neurology, Cantonal Hospital of Baden, Baden 5404, Switzerland
| | - Ueli Moehrlen
- Zurich Center for Fetal Diagnosis and Therapy, Zurich 8032, Switzerland
- Zurich Center for Spina Bifida, University Children’s Hospital Zurich, Zurich 8032, Switzerland
- University of Zurich, Zurich 8006, Switzerland
- Department of Pediatric Surgery, University Children's Hospital Zurich, Zurich 8032, Switzerland
| | - Beatrice Latal
- Children’s Research Center, University Children’s Hospital Zurich, Zurich 8032, Switzerland
- University Research Priority Program (URPP), Adaptive Brain Circuits in Development and Learning (AdaBD), University of Zurich, Zurich 8006, Switzerland
- University of Zurich, Zurich 8006, Switzerland
- Child Development Center, University Children’s Hospital Zurich, Zurich 8032, Switzerland
| | | | - Andras Jakab
- Center for MR Research, University Children’s Hospital Zurich, Zurich 8032, Switzerland
- Neuroscience Center Zurich, University of Zurich, Zurich 8006, Switzerland
- University Research Priority Program (URPP), Adaptive Brain Circuits in Development and Learning (AdaBD), University of Zurich, Zurich 8006, Switzerland
- University of Zurich, Zurich 8006, Switzerland
| |
Collapse
|
4
|
Mufti N, Chappell J, Aertsen M, Ebner M, Fidon L, Deprest J, David AL, Melbourne A. Assessment of longitudinal brain development using super-resolution magnetic resonance imaging following fetal surgery for open spina bifida. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 62:707-720. [PMID: 37161647 PMCID: PMC10947002 DOI: 10.1002/uog.26244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 04/18/2023] [Accepted: 05/01/2023] [Indexed: 05/11/2023]
Abstract
OBJECTIVES Prenatal surgery is offered for selected fetuses with open spina bifida (OSB) to improve long-term outcome. We studied the effect of fetal OSB surgery on brain development using advanced magnetic resonance imaging (MRI) techniques to quantify the volume, surface area and shape of cerebral structures and to analyze surface curvature by means of parameters that correspond to gyrification. METHODS We compared MRI data from 29 fetuses with OSB before fetal surgery (mean gestational age (GA), 23 + 3 weeks) and at 1 and 6 weeks after surgery, with that of 36 GA-matched control fetuses (GA range, 21 + 2 to 36 + 2 weeks). Automated super-resolution reconstruction provided three-dimensional isotropic volumetric brain images. Unmyelinated white matter, cerebellum and ventricles were segmented automatically and refined manually, after which volume, surface area and shape parameter (volume/surface area) were quantified. Mathematical markers (shape index (SI) and curvedness) were used to measure gyrification. Parameters were assessed according to lesion type (myelomeningocele vs myeloschisis (MS)), postoperative persistence of hindbrain herniation (HH) and the presence of supratentorial anomalies, namely partial agenesis of the corpus callosum (pACC) and heterotopia (HT). RESULTS Growth in ventricular volume per week and change in shape parameter per week were higher at 6 weeks after surgery in fetuses with OSB compared with controls (median, 2500.94 (interquartile range (IQR), 1689.70-3580.80) mm3 /week vs 708.21 (IQR, 474.50-925.00) mm3 /week; P < 0.001 and 0.075 (IQR, 0.047-0.112) mm/week vs 0.022 (IQR, 0.009-0.042) mm/week; P = 0.046, respectively). Ventricular volume growth increased 6 weeks after surgery in cases with pACC (P < 0.001) and those with persistent HH (P = 0.002). During that time period, the change in unmyelinated white-matter shape parameter per week was decreased in OSB fetuses compared with controls (0.056 (IQR, 0.044-0.092) mm/week vs 0.159 (IQR, 0.100-0.247) mm/week; P = 0.002), particularly in cases with persistent HH (P = 0.011), MS (P = 0.015), HT (P = 0.022), HT with corpus callosum anomaly (P = 0.017) and persistent HH with corpus callosum anomaly (P = 0.007). At 6 weeks postoperatively, despite OSB fetuses having a lower rate of change in curvedness compared with controls (0.061 (IQR, 0.040-0.093) mm-1 /week vs 0.094 (IQR, 0.070-0.146) mm-1 /week; P < 0.001), reversing the trend seen at 1 week after surgery (0.144 (IQR, 0.099-0.236) mm-1 /week vs 0.072 (IQR, 0.059-0.081) mm-1 /week; P < 0.001), gyrification, as determined using SI, appeared to be increased in OSB fetuses overall compared with controls. This observation was more prominent in fetuses with pACC and those with severe ventriculomegaly (P-value range, < 0.001 to 0.006). CONCLUSIONS Following fetal OSB repair, volume, shape and curvedness of ventricles and unmyelinated white matter differed significantly compared with those of normal fetuses. Morphological brain changes after fetal surgery were not limited to effects on the circulation of cerebrospinal fluid. These observations may have implications for postnatal neurocognitive outcome. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
Collapse
Affiliation(s)
- N. Mufti
- Elizabeth Garrett Anderson Institute for Women's HealthUniversity College LondonLondonUK
- School of Biomedical Engineering and Imaging Sciences (BMEIS)King's College LondonLondonUK
| | - J. Chappell
- School of Biomedical Engineering and Imaging Sciences (BMEIS)King's College LondonLondonUK
| | - M. Aertsen
- Department of RadiologyUniversity Hospitals Katholieke Universiteit (KU) LeuvenLeuvenBelgium
| | - M. Ebner
- School of Biomedical Engineering and Imaging Sciences (BMEIS)King's College LondonLondonUK
| | - L. Fidon
- School of Biomedical Engineering and Imaging Sciences (BMEIS)King's College LondonLondonUK
| | - J. Deprest
- Elizabeth Garrett Anderson Institute for Women's HealthUniversity College LondonLondonUK
- Department of Obstetrics and GynaecologyUniversity Hospitals Katholieke Universiteit (KU) LeuvenLeuvenBelgium
| | - A. L. David
- Elizabeth Garrett Anderson Institute for Women's HealthUniversity College LondonLondonUK
- Department of Obstetrics and GynaecologyUniversity Hospitals Katholieke Universiteit (KU) LeuvenLeuvenBelgium
- National Institute for Health and Care Research University College London Hospitals Biomedical Research CentreLondonUK
| | - A. Melbourne
- School of Biomedical Engineering and Imaging Sciences (BMEIS)King's College LondonLondonUK
- Medical Physics and Biomedical EngineeringUniversity College LondonLondonUK
| |
Collapse
|
5
|
Debbarma A, Chowdhary S, Bhagat P. Electrophysiological Study in the Right Upper and Lower Limbs in Infants with Lumbosacral Meningomyelocele and in Normal Infants: A Case-control Study. Int J Appl Basic Med Res 2023; 13:77-82. [PMID: 37614841 PMCID: PMC10443458 DOI: 10.4103/ijabmr.ijabmr_484_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 02/20/2023] [Accepted: 04/15/2023] [Indexed: 08/25/2023] Open
Abstract
Objective The study aimed to assess the electrophysiological parameters (Hofmann reflex [H-reflex] and motor nerve conduction velocity [MNCV]) on children's upper and lower limbs with lumbosacral meningomyelocele (MMC) and age-matched control to see the effect of the MMC on the cervical segment of the spinal cord. Materials and Methods The present study was performed on infants with lumbosacral MMC. Twenty-five infants were examined with a mean age of 50 days of either sex. Out of them, 13 infants were in control and the remaining 12 were diagnosed with MMC. The H-reflex parameter and MNCV were recorded in these children's right upper and lower limbs. Results H-reflex was elicited in all the control group babies. In MMC, the H-reflex was elicited in the upper limbs. However, H-reflex was not elicited in the lower limbs of a few MMC babies. The upper limb's H-reflex parameters and conduction velocity were significantly higher than those corresponding lower limbs in control babies. In MMC, where the H-reflex was elicited, such differences in the lower and upper limbs were not observed. However, the values of MNCV in the upper limb (right median nerve) were significantly less, and the values of Hmax in the lower limb (soleus muscle) were significantly more in MMC babies than in the control group. Conclusions The values of electrophysiological parameters were higher in the upper limbs as compared to the corresponding lower limbs in control. These values were not altered in the upper limbs than those corresponding lower limbs of MMC, suggesting that motor function development was impaired/delayed in the spinal segment cranial to MMC lesion, and motor impairment in MMC children is mostly a result of upper motor neuron dysfunction.
Collapse
Affiliation(s)
- Aparna Debbarma
- Department of Physiology, Tripura Medical College and Dr. B.R. Ambedkar Memorial Teaching Hospital, Agartala, Tripura, India
| | - Sarita Chowdhary
- Department of Pediatrics Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Priyanka Bhagat
- Department of Physiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| |
Collapse
|
6
|
Cayouette F, O’Hearn K, Gertsman S, Menon K. Operationalization of assent for research participation in pre-adolescent children: a scoping review. BMC Med Ethics 2022; 23:106. [PMID: 36329421 PMCID: PMC9632024 DOI: 10.1186/s12910-022-00844-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Seeking assent from children for participation in medical research is an ethical imperative of numerous institutions globally. However, none of these organizations provide specific guidance on the criteria or process to be used when obtaining assent. The primary objective of this scoping review was to determine the descriptions of assent discussed in the literature and the reported criteria used for seeking assent for research participation in pre-adolescent children. METHODS Medline and Embase databases were searched until November 2020 using the term "assent" in the title or abstract. Inclusion criteria were (1) studies enrolling children which specifically described operationalization of the assent process and (2) studies of the assent process which provided a description of assent. Data collected included participant information, patient criteria for seeking assent, guidelines referenced, description of assent reported, how assent was obtained and assent information presented, and reported assent rate. For qualitative articles focusing on the assent process, important themes were identified. RESULTS A total of 116 articles were included of which 79 (68.9%) operationalized assent and 57 studies (%) described the assent process. The most commonly reported criterion used to determine the ability of a child to assent was age (35.4%, 28/79). The reported minimal age for obtaining pediatric assent varied considerably across and within jurisdictions (5-13 years; median 7.5 years, IQR 7.0, 9.75). Cognitive ability was reported as a criterion for obtaining assent in 5.1% (4/79) of studies. Assent rates were only reported in 17.7% (14/79) of citations and ranged from 32.0 to 100%. Analysis of the 57 studies describing the assent process identified several themes, including age thresholds, assessment of capacity, variable knowledge of pediatric assent and parental roles. CONCLUSION We found significant variation in criteria used for assessment of patient capacity, delivery of information used to obtain assent and documentation of the assent process. While we acknowledge that individual children, settings and jurisdictions may require different approaches to obtaining assent, there should be agreement on important principles to be followed with resulting common guidance on assessing capacity, delivering information and documentation of the assent process for publication.
Collapse
Affiliation(s)
- Florence Cayouette
- grid.28046.380000 0001 2182 2255Division of Critical Care, Department of Pediatrics, Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON Canada
| | - Katie O’Hearn
- grid.414148.c0000 0000 9402 6172CHEO Research Institute, Children’s Hospital of Eastern Ontario, Ottawa, ON Canada
| | - Shira Gertsman
- grid.414148.c0000 0000 9402 6172CHEO Research Institute, Children’s Hospital of Eastern Ontario, Ottawa, ON Canada ,grid.25073.330000 0004 1936 8227Present Address: Faculty of Medicine, McMaster University, Hamilton, ON Canada
| | - Kusum Menon
- grid.28046.380000 0001 2182 2255Division of Critical Care, Department of Pediatrics, Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON Canada ,grid.414148.c0000 0000 9402 6172CHEO Research Institute, Children’s Hospital of Eastern Ontario, Ottawa, ON Canada
| |
Collapse
|
7
|
Mangano FT, Altaye M, Stevenson CB, Yuan W. The Construction of a Predictive Composite Index for Decision-Making of CSF Diversion Surgery in Pediatric Patients following Prenatal Myelomeningocele Repair. AJNR Am J Neuroradiol 2022; 43:1214-1221. [PMID: 35902125 PMCID: PMC9575433 DOI: 10.3174/ajnr.a7585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 06/06/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE There is a wide range of clinical and radiographic factors affecting individual surgeons' ultimate decision for CSF diversion for pediatric patients following prenatal myelomeningocele repair. Our aim was to construct a composite index (CSF diversion surgery index) that integrates conventional clinical measures and neuroimaging biomarkers to predict CSF diversion surgery in these pediatric patients. MATERIALS AND METHODS This was a secondary retrospective analysis of data from 33 patients with prenatal myelomeningocele repair (including 14 who ultimately required CSF diversion surgery). Potential independent variables, including the Management of Myelomeningocele Study Index (a dichotomized variable based on the shunt-placement criteria from the Management of Myelomeningocele Study), postnatal DTI measures (fractional anisotropy and mean diffusivity in the genu of the corpus callosum and the posterior limb of internal capsule), fronto-occipital horn ratio at the time of DTI, gestational ages, and sex, were evaluated using stepwise logistic regression analysis to identify the most important predictors. RESULTS The CSF diversion surgery index model showed that the Management of Myelomeningocele Study Index and fractional anisotropy in the genu of the corpus callosum were significant predictors (P < .05) of CSF diversion surgery. The predictive value of the CSF diversion surgery index was also affected by fractional anisotropy in the posterior limb of the internal capsule and sex with marginal effect (.05<P < .10), but not by the fronto-occipital horn ratio (P > .10). The overall CSF diversion surgery index model fit the data well with statistical significance (eg, likelihood ratio: P < .001), with the performance (sensitivity = 78.6%; specificity = 86.5%, overall accuracy = 84.8%) superior to all individual indices in sensitivity and overall accuracy, and most of the individual indices in specificity. CONCLUSIONS The CSF diversion surgery index model outperformed all single predictor models and, with additional validation, may potentially be developed and incorporated into a sensitive and robust clinical tool to assist clinicians in hydrocephalus management.
Collapse
Affiliation(s)
- F T Mangano
- From the Division of Pediatric Neurosurgery (F.T.M., C.B.S.).,University of Cincinnati College of Medicine (F.T.M., M.A., C.B.S., W.Y.), Cincinnati, Ohio
| | - M Altaye
- Division of Biostatistics and Epidemiology (M.A.).,University of Cincinnati College of Medicine (F.T.M., M.A., C.B.S., W.Y.), Cincinnati, Ohio
| | - C B Stevenson
- From the Division of Pediatric Neurosurgery (F.T.M., C.B.S.).,University of Cincinnati College of Medicine (F.T.M., M.A., C.B.S., W.Y.), Cincinnati, Ohio
| | - W Yuan
- Pediatric Neuroimaging Research Consortium (W.Y.), Division of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio .,University of Cincinnati College of Medicine (F.T.M., M.A., C.B.S., W.Y.), Cincinnati, Ohio
| |
Collapse
|
8
|
Diffusion weighted imaging as a biomarker of retinoic acid induced myelomeningocele. PLoS One 2021; 16:e0253583. [PMID: 34191842 PMCID: PMC8244849 DOI: 10.1371/journal.pone.0253583] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 06/08/2021] [Indexed: 12/16/2022] Open
Abstract
Neural tube defects are a common congenital anomaly involving incomplete closure of the spinal cord. Myelomeningocele (MMC) is a severe form in which there is complete exposure of neural tissue with a lack of skin, soft tissue, or bony covering to protect the spinal cord. The all-trans retinoic acid (ATRA) induced rat model of (MMC) is a reproducible, cost-effective means of studying this disease; however, there are limited modalities to objectively quantify disease severity, or potential benefits from experimental therapies. We sought to determine the feasibility of detecting differences between MMC and wild type (WT) rat fetuses using diffusion magnetic resonance imaging techniques (MRI). Rat dams were gavage-fed ATRA to produce MMC defects in fetuses, which were surgically delivered prior to term. Average diffusion coefficient (ADC) and fractional anisotropy (FA) maps were obtained for each fetus. Brain volumes and two anatomically defined brain length measurements (D1 and D2) were significantly decreased in MMC compared to WT. Mean ADC signal was significantly increased in MMC compared to WT, but no difference was found for FA signal. In summary, ADC and brain measurements were significantly different between WT and MMC rat fetuses. ADC could be a useful complementary imaging biomarker to current histopathologic analysis of MMC models, and potentially expedite therapeutic research for this disease.
Collapse
|
9
|
Jakab A, Payette K, Mazzone L, Schauer S, Muller CO, Kottke R, Ochsenbein-Kölble N, Tuura R, Moehrlen U, Meuli M. Emerging magnetic resonance imaging techniques in open spina bifida in utero. Eur Radiol Exp 2021; 5:23. [PMID: 34136989 PMCID: PMC8209133 DOI: 10.1186/s41747-021-00219-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 04/01/2021] [Indexed: 11/25/2022] Open
Abstract
Magnetic resonance imaging (MRI) has become an essential diagnostic modality for congenital disorders of the central nervous system. Recent advancements have transformed foetal MRI into a clinically feasible tool, and in an effort to find predictors of clinical outcomes in spinal dysraphism, foetal MRI began to unveil its potential. The purpose of our review is to introduce MRI techniques to experts with diverse backgrounds, who are involved in the management of spina bifida. We introduce advanced foetal MRI postprocessing potentially improving the diagnostic work-up. Importantly, we discuss how postprocessing can lead to a more efficient utilisation of foetal or neonatal MRI data to depict relevant anatomical characteristics. We provide a critical perspective on how structural, diffusion and metabolic MRI are utilised in an endeavour to shed light on the correlates of impaired development. We found that the literature is consistent about the value of MRI in providing morphological cues about hydrocephalus development, hindbrain herniation or outcomes related to shunting and motor functioning. MRI techniques, such as foetal diffusion MRI or diffusion tractography, are still far from clinical use; however, postnatal studies using these methods revealed findings that may reflect early neural correlates of upstream neuronal damage in spinal dysraphism.
Collapse
Affiliation(s)
- Andras Jakab
- Center for MR-Research, University Children's Hospital Zürich, Zürich, Switzerland. .,Neuroscience Center Zürich, University of Zürich, Zürich, Switzerland.
| | - Kelly Payette
- Center for MR-Research, University Children's Hospital Zürich, Zürich, Switzerland.,Neuroscience Center Zürich, University of Zürich, Zürich, Switzerland
| | - Luca Mazzone
- Department of Pediatric Surgery, University Children's Hospital Zurich, Zürich, Switzerland.,The Zurich Center for Fetal Diagnosis and Therapy, Zürich, Switzerland
| | - Sonja Schauer
- Department of Pediatric Surgery, University Children's Hospital Zurich, Zürich, Switzerland
| | | | - Raimund Kottke
- Department of Diagnostic Imaging, University Children's Hospital Zurich, Zurich, Switzerland
| | | | - Ruth Tuura
- Center for MR-Research, University Children's Hospital Zürich, Zürich, Switzerland
| | - Ueli Moehrlen
- Department of Pediatric Surgery, University Children's Hospital Zurich, Zürich, Switzerland.,The Zurich Center for Fetal Diagnosis and Therapy, Zürich, Switzerland.,University of Zurich, Zürich, Switzerland
| | - Martin Meuli
- Department of Pediatric Surgery, University Children's Hospital Zurich, Zürich, Switzerland.,The Zurich Center for Fetal Diagnosis and Therapy, Zürich, Switzerland.,University of Zurich, Zürich, Switzerland
| |
Collapse
|
10
|
[Prenatal ultrasound prognostic of myelomeningocele at the era of fetal surgery]. ACTA ACUST UNITED AC 2021; 49:617-629. [PMID: 34020095 DOI: 10.1016/j.gofs.2021.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Indexed: 11/21/2022]
Abstract
Myelomeningocele (MMC) is a severe congenital condition responsible for motor and sensory impairments of the lower limbs, incontinence and cognitive impairment. Its screening, sometimes as early as the first trimester, is one of the major goals of modern prenatal care, supported by the emergence of prenatal surgery that results in a significant improvement in motor function, ambulation and ventriculoperitoneal shunt rate in patients undergoing in-utero surgery. From screening to pre- and post-operative prognostic evaluation, prenatal ultrasound is now an essential tool in the antenatal management of this condition. Using the multi planar and three-dimensional modes, it can be used to assess the vertebral level of MMC, which remains the key antenatal prognostic marker for motor function and ambulation, incontinence and the need for a ventriculo-peritoneal shunt. A careful and systematic ultrasound examination also makes it possible to assess the severity and progression of ventriculomegaly, to search for associated cerebral, spinal cord or vertebral anomalies, or to rule out exclusion criteria for in-utero surgery such as severe kyphosis or serious cortical anomalies. New tools from post-natal evaluation, such as the "metameric" ultrasound assessment of lower limb mobility, appear to be promising either for the initial examination or after in-utero surgery. Ultrasonography, associated with fetal MRI, cytogenetic and next generation sequencing, now allows a highly customized prognostic evaluation of these fetuses affected by MMC and provides the parents with the best possible information on the expected benefits and limitations of fetal surgery.
Collapse
|
11
|
Mufti N, Aertsen M, Ebner M, Fidon L, Patel P, Rahman MBA, Brackenier Y, Ekart G, Fernandez V, Vercauteren T, Ourselin S, Thomson D, De Catte L, Demaerel P, Deprest J, David AL, Melbourne A. Cortical spectral matching and shape and volume analysis of the fetal brain pre- and post-fetal surgery for spina bifida: a retrospective study. Neuroradiology 2021; 63:1721-1734. [PMID: 33934181 PMCID: PMC8460513 DOI: 10.1007/s00234-021-02725-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 04/22/2021] [Indexed: 12/03/2022]
Abstract
Purpose A retrospective study was performed to study the effect of fetal surgery on brain development measured by MRI in fetuses with myelomeningocele (MMC). Methods MRI scans of 12 MMC fetuses before and after surgery were compared to 24 age-matched controls without central nervous system abnormalities. An automated super-resolution reconstruction technique generated isotropic brain volumes to mitigate 2D MRI fetal motion artefact. Unmyelinated white matter, cerebellum and ventricles were automatically segmented, and cerebral volume, shape and cortical folding were thereafter quantified. Biometric measures were calculated for cerebellar herniation level (CHL), clivus-supraocciput angle (CSO), transverse cerebellar diameter (TCD) and ventricular width (VW). Shape index (SI), a mathematical marker of gyrification, was derived. We compared cerebral volume, surface area and SI before and after MMC fetal surgery versus controls. We additionally identified any relationship between these outcomes and biometric measurements. Results MMC ventricular volume/week (mm3/week) increased after fetal surgery (median: 3699, interquartile range (IQR): 1651–5395) compared to controls (median: 648, IQR: 371–896); P = 0.015. The MMC SI is higher pre-operatively in all cerebral lobes in comparison to that in controls. Change in SI/week in MMC fetuses was higher in the left temporal lobe (median: 0.039, IQR: 0.021–0.054), left parietal lobe (median: 0.032, IQR: 0.023–0.039) and right occipital lobe (median: 0.027, IQR: 0.019–0.040) versus controls (P = 0.002 to 0.005). Ventricular volume (mm3) and VW (mm) (r = 0.64), cerebellar volume and TCD (r = 0.56) were moderately correlated. Conclusions Following fetal myelomeningocele repair, brain volume, shape and SI were significantly different from normal in most cerebral layers. Morphological brain changes after fetal surgery are not limited to hindbrain herniation reversal. These findings may have neurocognitive outcome implications and require further evaluation. Supplementary Information The online version contains supplementary material available at 10.1007/s00234-021-02725-8.
Collapse
Affiliation(s)
- Nada Mufti
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, 1st Floor Charles Bell House, 43-45 Foley Street, W1W 7TS, London, UK. .,School of Biomedical Engineering & Imaging Sciences (BMEIS), King's College London, London, UK.
| | - Michael Aertsen
- Department of Radiology, University Hospitals Katholieke Universiteit (KU), Leuven, Belgium
| | - Michael Ebner
- School of Biomedical Engineering & Imaging Sciences (BMEIS), King's College London, London, UK.,Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Lucas Fidon
- School of Biomedical Engineering & Imaging Sciences (BMEIS), King's College London, London, UK
| | - Premal Patel
- Radiology Department, Great Ormond Street Hospital for Children, London, UK
| | | | - Yannick Brackenier
- School of Biomedical Engineering & Imaging Sciences (BMEIS), King's College London, London, UK
| | - Gregor Ekart
- School of Biomedical Engineering & Imaging Sciences (BMEIS), King's College London, London, UK
| | - Virginia Fernandez
- School of Biomedical Engineering & Imaging Sciences (BMEIS), King's College London, London, UK
| | - Tom Vercauteren
- School of Biomedical Engineering & Imaging Sciences (BMEIS), King's College London, London, UK.,Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Sebastien Ourselin
- School of Biomedical Engineering & Imaging Sciences (BMEIS), King's College London, London, UK.,Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Dominic Thomson
- Paediatric Neurosurgery Department, Great Ormond Street Hospital for Children, London, UK
| | - Luc De Catte
- Department of Obstetrics and Gynaecology, University Hospitals, Katholieke Universiteit (KU) Leuven, Leuven, Belgium.,Cluster 'Women and Child', Dept. Development and Regeneration, Biomedical Sciences, Katholieke Universiteit (KU) Leuven, Leuven, Belgium
| | - Philippe Demaerel
- Department of Radiology, University Hospitals Katholieke Universiteit (KU), Leuven, Belgium
| | - Jan Deprest
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, 1st Floor Charles Bell House, 43-45 Foley Street, W1W 7TS, London, UK.,Department of Obstetrics and Gynaecology, University Hospitals, Katholieke Universiteit (KU) Leuven, Leuven, Belgium.,Cluster 'Women and Child', Dept. Development and Regeneration, Biomedical Sciences, Katholieke Universiteit (KU) Leuven, Leuven, Belgium
| | - Anna L David
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, 1st Floor Charles Bell House, 43-45 Foley Street, W1W 7TS, London, UK.,Department of Obstetrics and Gynaecology, University Hospitals, Katholieke Universiteit (KU) Leuven, Leuven, Belgium.,Cluster 'Women and Child', Dept. Development and Regeneration, Biomedical Sciences, Katholieke Universiteit (KU) Leuven, Leuven, Belgium
| | - Andrew Melbourne
- School of Biomedical Engineering & Imaging Sciences (BMEIS), King's College London, London, UK.,Medical Physics and Biomedical Engineering, University College London, London, UK
| |
Collapse
|
12
|
Yuan W, Stevenson CB, Altaye M, Jones BV, Leach J, Lovha M, Rennert N, Mangano FT. Diffusion tensor imaging in children following prenatal myelomeningocele repair and its predictive value for the need and timing of subsequent CSF diversion surgery for hydrocephalus. J Neurosurg Pediatr 2021; 27:391-399. [PMID: 33545679 DOI: 10.3171/2020.9.peds20570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 09/02/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study was to investigate diffusion tensor imaging (DTI), an objective and noninvasive neuroimaging technique, for its potential as an imaging biomarker to predict the need and timing of CSF diversion surgery in patients after prenatal myelomeningocele (MMC) repair. METHODS This was a retrospective analysis of data based on 35 pediatric patients after prenatal MMC repair (gestational age at birth 32.68 ± 3.42 weeks, range 24-38 weeks; 15 females and 20 males). A logistic regression analysis was used to classify patients to determine the need for CSF diversion surgery. The model performance was compared between using the frontooccipital horn ratio (FOHR) alone and using the FOHR combined with DTI values (the genu of the corpus callosum [gCC] and the posterior limb of the internal capsule [PLIC]). For patients who needed to be treated surgically, timing of the procedure was used as the clinical outcome to test the predictive value of DTI acquired prior to surgery based on a linear regression analysis. RESULTS Significantly lower fractional anisotropy (FA) values in the gCC (p = 0.014) and PLIC (p = 0.037) and higher mean diffusivity (MD) values in the gCC (p = 0.013) were found in patients who required CSF diversion surgery compared with those who did not require surgery (all p values adjusted for age). Based on the logistic regression analysis, the FOHR alone showed an accuracy of performance of 0.69 and area under the receiver operating characteristic curve (AUC) of 0.60. The performance of the model was higher when DTI measures were used in the logistic regression model (accuracy = 0.77, AUC = 0.84 for using DTI values in gCC; accuracy = 0.75, AUC = 0.84 for using DTI values in PLIC). Combining the DTI values of the gCC or PLIC and FOHR did not improve the model performance when compared with using the DTI values alone. In patients who needed CSF diversion surgery, significant correlation was found between DTI values in the gCC and the time interval between imaging and surgery (FA: ρ = 0.625, p = 0.022; MD: ρ = -0.6830, p = 0.010; both adjusted for age and FOHR). CONCLUSIONS The authors' data demonstrated that DTI could potentially serve as an objective biomarker differentiating patients after prenatal MMC repair regarding those who may require surgery for MMC-associated hydrocephalus. The predictive value for the need and timing of CSF diversion surgery is highly clinically relevant for improving and optimizing decision-making for the treatment of hydrocephalus in this patient population.
Collapse
Affiliation(s)
- Weihong Yuan
- 1Pediatric Neuroimaging Research Consortium, Radiology, and.,5University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Charles B Stevenson
- Divisions of2Pediatric Neurosurgery.,5University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Mekibib Altaye
- 3Biostatistics and Epidemiology, and.,5University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Blaise V Jones
- 4Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati.,5University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - James Leach
- 4Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati.,5University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | | - Noa Rennert
- 7Department of Neurosurgery, Sheba Medical Center, Ramat-Gan, Israel
| | - Francesco T Mangano
- Divisions of2Pediatric Neurosurgery.,5University of Cincinnati College of Medicine, Cincinnati, Ohio
| |
Collapse
|
13
|
Morais BA, Solla DJF, Yamaki VN, Ferraciolli SF, Alves CAPF, Cardeal DD, Matushita H, Teixeira MJ. Brain abnormalities in myelomeningocele patients. Childs Nerv Syst 2020; 36:1507-1513. [PMID: 31664560 DOI: 10.1007/s00381-019-04386-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 09/23/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Myelomeningocele (MMC) is often related to hydrocephalus and Chiari malformation (CM) type 2; however, other brain abnormalities have been reported in this population. In order to better understand and quantify other forebrain abnormalities, we analyzed magnetic resonance imaging (MRI) of MMC patients treated in utero or postnatal. METHODS Between January 2014 and March 2017, 59 MMC were treated in our hospital. Thirty-seven patients (32 postnatal and 5 intrautero repair) had brain MRI and were enrolled at the study. MRI was analyzed by two experienced neuroradiologists to identify the supra and infratentorial brain abnormalities. RESULTS A wide range of brain abnormalities was consistently identified in MMC patients. As expected, the most common were hydrocephalus (94.5%) and CM type II (89.1%). Of note, we found high incidence of corpus callosum abnormalities (86.4%), mostly represented by dysplasia (46%). CONCLUSIONS The data are consistent with the concept that brain abnormalities related to MMC can be both infratentorial and supratentorial, cortical, and subcortical. More studies are needed to correlate these forebrain abnormalities to long-term functional outcome and their prognostic value for these patients.
Collapse
Affiliation(s)
- Bárbara Albuquerque Morais
- Department of Neurosurgery, Hospital das Clínicas, School of Medicine, University of São Paulo, Street Eneas de Carvalho, 155, Pinheiros-, São Paulo, São Paulo, Brazil.
| | - Davi Jorge Fontoura Solla
- Department of Neurosurgery, Hospital das Clínicas, School of Medicine, University of São Paulo, Street Eneas de Carvalho, 155, Pinheiros-, São Paulo, São Paulo, Brazil
| | - Vitor Nagai Yamaki
- Department of Neurosurgery, Hospital das Clínicas, School of Medicine, University of São Paulo, Street Eneas de Carvalho, 155, Pinheiros-, São Paulo, São Paulo, Brazil
| | - Suely Fazio Ferraciolli
- Department of Radiology, Hospital das Clínicas, School of Medicine, University of São Paulo, Street Eneas de Carvalho, 155, Pinheiros-, São Paulo, São Paulo, Brazil
| | - Cesar Augusto P F Alves
- Department of Radiology, Hospital das Clínicas, School of Medicine, University of São Paulo, Street Eneas de Carvalho, 155, Pinheiros-, São Paulo, São Paulo, Brazil
| | - Daniel Dante Cardeal
- Department of Neurosurgery, Hospital das Clínicas, School of Medicine, University of São Paulo, Street Eneas de Carvalho, 155, Pinheiros-, São Paulo, São Paulo, Brazil
| | - Hamilton Matushita
- Department of Neurosurgery, Hospital das Clínicas, School of Medicine, University of São Paulo, Street Eneas de Carvalho, 155, Pinheiros-, São Paulo, São Paulo, Brazil
| | - Manoel Jacobsen Teixeira
- Department of Neurosurgery, Hospital das Clínicas, School of Medicine, University of São Paulo, Street Eneas de Carvalho, 155, Pinheiros-, São Paulo, São Paulo, Brazil
| |
Collapse
|
14
|
Mangano FT, Stevenson CB, Nagaraj U, Conley A, Yuan W. Abnormal anisotropic diffusion properties in pediatric myelomeningocele patients treated with fetal surgery: an initial DTI study. Childs Nerv Syst 2020; 36:827-833. [PMID: 31399765 DOI: 10.1007/s00381-019-04339-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 08/01/2019] [Indexed: 01/13/2023]
Abstract
PURPOSE To investigate white matter microstructural abnormality based on diffusion tensor imaging (DTI) in pediatric patients with fetal repair for myelomeningocele (MMC). METHODS This was a retrospective analysis of DTI data from 8 pediatric patients with prenatal MMC repair (age range 1.64-33.70 months; sex 3F/5M) and 8 age-matched controls (age 2.24-31.20 months; sex 5F/2M). All participants were scanned on 1.5T GE Signa MR scanner (GE Healthcare, Milwaukee, WI) with the same sequence specifications. Two DTI measures, including fractional anisotropy (FA) and mean diffusivity (MD), were calculated from the genu of corpus callosum (gCC) and the posterior limb of internal capsule (PLIC). DTI values and fronto-occipital horn ratio (FOHR) were tested for group difference based on two-tailed paired t test. RESULTS The ventricle size based on FOHR in patients with prenatal MMC repair was significantly larger than that in the age-matched control group (p < 0.001). Statistically significant group difference in DTI (lower FA and higher MD in patient group) was found in gCC (p = 0.007 and 0.003, respectively). A trend level increase in MD was also found (p = 0.065) in PLIC in patients when compared with the age-matched controls. CONCLUSION Our data showed white matter abnormality based on DTI in pediatric patient with fetal repair for MMC. The sensitivity of DTI in detecting white matter abnormality, as shown in the present study, may help to serve as an imaging biomarker for assessing hydrocephalus and improve and optimize decision making for the treatment of hydrocephalus in this patient population.
Collapse
Affiliation(s)
- Francesco T Mangano
- Division of Pediatric Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Charles B Stevenson
- Division of Pediatric Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Usha Nagaraj
- University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Division of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Adam Conley
- Specialty Pediatric Center, Children's Hospital & Medical Center, Omaha, NE, USA
| | - Weihong Yuan
- University of Cincinnati College of Medicine, Cincinnati, OH, USA. .,Pediatric Neuroimaging Research Consortium, Division of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 5033, Cincinnati, OH, 45229, USA.
| |
Collapse
|
15
|
Schilling KG, By S, Feiler HR, Box BA, O'Grady KP, Witt A, Landman BA, Smith SA. Diffusion MRI microstructural models in the cervical spinal cord - Application, normative values, and correlations with histological analysis. Neuroimage 2019; 201:116026. [PMID: 31326569 DOI: 10.1016/j.neuroimage.2019.116026] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 07/12/2019] [Accepted: 07/16/2019] [Indexed: 12/14/2022] Open
Abstract
Multi-compartment tissue modeling using diffusion magnetic resonance imaging has proven valuable in the brain, offering novel indices sensitive to the tissue microstructural environment in vivo on clinical MRI scanners. However, application, characterization, and validation of these models in the spinal cord remain relatively under-studied. In this study, we apply a diffusion "signal" model (diffusion tensor imaging, DTI) and two commonly implemented "microstructural" models (neurite orientation dispersion and density imaging, NODDI; spherical mean technique, SMT) in the human cervical spinal cord of twenty-one healthy controls. We first provide normative values of DTI, SMT, and NODDI indices in a number of white matter ascending and descending pathways, as well as various gray matter regions. We then aim to validate the sensitivity and specificity of these diffusion-derived contrasts by relating these measures to indices of the tissue microenvironment provided by a histological template. We find that DTI indices are sensitive to a number of microstructural features, but lack specificity. The microstructural models also show sensitivity to a number of microstructure features; however, they do not capture the specific microstructural features explicitly modelled. Although often regarded as a simple extension of the brain in the central nervous system, it may be necessary to re-envision, or specifically adapt, diffusion microstructural models for application to the human spinal cord with clinically feasible acquisitions - specifically, adjusting, adapting, and re-validating the modeling as it relates to both theory (i.e. relevant biology, assumptions, and signal regimes) and parameter estimation (for example challenges of acquisition, artifacts, and processing).
Collapse
Affiliation(s)
- Kurt G Schilling
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Samantha By
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Haley R Feiler
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Bailey A Box
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kristin P O'Grady
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Atlee Witt
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Bennett A Landman
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA; Department of Electrical Engineering, Vanderbilt University, Nashville, TN, USA
| | - Seth A Smith
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA; Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| |
Collapse
|
16
|
Jiang M, Wen Z, Long L, Wong CW, Ye N, Zee C, Chen BT. Assessing Cerebral White Matter Microstructure in Children With Congenital Sensorineural Hearing Loss: A Tract-Based Spatial Statistics Study. Front Neurosci 2019; 13:597. [PMID: 31293368 PMCID: PMC6598398 DOI: 10.3389/fnins.2019.00597] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 05/27/2019] [Indexed: 12/16/2022] Open
Abstract
Objectives To assess the microstructural properties of cerebral white matter in children with congenital sensorineural hearing loss (CSNHL). Methods Children (>4 years of age) with profound CSNHL and healthy controls with normal hearing (the control group) were enrolled and underwent brain magnetic resonance imaging (MRI) scans with diffusion tensor imaging (DTI). DTI parameters including fractional anisotropy, mean diffusivity, axial diffusivity, and radial diffusivity were obtained from a whole-brain tract-based spatial statistics analysis and were compared between the two groups. In addition, a region of interest (ROI) approach focusing on auditory cortex, i.e., Heschl’s gyrus, using visual cortex, i.e., forceps major as an internal control, was performed. Correlations between mean DTI values and age were obtained with the ROI method. Results The study cohort consisted of 23 children with CSHNL (11 boys and 12 girls; mean age ± SD: 7.21 ± 2.67 years; range: 4.1–13.5 years) and 18 children in the control group (11 boys and 7 girls; mean age ± SD: 10.86 ± 3.56 years; range: 4.5–15.3 years). We found the axial diffusivity values being significantly greater in the left anterior thalamic radiation, right corticospinal tract, and corpus callosum in the CSHNL group than in the control group (p < 0.05). Significantly higher radial diffusivity values in the white matter tracts were noted in the CSHNL group as compared to the control group (p < 0.05). The fractional anisotropy values in the Heschl’s gyrus in the CSNHL group were lower compared to the control group (p = 0.0015). There was significant negative correlation between the mean fractional anisotropy values in Heschl’s gyrus and age in the CSNHL group < 7 years of age (r = −0.59, p = 0.004). Conclusion Our study showed higher axial and radial diffusivities in the children affected by CNHNL as compared to the hearing children. We also found lower fractional anisotropy values in the Heschl’s gyrus in the CSNHL group. Furthermore, we identified negative correlation between the fractional anisotropy values and age up to 7 years in the children born deaf. Our study findings suggest that myelination and axonal structure may be affected due to acoustic deprivation. This information may help to monitor hearing rehabilitation in the deaf children.
Collapse
Affiliation(s)
- Muliang Jiang
- Department of Diagnostic Radiology, City of Hope National Medical Center, Duarte, CA, United States
| | - Zuguang Wen
- Department of Radiology, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Liling Long
- Department of Radiology, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Chi Wah Wong
- Center for Informatics, City of Hope National Medical Center, Duarte, CA, United States
| | - Ningrong Ye
- Department of Diagnostic Radiology, City of Hope National Medical Center, Duarte, CA, United States
| | - Chishing Zee
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Bihong T Chen
- Department of Diagnostic Radiology, City of Hope National Medical Center, Duarte, CA, United States
| |
Collapse
|
17
|
Meoded A, Huisman TAGM. Diffusion Tensor Imaging of Brain Malformations: Exploring the Internal Architecture. Neuroimaging Clin N Am 2019; 29:423-434. [PMID: 31256863 DOI: 10.1016/j.nic.2019.03.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Diffusion tensor imaging (DTI) is an advanced MR imaging technique that provides noninvasive qualitative and quantitative information about the white matter microarchitecture. By measuring the three-dimensional directional characteristics of water molecule diffusion/mobility, DTI generates unique tissue contrasts that are used to study the axonal organization of the central nervous system. Its applications include quantitative evaluation of the brain connectivity, development, and white matter diseases. This article reviews DTI and fiber tractography findings in several brain malformations and highlights the added value of DTI and fiber tractography compared with conventional MR imaging.
Collapse
Affiliation(s)
- Avner Meoded
- Johns Hopkins All Children's Hospital, 501 6th Avenue South, St Petersburg, FL 33701, USA.
| | - Thierry A G M Huisman
- Edward B. Singleton Department of Radiology, Texas Children's Hospital, 6701 Fannin Street, Suite 470, Houston, TX 77030, USA
| |
Collapse
|
18
|
Role of Neurocognitive Factors in Academic Fluency for Children and Adults With Spina Bifida Myelomeningocele. J Int Neuropsychol Soc 2019; 25:249-265. [PMID: 30864535 DOI: 10.1017/s1355617718001200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES Fluency is a major problem for individuals with neurodevelopmental disorders, including fluency deficits for academic skills. The aim of this study was to determine neurocognitive predictors of academic fluency within and across domains of reading, writing, and math, in children and adults, with and without spina bifida. In addition to group differences, we expected some neurocognitive predictors (reaction time, inattention) to have similar effects for each academic fluency outcome, and others (dexterity, vocabulary, nonverbal reasoning) to have differential effects across outcomes. METHODS Neurocognitive predictors were reaction time, inattention, dexterity, vocabulary, and nonverbal reasoning; other factors included group (individuals with spina bifida, n=180; and without, n=81), age, and demographic and untimed academic content skill covariates. Univariate and multivariate regressions evaluated hypotheses. RESULTS Univariate regressions were significant and robust (R 2 =.78, .70, .73, for reading, writing, and math fluency, respectively), with consistent effects of covariates, age, reaction time, and vocabulary; group and group moderation showed small effect sizes (<2%). Multivariate contrasts showed differential prediction across academic fluency outcomes for reaction time and vocabulary. CONCLUSIONS The novelty of the present work is determining neurocognitive predictors for an important outcome (academic fluency), within and across fluency domains, across population (spina bifida versus typical), over a large developmental span, in the context of well-known covariates. Results offer insight into similarities and differences regarding prediction of different domains of academic fluency, with implications for addressing academic weakness in spina bifida, and for evaluating similar questions in other neurodevelopmental disorders. (JINS, 2019, 25, 249-265).
Collapse
|
19
|
Tan K, Meiri A, Mowrey WB, Abbott R, Goodrich JT, Sandler AL, Suri AK, Lipton ML, Wagshul ME. Diffusion tensor imaging and ventricle volume quantification in patients with chronic shunt-treated hydrocephalus: a matched case-control study. J Neurosurg 2018; 129:1611-1622. [PMID: 29350598 DOI: 10.3171/2017.6.jns162784] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 06/19/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThe object of this study was to use diffusion tensor imaging (DTI) and tract-based spatial statistics (TBSS) to characterize the long-term effects of hydrocephalus and shunting on white matter integrity and to investigate the relationship of ventricular size and alterations in white matter integrity with headache and quality-of-life outcome measures.METHODSPatients with shunt-treated hydrocephalus and age- and sex-matched healthy controls were recruited into the study and underwent anatomical and DTI imaging on a 3-T MRI scanner. All patients were clinically stable, had undergone CSF shunt placement before 2 years of age, and had a documented history of complaints of headaches. Outcome was scored based on the Headache Disability Inventory and the Hydrocephalus Outcome Questionnaire. Fractional anisotropy (FA) and other DTI-based measures (axial, radial, and mean diffusivity; AD, RD, and MD, respectively) were extracted in the corpus callosum and internal capsule with manual region-of-interest delineation and in other regions with TBSS. Paired t-tests, corrected with a 5% false discovery rate, were used to identify regions with significant differences between patients and controls. Within the patient group, linear regression models were used to investigate the relationship between FA or ventricular volume and outcome, as well as the effect of shunt-related covariates.RESULTSTwenty-one hydrocephalus patients and 21 matched controls completed the study, and their data were used in the final analysis. The authors found significantly lower FA for patients than for controls in 20 of the 48 regions, mostly posterior white matter structures, in periventricular as well as more distal tracts. Of these 20 regions, 17 demonstrated increased RD, while only 5 showed increased MD and 3 showed decreased AD. No areas of increased FA were observed. Higher FA in specific periventricular white matter tracts, tending toward FA in controls, was associated with increased ventricular size, as well as improved clinical outcome.CONCLUSIONSThe study shows that TBSS-based DTI is a sensitive technique for elucidating changes in white matter structures due to hydrocephalus and chronic CSF shunting and provides preliminary evidence that DTI may be a valuable tool for tailoring shunt procedures to monitor ventricular size following shunting and achieve optimal outcome, as well as for guiding the development of alternate therapies for hydrocephalus.
Collapse
Affiliation(s)
- Kristy Tan
- 1Department of Radiology, Gruss Magnetic Resonance Research Center, and
| | - Avital Meiri
- 1Department of Radiology, Gruss Magnetic Resonance Research Center, and
| | | | - Rick Abbott
- 3Department of Neurological Surgery, Children's Hospital at Montefiore; and
| | - James T Goodrich
- 3Department of Neurological Surgery, Children's Hospital at Montefiore; and
| | - Adam L Sandler
- 3Department of Neurological Surgery, Children's Hospital at Montefiore; and
| | - Asif K Suri
- 1Department of Radiology, Gruss Magnetic Resonance Research Center, and
- 5Department of Radiology, Montefiore Medical Center, Bronx, New York
| | - Michael L Lipton
- 1Department of Radiology, Gruss Magnetic Resonance Research Center, and
- 4Neuroscience
- 5Department of Radiology, Montefiore Medical Center, Bronx, New York
- 6Psychiatry and Behavioral Sciences, and
| | - Mark E Wagshul
- 1Department of Radiology, Gruss Magnetic Resonance Research Center, and
- 7Physiology and Biophysics, Albert Einstein College of Medicine
| |
Collapse
|
20
|
Stubberud J. Theory of mind in spina bifida: Relationship with intellectual and executive functioning. Scand J Psychol 2017; 58:379-388. [DOI: 10.1111/sjop.12390] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 08/01/2017] [Indexed: 12/17/2022]
Affiliation(s)
- Jan Stubberud
- TRS National Resource Centre for Rare Disorders; Sunnaas Rehabilitation Hospital; Nesoddtangen Norway
- Department of Psychology; University of Oslo; Norway
- Lovisenberg Diaconal Hospital; Norway
| |
Collapse
|
21
|
Yuan W, Meller A, Shimony JS, Nash T, Jones BV, Holland SK, Altaye M, Barnard H, Phillips J, Powell S, McKinstry RC, Limbrick DD, Rajagopal A, Mangano FT. Left hemisphere structural connectivity abnormality in pediatric hydrocephalus patients following surgery. NEUROIMAGE-CLINICAL 2016; 12:631-639. [PMID: 27722087 PMCID: PMC5048110 DOI: 10.1016/j.nicl.2016.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 08/19/2016] [Accepted: 09/02/2016] [Indexed: 01/03/2023]
Abstract
Neuroimaging research in surgically treated pediatric hydrocephalus patients remains challenging due to the artifact caused by programmable shunt. Our previous study has demonstrated significant alterations in the whole brain white matter structural connectivity based on diffusion tensor imaging (DTI) and graph theoretical analysis in children with hydrocephalus prior to surgery or in surgically treated children without programmable shunts. This study seeks to investigate the impact of brain injury on the topological features in the left hemisphere, contratelateral to the shunt placement, which will avoid the influence of shunt artifacts and makes further group comparisons feasible for children with programmable shunt valves. Three groups of children (34 in the control group, 12 in the 3-month post-surgery group, and 24 in the 12-month post-surgery group, age between 1 and 18 years) were included in the study. The structural connectivity data processing and analysis were performed based on DTI and graph theoretical analysis. Specific procedures were revised to include only left brain imaging data in normalization, parcellation, and fiber counting from DTI tractography. Our results showed that, when compared to controls, children with hydrocephalus in both the 3-month and 12-month post-surgery groups had significantly lower normalized clustering coefficient, lower small-worldness, and higher global efficiency (all p < 0.05, corrected). At a regional level, both patient groups showed significant alteration in one or more regional connectivity measures in a series of brain regions in the left hemisphere (8 and 10 regions in the 3-month post-surgery and the 12-month post-surgery group, respectively, all p < 0.05, corrected). No significant correlation was found between any of the global or regional measures and the contemporaneous neuropsychological outcomes [the General Adaptive Composite (GAC) from the Adaptive Behavior Assessment System, Second Edition (ABAS-II)]. However, one global network measure (global efficiency) and two regional network measures in the insula (local efficiency and between centrality) tested at 3-month post-surgery were found to correlate with GAC score tested at 12-month post-surgery with statistical significance (all p < 0.05, corrected). Our data showed that the structural connectivity analysis based on DTI and graph theory was sensitive in detecting both global and regional network abnormality when the analysis was conducted in the left hemisphere only. This approach provides a new avenue enabling the application of advanced neuroimaging analysis methods in quantifying brain damage in children with hydrocephalus surgically treated with programmable shunts. We studied the structural connectivity of left hemisphere brain network in children with hydrocephalus post-surgery Children with hydrocephalus post-surgery had significantly abnormal structural connectivity in the left hemisphere based on graph analysis Significant correlation was found between graph measures at 3-months post-surgery and developmental outcome at 12-month post-surgery
Collapse
Affiliation(s)
- Weihong Yuan
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Artur Meller
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Joshua S Shimony
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, MO, United States
| | - Tiffany Nash
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Blaise V Jones
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Scott K Holland
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Mekibib Altaye
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Holly Barnard
- Division of Developmental and Behavioral Pediatrics - Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Jannel Phillips
- Division of Developmental and Behavioral Pediatrics - Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Stephanie Powell
- Department of Neurology, Washington University School of Medicine, Saint Louis, MO, United States; Department of Psychology, St. Louis Children's Hospital, St. Louis, MO, United States
| | - Robert C McKinstry
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, MO, United States
| | - David D Limbrick
- Department of Neurological Surgery, Washington University School of Medicine, Saint Louis, MO, United States
| | - Akila Rajagopal
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Francesco T Mangano
- Division of Pediatric Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; University of Cincinnati College of Medicine, Cincinnati, OH, United States
| |
Collapse
|
22
|
Mangano FT, Altaye M, McKinstry RC, Shimony JS, Powell SK, Phillips JM, Barnard H, Limbrick DD, Holland SK, Jones BV, Dodd J, Simpson S, Deanna M, Rajagopal A, Bidwell S, Yuan W. Diffusion tensor imaging study of pediatric patients with congenital hydrocephalus: 1-year postsurgical outcomes. J Neurosurg Pediatr 2016; 18:306-19. [PMID: 27203134 PMCID: PMC5035704 DOI: 10.3171/2016.2.peds15628] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE The purpose of this study was to investigate white matter (WM) structural abnormalities using diffusion tensor imaging (DTI) in children with hydrocephalus before CSF diversionary surgery (including ventriculoperitoneal shunt insertion and endoscopic third ventriculostomy) and during the course of recovery after surgery in association with neuropsychological and behavioral outcome. METHODS This prospective study included 54 pediatric patients with congenital hydrocephalus (21 female, 33 male; age range 0.03-194.5 months) who underwent surgery and 64 normal controls (30 female, 34 male; age range 0.30-197.75 months). DTI and neurodevelopmental outcome data were collected once in the control group and 3 times (preoperatively and at 3 and 12 months postoperatively) in the patients with hydrocephalus. DTI measures, including fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) values were extracted from the genu of the corpus callosum (gCC) and the posterior limb of internal capsule (PLIC). Group analysis was performed first cross-sectionally to quantify DTI abnormalities at 3 time points by comparing the data obtained in the hydrocephalus group for each of the 3 time points to data obtained in the controls. Longitudinal comparisons were conducted pairwise between different time points in patients whose data were acquired at multiple time points. Neurodevelopmental data were collected and analyzed using the Adaptive Behavior Assessment System, Second Edition, and the Bayley Scales of Infant Development, Third Edition. Correlation analyses were performed between DTI and behavioral measures. RESULTS Significant DTI abnormalities were found in the hydrocephalus patients in both the gCC (lower FA and higher MD, AD, and RD) and the PLIC (higher FA, lower AD and RD) before surgery. The DTI measures in the gCC remained mostly abnormal at 3 and 12 months after surgery. The DTI abnormalities in the PLIC were significant in FA and AD at 3 months after surgery but did not persist when tested at 12 months after surgery. Significant longitudinal DTI changes in the patients with hydrocephalus were found in the gCC when findings at 3 and 12 months after surgery were compared. In the PLIC, trend-level longitudinal changes were observed between preoperative findings and 3-month postoperative findings, as well as between 3- and 12-month postoperative findings. Significant correlation between DTI and developmental outcome was found at all 3 time points. Notably, a significant correlation was found between DTI in the PLIC at 3 months after surgery and developmental outcome at 12 months after surgery. CONCLUSIONS The data showed significant WM abnormality based on DTI in both the gCC and the PLIC in patients with congenital hydrocephalus before surgery, and the abnormalities persisted in both the gCC and the PLIC at 3 months after surgery. The DTI values remained significantly abnormal in the gCC at 12 months after surgery. Longitudinal analysis showed signs of recovery in both WM structures between different time points. Combined with the significant correlation found between DTI and neuropsychological measures, the findings of this study suggest that DTI can serve as a sensitive imaging biomarker for underlying neuroanatomical changes and postsurgical developmental outcome and even as a predictor for future outcomes.
Collapse
Affiliation(s)
- Francesco T. Mangano
- Division of Pediatric Neurosurgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio,University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Mekibib Altaye
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio,University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Robert C. McKinstry
- Mallinckrodt Institute of Radiology, Saint Louis, MO,Washington University School of Medicine, Saint Louis, MO
| | - Joshua S. Shimony
- Mallinckrodt Institute of Radiology, Saint Louis, MO,Washington University School of Medicine, Saint Louis, MO
| | - Stephanie K. Powell
- Department of Neurology, Saint Louis, MO,Washington University School of Medicine, Saint Louis, MO,Department of Psychology, St. Louis Children’s Hospital, St. Louis, MO
| | - Jannel M. Phillips
- Division of Developmental and Behavioral Pediatrics – Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio,University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Holly Barnard
- Division of Developmental and Behavioral Pediatrics – Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio,University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - David D. Limbrick
- Department of Neurological Surgery, Saint Louis, MO,Washington University School of Medicine, Saint Louis, MO
| | - Scott K. Holland
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio,University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Blaise V. Jones
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio,University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Jonathon Dodd
- Department of Neurology, Saint Louis, MO,Washington University School of Medicine, Saint Louis, MO,Department of Psychology, St. Louis Children’s Hospital, St. Louis, MO
| | - Sarah Simpson
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Mercer Deanna
- Department of Neurological Surgery, Saint Louis, MO,Washington University School of Medicine, Saint Louis, MO
| | | | - Sarah Bidwell
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Weihong Yuan
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio,University of Cincinnati College of Medicine, Cincinnati, Ohio
| |
Collapse
|
23
|
Aojula A, Botfield H, McAllister JP, Gonzalez AM, Abdullah O, Logan A, Sinclair A. Diffusion tensor imaging with direct cytopathological validation: characterisation of decorin treatment in experimental juvenile communicating hydrocephalus. Fluids Barriers CNS 2016; 13:9. [PMID: 27246837 PMCID: PMC4888658 DOI: 10.1186/s12987-016-0033-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 05/20/2016] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND In an effort to develop novel treatments for communicating hydrocephalus, we have shown previously that the transforming growth factor-β antagonist, decorin, inhibits subarachnoid fibrosis mediated ventriculomegaly; however decorin's ability to prevent cerebral cytopathology in communicating hydrocephalus has not been fully examined. Furthermore, the capacity for diffusion tensor imaging to act as a proxy measure of cerebral pathology in multiple sclerosis and spinal cord injury has recently been demonstrated. However, the use of diffusion tensor imaging to investigate cytopathological changes in communicating hydrocephalus is yet to occur. Hence, this study aimed to determine whether decorin treatment influences alterations in diffusion tensor imaging parameters and cytopathology in experimental communicating hydrocephalus. Moreover, the study also explored whether diffusion tensor imaging parameters correlate with cellular pathology in communicating hydrocephalus. METHODS Accordingly, communicating hydrocephalus was induced by injecting kaolin into the basal cisterns in 3-week old rats followed immediately by 14 days of continuous intraventricular delivery of either human recombinant decorin (n = 5) or vehicle (n = 6). Four rats remained as intact controls and a further four rats served as kaolin only controls. At 14-days post-kaolin, just prior to sacrifice, routine magnetic resonance imaging and magnetic resonance diffusion tensor imaging was conducted and the mean diffusivity, fractional anisotropy, radial and axial diffusivity of seven cerebral regions were assessed by voxel-based analysis in the corpus callosum, periventricular white matter, caudal internal capsule, CA1 hippocampus, and outer and inner parietal cortex. Myelin integrity, gliosis and aquaporin-4 levels were evaluated by post-mortem immunohistochemistry in the CA3 hippocampus and in the caudal brain of the same cerebral structures analysed by diffusion tensor imaging. RESULTS Decorin significantly decreased myelin damage in the caudal internal capsule and prevented caudal periventricular white matter oedema and astrogliosis. Furthermore, decorin treatment prevented the increase in caudal periventricular white matter mean diffusivity (p = 0.032) as well as caudal corpus callosum axial diffusivity (p = 0.004) and radial diffusivity (p = 0.034). Furthermore, diffusion tensor imaging parameters correlated primarily with periventricular white matter astrocyte and aquaporin-4 levels. CONCLUSIONS Overall, these findings suggest that decorin has the therapeutic potential to reduce white matter cytopathology in hydrocephalus. Moreover, diffusion tensor imaging is a useful tool to provide surrogate measures of periventricular white matter pathology in communicating hydrocephalus.
Collapse
Affiliation(s)
- Anuriti Aojula
- />Institute of Metabolism and Systems Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
- />Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, B15 2TH UK
- />Neurotrauma, College of Medicine and Dentistry, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - Hannah Botfield
- />Institute of Metabolism and Systems Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
- />Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, B15 2TH UK
- />Neurotrauma, College of Medicine and Dentistry, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - James Patterson McAllister
- />Department of Neurosurgery, Division of Pediatric Neurosurgery at the Washington University School of Medicine and the Saint Louis Children’s Hospital, St. Louis, MO 63110 USA
| | - Ana Maria Gonzalez
- />Institute of Metabolism and Systems Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
- />Neurotrauma, College of Medicine and Dentistry, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - Osama Abdullah
- />Department of Bioengineering, University of Utah, Salt Lake City, UT 84112 USA
| | - Ann Logan
- />Department of Bioengineering, University of Utah, Salt Lake City, UT 84112 USA
- />Neurotrauma, College of Medicine and Dentistry, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - Alexandra Sinclair
- />Institute of Metabolism and Systems Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
- />Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, B15 2TH UK
- />Neurotrauma, College of Medicine and Dentistry, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
- />Department of Neurology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2TH UK
| |
Collapse
|
24
|
Poretti A, Boltshauser E, Huisman TA. Chiari Malformations and Syringohydromyelia in Children. Semin Ultrasound CT MR 2016; 37:129-42. [DOI: 10.1053/j.sult.2015.12.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
|
25
|
Li Y, Zhao C, Tan Z, Wang Y, Zhang H, Wang J, Guo H, Zeng B, Huang W. Longitudinal Changes in the Brain Following Third Ventriculostomy in a Child With Hydrocephalus: A Case Report. Medicine (Baltimore) 2015; 94:e2095. [PMID: 26632724 PMCID: PMC5058993 DOI: 10.1097/md.0000000000002095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The goal of this study was to detect the long-term effect of shunting on the integrity of white matter in young children with hydrocephalus.The authors reported the case of a 6-month-old boy with hydrocephalus who was evaluated by diffusion tensor imaging (DTI) before and after a shunt operation.When compared with normal children, the structures of the corpus callosum, internal capsule, and corona radiata in the patient showed a decrease in fractional anisotropy and an increase in radial diffusivity values before the shunt operation. Following successful cerebrospinal fluid shunting, long-term follow-up DTI demonstrated a trend toward normalization of the fractional anisotropy and radial diffusivity values.Shunt treatment can prevent further damage to the brain and grossly reconstitute the distorted anatomy. DTI could be a useful tool in detecting longitudinal changes after a shunt operation. Further studies involving larger case numbers are needed to detect the long-term effect of shunting on the brains of children with hydrocephalus.
Collapse
Affiliation(s)
- Yongxin Li
- From the Institute of Clinical Anatomy, Southern Medical University, Guangzhou (YL, YW, JW, HG, BZ, WH); Department of Pediatric Radiology, Shenzhen Children Hospital (CZ); Department of Pediatric Neurosurgery, Shenzhen Children Hospital (ZT); and Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China (HZ)
| | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Sato T, Maruyama N, Hoshida T, Minato K. Correlation between diffusion tensor tractography and proton MR spectroscopy in normal controls. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2015; 2013:515-8. [PMID: 24109737 DOI: 10.1109/embc.2013.6609550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Tractography is a procedure that can track and demonstrate the 3D neural tracts of the white matter of the brain. The images of the brain are obtained by analyzing the diffusion tensor, identification of which can provide the anatomical connections of the brain. Studying these connections is integral to the understanding of the brain function. Specifically, the uncinate fasciculus and fornix, which are the white matter in the human brain, are said to be related to cognitive function. The tractography is calculated using diffusion tensor imaging (DTI) parameter. Studies have shown that the DTI parameter of dementia patients is lower than that of healthy individuals. It is also suggested that the DTI parameter of healthy individuals decreases with age. In addition, Proton MR Spectroscopy ((1)H-MRS) is indicative of neuronal damage and has been used for decades as a noninvasive technique for assessing the biochemistry of the human brain. This is reflected by the increasing number of clinical MRS investigations of neurological disorders. Thus, MRS and DTI can provide complementary images on white matter in brain and it is important to investigate the white matter brain changes by simultaneously acquiring DTI and MRS in health control subjects. In this research, we have calculated the correlation coefficient between the DTI parameter of uncinate fasciculus, fornix and (1)H-MRS. Our result shows that the correlation coefficient of DTI parameter and (1)H-MRS of a left fornix is 0.65 at the maximum. Correlation between DTI measurement and (1)H-MRS suggests the relationships between the uncinate fasciculus, fornix and cognitive neuronal function. Our finding matches previous reports on the correlation between DTI parameters and (1)H-MRS.
Collapse
|
27
|
Dennis M, Cirino PT, Simic N, Juranek J, Taylor WP, Fletcher JM. White and grey matter relations to simple, choice, and cognitive reaction time in spina bifida. Brain Imaging Behav 2015; 10:238-51. [DOI: 10.1007/s11682-015-9388-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
28
|
Abstract
Spina bifida is a birth defect in which the vertebral column is open, often with spinal cord involvement. The most clinically significant subtype is myelomeningocele (open spina bifida), which is a condition characterized by failure of the lumbosacral spinal neural tube to close during embryonic development. The exposed neural tissue degenerates in utero, resulting in neurological deficit that varies with the level of the lesion. Occurring in approximately 1 per 1,000 births worldwide, myelomeningocele is one of the most common congenital malformations, but its cause is largely unknown. The genetic component is estimated at 60-70%, but few causative genes have been identified to date, despite much information from mouse models. Non-genetic maternal risk factors include reduced folate intake, anticonvulsant therapy, diabetes mellitus and obesity. Primary prevention by periconceptional supplementation with folic acid has been demonstrated in clinical trials, leading to food fortification programmes in many countries. Prenatal diagnosis is achieved by ultrasonography, enabling women to seek termination of pregnancy. Individuals who survive to birth have their lesions closed surgically, with subsequent management of associated defects, including the Chiari II brain malformation, hydrocephalus, and urological and orthopaedic sequelae. Fetal surgical repair of myelomeningocele has been associated with improved early neurological outcome compared with postnatal operation. Myelomeningocele affects quality of life during childhood, adolescence and adulthood, posing a challenge for individuals, families and society as a whole. For an illustrated summary of this Primer, visit: http://go.nature.com/fK9XNa.
Collapse
|
29
|
Abnormal structural connectivity in the brain networks of children with hydrocephalus. NEUROIMAGE-CLINICAL 2015; 8:483-92. [PMID: 26106573 PMCID: PMC4474092 DOI: 10.1016/j.nicl.2015.04.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 03/18/2015] [Accepted: 04/26/2015] [Indexed: 12/21/2022]
Abstract
Increased intracranial pressure and ventriculomegaly in children with hydrocephalus are known to have adverse effects on white matter structure. This study seeks to investigate the impact of hydrocephalus on topological features of brain networks in children. The goal was to investigate structural network connectivity, at both global and regional levels, in the brains in children with hydrocephalus using graph theory analysis and diffusion tensor tractography. Three groups of children were included in the study (29 normally developing controls, 9 preoperative hydrocephalus patients, and 17 postoperative hydrocephalus patients). Graph theory analysis was applied to calculate the global network measures including small-worldness, normalized clustering coefficients, normalized characteristic path length, global efficiency, and modularity. Abnormalities in regional network parameters, including nodal degree, local efficiency, clustering coefficient, and betweenness centrality, were also compared between the two patients groups (separately) and the controls using two tailed t-test at significance level of p < 0.05 (corrected for multiple comparison). Children with hydrocephalus in both the preoperative and postoperative groups were found to have significantly lower small-worldness and lower normalized clustering coefficient than controls. Children with hydrocephalus in the postoperative group were also found to have significantly lower normalized characteristic path length and lower modularity. At regional level, significant group differences (or differences at trend level) in regional network measures were found between hydrocephalus patients and the controls in a series of brain regions including the medial occipital gyrus, medial frontal gyrus, thalamus, cingulate gyrus, lingual gyrus, rectal gyrus, caudate, cuneus, and insular. Our data showed that structural connectivity analysis using graph theory and diffusion tensor tractography is sensitive to detect abnormalities of brain network connectivity associated with hydrocephalus at both global and regional levels, thus providing a new avenue for potential diagnosis and prognosis tool for children with hydrocephalus.
Collapse
|
30
|
Dennis M, Spiegler BJ, Simic N, Sinopoli KJ, Wilkinson A, Yeates KO, Taylor HG, Bigler ED, Fletcher JM. Functional plasticity in childhood brain disorders: when, what, how, and whom to assess. Neuropsychol Rev 2014; 24:389-408. [PMID: 24821533 PMCID: PMC4231018 DOI: 10.1007/s11065-014-9261-x] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Accepted: 04/17/2014] [Indexed: 12/29/2022]
Abstract
At every point in the lifespan, the brain balances malleable processes representing neural plasticity that promote change with homeostatic processes that promote stability. Whether a child develops typically or with brain injury, his or her neural and behavioral outcome is constructed through transactions between plastic and homeostatic processes and the environment. In clinical research with children in whom the developing brain has been malformed or injured, behavioral outcomes provide an index of the result of plasticity, homeostasis, and environmental transactions. When should we assess outcome in relation to age at brain insult, time since brain insult, and age of the child at testing? What should we measure? Functions involving reacting to the past and predicting the future, as well as social-affective skills, are important. How should we assess outcome? Information from performance variability, direct measures and informants, overt and covert measures, and laboratory and ecological measures should be considered. In whom are we assessing outcome? Assessment should be cognizant of individual differences in gene, socio-economic status (SES), parenting, nutrition, and interpersonal supports, which are moderators that interact with other factors influencing functional outcome.
Collapse
Affiliation(s)
- Maureen Dennis
- Department of Psychology, Program in Neurosciences and Mental Health, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada,
| | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Ware AL, Juranek J, Williams VJ, Cirino PT, Dennis M, Fletcher JM. Anatomical and diffusion MRI of deep gray matter in pediatric spina bifida. NEUROIMAGE-CLINICAL 2014; 5:120-7. [PMID: 25057465 PMCID: PMC4097001 DOI: 10.1016/j.nicl.2014.05.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 05/15/2014] [Accepted: 05/20/2014] [Indexed: 01/10/2023]
Abstract
Individuals with spina bifida myelomeningocele (SBM) exhibit brain abnormalities in cortical thickness, white matter integrity, and cerebellar structure. Little is known about deep gray matter macro- and microstructure in this population. The current study utilized volumetric and diffusion-weighted MRI techniques to examine gray matter volume and microstructure in several subcortical structures: basal ganglia nuclei, thalamus, hippocampus, and amygdala. Sixty-six children and adolescents (ages 8–18; M = 12.0, SD = 2.73) with SBM and typically developing (TD) controls underwent T1- and diffusion-weighted neuroimaging. Microstructural results indicated that hippocampal volume was disproportionately reduced, whereas the putamen volume was enlarged in the group with SBM. Microstructural analyses indicated increased mean diffusivity (MD) and fractional anisotropy (FA) in the gray matter of most examined structures (i.e., thalamus, caudate, hippocampus), with the putamen exhibiting a unique pattern of decreased MD and increased FA. These results provide further support that SBM differentially disrupts brain regions whereby some structures are volumetrically normal whereas others are reduced or enlarged. In the hippocampus, volumetric reduction coupled with increased MD may imply reduced cellular density and aberrant organization. Alternatively, the enlarged volume and significantly reduced MD in the putamen suggest increased density. Spina bifida resulted in reduced hippocampal and enlarged putamen volumes. Spina bifida resulted in reduced MD and increased FA in the putamen. Periventricular regions were differentiated by increased MD and FA in spina bifida. Spina bifida resulted in greater FA for all regions, except the hippocampus.
Collapse
Affiliation(s)
- Ashley L Ware
- Department of Psychology, Texas Institute for Measurements, Evaluation and Statistics, University of Houston, 8201 Cullen St., Houston, TX 77204-6602, USA
| | - Jenifer Juranek
- Department of Pediatrics, Children's Learning Institute BRAIN Lab, University of Texas Health Science Center at Houston, 6655 Travis Street Suite 1000, Houston, TX 77030, USA
| | - Victoria J Williams
- Department of Psychology, Texas Institute for Measurements, Evaluation and Statistics, University of Houston, 8201 Cullen St., Houston, TX 77204-6602, USA
| | - Paul T Cirino
- Department of Psychology, Texas Institute for Measurements, Evaluation and Statistics, University of Houston, 8201 Cullen St., Houston, TX 77204-6602, USA
| | - Maureen Dennis
- Program in Neurosciences and Mental Health, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Canada
| | - Jack M Fletcher
- Department of Psychology, Texas Institute for Measurements, Evaluation and Statistics, University of Houston, 8201 Cullen St., Houston, TX 77204-6602, USA
| |
Collapse
|
32
|
Haase VG, Nicolau NC, Viana VN, Barreto GDV, Pinto JA. Executive function and processing speed in Brazilian HIV-infected children and adolescents. Dement Neuropsychol 2014; 8:32-39. [PMID: 29213877 PMCID: PMC5619446 DOI: 10.1590/s1980-57642014dn81000006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Cognitive disorders in infants and children who are vertically infected with human immunodeficiency virus (HIV) have been recognized since the inception of the epidemic. Objective The present study investigated neuropsychological performance in a cohort of vertically infected Brazilian children and adolescents who underwent antiretroviral therapy. The neuropsychological tasks were designed to evaluate executive function and processing speed. Methods Children and adolescents were recruited at a major research and treatment reference center for human immunodeficiency virus/acquired immunodeficiency syndrome (HIV) in Minas Gerais, Brazil. Forty-one individuals aged 5 to 17 years were enrolled. Twelve were mildly symptomatic (HIV-infected group, Centers for Disease Control and Prevention [CDC] class A or B), and 29 had advanced clinical disease (AIDS group, CDC class C). Results The results showed that HIV-infected children and adolescents exhibited lower performance on neuropsychological tasks than sociodemographically comparable, typically developing controls. Motor and cognitive processing speed and executive function appeared to be the most discriminative domains. Conclusion HIV-infected individuals with more-advanced disease stages exhibited lower performance levels and had greater performance heterogeneity on neuropsychological tasks. Thus, the observed neuropsychological impairments, although more pronounced in participants with more advanced stages of the disease, did not correlate with the variable used (CDC stage).
Collapse
Affiliation(s)
- Vitor Geraldi Haase
- Faculdade de Filosofia e Ciências Humanas - Universidade Federal de Minas Gerais, Minas Gerais, Brasil
| | - Nelsa Carol Nicolau
- Faculdade de Medicina, Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Universidade Federal de Minas Gerais, Brasil
| | - Virgínia Nunes Viana
- Instituto de Ciências Biológicas - Pós-Graduação em Neurociências, Universidade Federal de Minas Gerais, Brasil
| | - Gustavo de Val Barreto
- Instituto de Ciências Biológicas - Pós-Graduação em Neurociências, Universidade Federal de Minas Gerais, Brasil.,Centro Universitário UNA
| | - Jorge Andrade Pinto
- Faculdade de Medicina, Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Universidade Federal de Minas Gerais, Brasil
| |
Collapse
|
33
|
Dennis M, Spiegler BJ, Juranek JJ, Bigler ED, Snead OC, Fletcher JM. Age, plasticity, and homeostasis in childhood brain disorders. Neurosci Biobehav Rev 2013; 37:2760-73. [PMID: 24096190 PMCID: PMC3859812 DOI: 10.1016/j.neubiorev.2013.09.010] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Revised: 07/29/2013] [Accepted: 09/19/2013] [Indexed: 12/26/2022]
Abstract
It has been widely accepted that the younger the age and/or immaturity of the organism, the greater the brain plasticity, the young age plasticity privilege. This paper examines the relation of a young age to plasticity, reviewing human pediatric brain disorders, as well as selected animal models, human developmental and adult brain disorder studies. As well, we review developmental and childhood acquired disorders that involve a failure of regulatory homeostasis. Our core arguments are as follows:
Collapse
Affiliation(s)
- Maureen Dennis
- Program in Neurosciences and Mental Health, The Hospital for Sick Children, Toronto Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, ON M5G 1X8, Canada.
| | | | | | | | | | | |
Collapse
|
34
|
Sato T, Maruyama N, Hoshida T, Minato K. Correlation between uncinate fasciculus and memory tasks in healthy individual using diffusion tensor tractography. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2013; 2012:424-7. [PMID: 23365919 DOI: 10.1109/embc.2012.6345958] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Tractography is a procedure that can track and demonstrate the 3D neural tracts of the white matter of the brain. The images of the brain are obtained by analyzing the diffusion tensor, identification of which can provide the anatomical connections of the brain. Studying these connections is integral to the understanding of the brain function. Specifically, the uncinate fasciculus (UF), which is the white matter in the human brain, is said to be related to cognitive function. The UF tractography is calculated using diffusion tensor imaging (DTI) parameter. Studies have shown that the DTI parameter of dementia patients is lower than that of healthy individuals. It is also suggested that the DTI parameter of healthy individuals decreases with age. In addition, the WMS-R score, which is indicative of general memory, verbal memory and other cognitive functions, of the elderly are lower than of the young. However, there is no report yet that has holistically investigated DTI parameter and the memory functions. Thus, in this research, we have calculated the correlation coefficient between the DTI parameter of UF and WMS-R score. Our result shows that the correlation coefficient of diffusivity of the fiber direction and visual memory of a left UF is -0.226 at the maximum. Correlation between DTI measurement and memory performance suggests the relationships between the UF and function in memory tasks lateralization. Our finding matches previous reports on the correlation between FA in the left, or L1 in the right UF, and performance on visual memory.
Collapse
Affiliation(s)
- T Sato
- Nara Institute of Science and Technology, Ikoma, Nara 6300192, Japan.
| | | | | | | |
Collapse
|
35
|
Mignone Philpott C, Shannon P, Chitayat D, Ryan G, Raybaud CA, Blaser SI. Diffusion-weighted imaging of the cerebellum in the fetus with Chiari II malformation. AJNR Am J Neuroradiol 2013; 34:1656-60. [PMID: 23721901 DOI: 10.3174/ajnr.a3468] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Diffusion-weighted imaging can be used to characterize brain maturation. MR imaging of the fetus is used in cases of suspected Chiari II malformation when further evaluation of the posterior fossa is required. We sought to investigate whether there were any quantitative ADC abnormalities of the cerebellum in fetuses with this malformation. MATERIALS AND METHODS Measurements from ROIs acquired in each cerebellar hemisphere and the pons were obtained from calculated ADC maps performed on our Avanto 1.5T imaging system. Values in groups of patients with Chiari II malformations were compared with those from fetuses with structurally normal brains, allowing for the dependent variable of GA by using linear regression analysis. RESULTS There were 8 fetuses with Chiari II malformations and 23 healthy fetuses, ranging from 20 to 31 GW. There was a significant linear decline in the cerebellar ADC values with advancing gestation in our healthy fetus group, as expected. The ADC values of the cerebellum of fetuses with Chiari II malformation were higher [1820 (±100) × 10⁻⁶ mm²/s] than ADC values in the healthy fetuses (1370 ± 70) × 10⁻⁶ mm²/s. This was statistically significant, even when allowing for the dependent variable of GA (P = .0126). There was no significant difference between the pons ADC values in these groups (P = .645). CONCLUSIONS While abnormal white matter organization or early cerebellar degeneration could potentially contribute to our findings, the most plausible explanation pertains to abnormalities of CSF drainage in the posterior fossa, with increased extracellular water possibly accounting for this phenomenon.
Collapse
Affiliation(s)
- C Mignone Philpott
- Division of Neuroradiology, Department of Diagnostic Imaging, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
| | | | | | | | | | | |
Collapse
|
36
|
Jang SH, Choi BY, Chang CH, Jung YJ, Byun WM, Kim SH, Yeo SS. The effects of hydrocephalus on the periventricular white matter in intracerebral hemorrhage: a diffuser tensor imaging study. Int J Neurosci 2013; 123:420-4. [DOI: 10.3109/00207454.2012.763164] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
37
|
Yuan W, McKinstry RC, Shimony JS, Altaye M, Powell SK, Phillips JM, Limbrick DD, Holland SK, Jones BV, Rajagopal A, Simpson S, Mercer D, Mangano FT. Diffusion tensor imaging properties and neurobehavioral outcomes in children with hydrocephalus. AJNR Am J Neuroradiol 2013; 34:439-45. [PMID: 22899790 DOI: 10.3174/ajnr.a3218] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE White matter structural alterations and the correlation with neuropsychological deficits in children with hydrocephalus have not been well investigated. In this prospective study, the objectives were the following: 1) to apply DTI to detect in vivo white matter alterations based on diffusion properties in children with acute hydrocephalus, 2) to quantify early neuropsychological deficits, and 3) to explore the correlation between potential neuropsychological deficits and abnormalities in functionally related white matter. MATERIALS AND METHODS A total of 44 children, 24 with hydrocephalus and 20 controls, were enrolled in the study. DTI indices, FA, MD, AD, and RD, were evaluated in the gCC, sCC, PLIC, and ALIC. The ABAS-II was used as a broad screener of development, including conceptual, social, practical, and motor skills. The correlation between the Motor Scale and DTI indices in the PLIC was analyzed. RESULTS DTI analyses showed that the gCC and sCC in children with hydrocephalus had lower FA and higher MD, driven by the increased RD with statistical significance (P < .05) or trend-level significance (P = .06). The PLIC and ALIC had significantly higher AD in children with hydrocephalus (P < .05). On the ABAS-II, parent ratings of general adaptive skills, conceptual skills, and motor skills were significantly lower in children with hydrocephalus (all at P < .05). The MD and RD values in the PLIC were found to have trend-level or significant correlation with the Motor Scale (P = .057, .041, respectively). CONCLUSIONS DTI reveals alterations in the white matter structure in children with hydrocephalus with preliminary findings suggesting correlation with clinical motor deficits.
Collapse
Affiliation(s)
- W Yuan
- Department of Radiology, Cincinnati Children's Hospital Medical center, Cincinnati, Ohio, USA
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Poretti A, Meoded A, Rossi A, Raybaud C, Huisman TAGM. Diffusion tensor imaging and fiber tractography in brain malformations. Pediatr Radiol 2013; 43:28-54. [PMID: 23288476 DOI: 10.1007/s00247-012-2428-9] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Accepted: 04/09/2012] [Indexed: 01/19/2023]
Abstract
Diffusion tensor imaging (DTI) is an advanced MR technique that provides qualitative and quantitative information about the micro-architecture of white matter. DTI and its post-processing tool fiber tractography (FT) have been increasingly used in the last decade to investigate the microstructural neuroarchitecture of brain malformations. This article aims to review the use of DTI and FT in the evaluation of a variety of common, well-described brain malformations, in particular by pointing out the additional information that DTI and FT renders compared with conventional MR sequences. In addition, the relevant existing literature is summarized.
Collapse
Affiliation(s)
- Andrea Poretti
- Division of Pediatric Radiology, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, 600 N. Wolfe St., Nelson Basement, B-173, Baltimore, MD 21287-0842, USA
| | | | | | | | | |
Collapse
|
39
|
Contribution of the corticospinal tract to motor impairment in spina bifida. Pediatr Neurol 2012; 47:270-8. [PMID: 22964441 DOI: 10.1016/j.pediatrneurol.2012.06.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Accepted: 06/20/2012] [Indexed: 11/22/2022]
Abstract
We aimed to disentangle the proportional contributions of upper and lower motor neuron dysfunction to motor impairment in children with spina bifida. We enrolled 42 children (mean age, 11.2 years; standard deviation, 2.8 years) with spina bifida and 36 control children (mean age, 11.4 years; standard deviation, 2.6 years). Motor impairment was graded to severity scales in children with spina bifida. We recorded motor evoked potentials after transcranial and lumbosacral magnetic stimulation and compound muscle action potentials after electric nerve stimulation. Regarding lower motor neuron function, severely impaired children with spina bifida demonstrated smaller compound muscle action potential areas and lumbosacral motor evoked potential areas than control children; mildly impaired children hardly differed from control children. Compound muscle action potential latencies and lumbosacral motor evoked potential latencies did not differ between children with spina bifida and control children. Regarding upper motor neuron function, children with spina bifida demonstrated smaller transcranial motor evoked potential areas and longer central motor conduction times than control children. The smallest motor evoked potential areas and longest central motor conduction times were observed in severely impaired children. In children with spina bifida, the contribution of upper motor neuron dysfunction to motor impairment is more considerable than expected from clinical neurologic examination.
Collapse
|
40
|
Scheel M, Diekhoff T, Sprung C, Hoffmann KT. Diffusion tensor imaging in hydrocephalus--findings before and after shunt surgery. Acta Neurochir (Wien) 2012; 154:1699-706. [PMID: 22610531 DOI: 10.1007/s00701-012-1377-2] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Accepted: 05/01/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND To evaluate changes in diffusion tensor imaging (DTI)-derived parameters in patients with hydrocephalus (HC) before and several weeks after shunt surgery. METHODS Thirteen HC patients were examined with DTI before and after shunt surgery. In a combined region of interest and whole brain voxel-based analysis, different DTI parameters were compared with an age-matched control group. RESULTS Alteration of DTI parameters in HC patients and changes after shunt surgery are regionally different. HC patients show an increase in fractional anisotropy values based on increases in parallel diffusivity in the corticospinal tract. On the other hand, reduced fractional anisotropy values are found in the corpus callosum of HC patients. Following shunt surgery, all DTI parameters showed a trend towards normalization, yet differences to healthy control subjects remained. CONCLUSION Our results show that DTI parameter changes are regionally dependent and need a careful interpretation of the underlying diffusivities to serve as a diagnostic or follow-up measure in patients with hydrocephalus.
Collapse
Affiliation(s)
- Michael Scheel
- Department of Neuroradiology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | | | | | | |
Collapse
|
41
|
Treble A, Juranek J, Stuebing KK, Dennis M, Fletcher JM. Functional significance of atypical cortical organization in spina bifida myelomeningocele: relations of cortical thickness and gyrification with IQ and fine motor dexterity. Cereb Cortex 2012; 23:2357-69. [PMID: 22875857 DOI: 10.1093/cercor/bhs226] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The cortex in spina bifida myelomeningocele (SBM) is atypically organized, but it is not known how specific features of atypical cortical organization promote or disrupt cognitive and motor function. Relations of deviant cortical thickness and gyrification with IQ and fine motor dexterity were investigated in 64 individuals with SBM and 26 typically developing (TD) individuals, aged 8-28 years. Cortical thickness and 3D local gyrification index (LGI) were quantified from 33 cortical regions per hemisphere using FreeSurfer. Results replicated previous findings, showing regions of higher and lower cortical thickness and LGI in SBM relative to the TD comparison individuals. Cortical thickness and LGI were negatively associated in most cortical regions, though less consistently in the TD group. Whereas cortical thickness and LGI tended to be negatively associated with IQ and fine motor outcomes in regions that were thicker or more gyrified in SBM, associations tended to be positive in regions that were thinner or less gyrified in SBM. The more deviant the levels of cortical thickness and LGI-whether higher or lower relative to the TD group-the more impaired the IQ and fine motor outcomes, suggesting that these cortical atypicalities in SBM are functionally maladaptive, rather than adaptive.
Collapse
Affiliation(s)
- Amery Treble
- Department of Psychology, University of Houston, Houston, TX, USA
| | | | | | | | | |
Collapse
|
42
|
Buckley RT, Yuan W, Mangano FT, Phillips JM, Powell S, McKinstry R, Rajagopal A, Jones BV, Holland S, Limbrick DD. Longitudinal comparison of diffusion tensor imaging parameters and neuropsychological measures following endoscopic third ventriculostomy for hydrocephalus. J Neurosurg Pediatr 2012; 9:630-5. [PMID: 22656255 PMCID: PMC4558885 DOI: 10.3171/2012.2.peds11331] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The authors report the case of a 25-month-old boy who underwent endoscopic third ventriculostomy (ETV) for hydrocephalus resulting from aqueductal stenosis. The patient's recovery was monitored longitudinally and prospectively using MR diffusion tensor imaging (DTI) and formal neuropsychological testing. Despite minimal change in ventricle size, improvement in the DTI characteristics and neurodevelopmental trajectory was observed following ETV. These data support the use of DTI as a biomarker to assess therapeutic response in children undergoing surgical treatment for hydrocephalus. In the patient featured in this report, DTI appeared to provide more information regarding postoperative neurodevelopmental outcome than ventricle size alone.
Collapse
Affiliation(s)
- Robert T. Buckley
- Department of Neurological Surgery, St. Louis Children’s Hospital, Washington University School of Medicine, St. Louis, MO
| | - Weihong Yuan
- Department of Radiology, Cincinnati Children’s Hospital, Cincinnati, OH
| | - Francesco T. Mangano
- Department of Neurological Surgery, Cincinnati Children’s Hospital, Cincinnati, OH,Department of Pediatrics, Cincinnati Children’s Hospital, Cincinnati, OH
| | | | - Stephanie Powell
- Department of Psychology, St. Louis Children’s Hospital, Washington University School of Medicine, St. Louis, MO
| | - Robert McKinstry
- Department of Radiology, St. Louis Children’s Hospital, Washington University School of Medicine, St. Louis, MO
| | - Akala Rajagopal
- Department of Psychology, Cincinnati Children’s Hospital, Cincinnati, OH
| | - Blaise V. Jones
- Department of Psychology, Cincinnati Children’s Hospital, Cincinnati, OH
| | - Scott Holland
- Department of Psychology, Cincinnati Children’s Hospital, Cincinnati, OH
| | - David D. Limbrick
- Department of Neurological Surgery, St. Louis Children’s Hospital, Washington University School of Medicine, St. Louis, MO,Department of Pediatrics, St. Louis Children’s Hospital, Washington University School of Medicine, St. Louis, MO
| |
Collapse
|
43
|
Awad RA. Neurogenic bowel dysfunction in patients with spinal cord injury, myelomeningocele, multiple sclerosis and Parkinson’s disease. World J Gastroenterol 2011; 17:5035-48. [PMID: 22171138 PMCID: PMC3235587 DOI: 10.3748/wjg.v17.i46.5035] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2011] [Revised: 06/20/2011] [Accepted: 06/27/2011] [Indexed: 02/06/2023] Open
Abstract
Exciting new features have been described concerning neurogenic bowel dysfunction, including interactions between the central nervous system, the enteric nervous system, axonal injury, neuronal loss, neurotransmission of noxious and non-noxious stimuli, and the fields of gastroenterology and neurology. Patients with spinal cord injury, myelomeningocele, multiple sclerosis and Parkinson’s disease present with serious upper and lower bowel dysfunctions characterized by constipation, incontinence, gastrointestinal motor dysfunction and altered visceral sensitivity. Spinal cord injury is associated with severe autonomic dysfunction, and bowel dysfunction is a major physical and psychological burden for these patients. An adult myelomeningocele patient commonly has multiple problems reflecting the multisystemic nature of the disease. Multiple sclerosis is a neurodegenerative disorder in which axonal injury, neuronal loss, and atrophy of the central nervous system can lead to permanent neurological damage and clinical disability. Parkinson's disease is a multisystem disorder involving dopaminergic, noradrenergic, serotoninergic and cholinergic systems, characterized by motor and non-motor symptoms. Parkinson's disease affects several neuronal structures outside the substantia nigra, among which is the enteric nervous system. Recent reports have shown that the lesions in the enteric nervous system occur in very early stages of the disease, even before the involvement of the central nervous system. This has led to the postulation that the enteric nervous system could be critical in the pathophysiology of Parkinson's disease, as it could represent the point of entry for a putative environmental factor to initiate the pathological process. This review covers the data related to the etiology, epidemiology, clinical expression, pathophysiology, genetic aspects, gastrointestinal motor dysfunction, visceral sensitivity, management, prevention and prognosis of neurogenic bowel dysfunction patients with these neurological diseases. Embryological, morphological and experimental studies on animal models and humans are also taken into account.
Collapse
|
44
|
Diffusion tensor imaging evaluation of white matter in adolescents with myelomeningocele and Chiari II malformation. Pediatr Radiol 2011; 41:1407-15. [PMID: 21725712 DOI: 10.1007/s00247-011-2180-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2011] [Revised: 05/19/2011] [Accepted: 05/25/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Macrostructural abnormalities in cerebral white matter in patients with myelomeningocele are well known, but microstructural abnormalities are not as well studied. OBJECTIVE The aim of this study was to evaluate cerebral white matter in adolescents with myelomeningocele using diffusion tensor imaging (DTI), and to investigate the effects of ventricular dilation and CSF shunt presence on white matter microstructure in these patients. MATERIALS AND METHODS DTI and T1-weighted 3-D (T1-3-D) MRI were performed on nine adolescents with myelomeningocele and Chiari II malformation and nine age-matched controls. The fractional anisotropy (FA) and mean diffusivity (MD) values were measured and compared. RESULTS Significantly decreased FA and increased MD values were observed in most white matter regions and fibers in adolescents with myelomeningocele compared to controls. Further analysis in patients revealed significant changes in DTI parameters in hemispheres with enlarged lateral ventricles compared to those with normal ventricle size. In addition, a significant difference in FA values in the posterior limb of the internal capsule was found in the comparison of hemispheres in patients with or without CSF shunt catheters. CONCLUSION This study revealed widespread microstructural abnormalities in white matter in adolescents with myelomeningocele and Chiari II malformation. Ventricular dilation may have additional effects on white matter microstructure in this patient population. CSF shunt diversion effects on white matter may be multifactorial and need further investigation.
Collapse
|
45
|
Kumar R, Nguyen HD, Macey PM, Woo MA, Harper RM. Regional brain axial and radial diffusivity changes during development. J Neurosci Res 2011; 90:346-55. [PMID: 21938736 DOI: 10.1002/jnr.22757] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Revised: 06/20/2011] [Accepted: 07/01/2011] [Indexed: 01/08/2023]
Abstract
The developing human brain shows rapid myelination and axonal changes during childhood, adolescence, and early adulthood, requiring successive evaluations to determine normative values for potential pathological assessment. Fiber characteristics can be examined by axial and radial diffusivity procedures, which measure water diffusion parallel and perpendicular to axons and show primarily axonal status and myelin changes, respectively. Such measures are lacking from widespread sites for the developing brain. Diffusion tensor imaging data were acquired from 30 healthy subjects (age 17.7 ± 4.6 years, range 8-24 years, body mass index 21.5 ± 4.5 kg/m(2), 18 males) using a 3.0-Tesla MRI scanner. Diffusion tensors were calculated, principal eigenvalues determined, and axial and radial diffusivity maps calculated and normalized to a common space. A set of regions of interest was outlined from widespread brain areas within rostral, thalamic, hypothalamic, cerebellar, and pontine regions, and average diffusivity values were calculated using normalized diffusivity maps and these regions of interest masks. Age-related changes were assessed with Pearson's correlations, and gender differences evaluated with Student's t-tests. Axial and radial diffusivity values declined with age in the majority of brain areas, except for midhippocampus, where axial diffusivity values correlated positively with age. Gender differences emerged within putamen, thalamic, hypothalamic, cerebellar, limbic, temporal, and other cortical sites. Documentation of normal axial and radial diffusivity values will help assess disease-related tissue changes. Axial and radial diffusivities change with age,with fiber structure and organization differing between sexes in several brain areas. The findings may underlie gender-based functional characteristics, and mandate partitioning age- and gender-related changes during developmental brain pathology evaluation.
Collapse
Affiliation(s)
- Rajesh Kumar
- Department of Neurobiology, David Geffen School of Medicine at UCLA, University of California at Los Angeles, Los Angeles, California 90095-1763, USA
| | | | | | | | | |
Collapse
|
46
|
Simos PG, Papanicolaou AC, Castillo EM, Juranek J, Cirino PT, Rezaie R, Fletcher JM. Brain mechanisms for reading and language processing in spina bifida meningomyelocele: a combined magnetic source- and structural magnetic resonance imaging study. Neuropsychology 2011; 25:590-601. [PMID: 21574714 PMCID: PMC3175695 DOI: 10.1037/a0023694] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE The development of the ability to process spoken and written language depends upon a network of left hemisphere temporal, parietal, and frontal regions. The present study explored features of brain organization in children with spina bifida meningomyelocele (SBM) and shunted hydrocephalus, who commonly present with precocious development of word reading skills and preservation of vocabulary and grammar skills. METHOD Eight children with SBM were compared with 15 IQ and reading-level matched, typically developing controls on MRI-based morphometric and Magnetic Source Imaging-derived neurophysiological profiles. RESULTS Children with SBM showed reduced magnetic activity in left inferior parietal regions during spoken word recognition and pseudoword reading tasks. We also noted reduced surface area/volume in inferior parietal and posterior temporal regions in SBM and increased gray matter volumes in left middle frontal regions and gyral complexity in left posterior temporal and inferior parietal regions. CONCLUSIONS A complex pattern of changes in cortical morphology and activation may serve as evidence for structural and functional brain reorganization ensuring preservation of language and decoding abilities in children with SBM.
Collapse
|
47
|
Jang SH, Ho Kim S. Diffusion tensor imaging following shunt in a patient with hydrocephalus. J Neuroimaging 2011; 21:69-72. [PMID: 19555407 DOI: 10.1111/j.1552-6569.2009.00394.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
We report on a patient with hydrocephalus who was evaluated by diffusion tensor imaging (DTI) follow-up study before and after a shunt operation. A 48-year-old male patient and 6 age-matched control subjects were evaluated. The patient presented with hydrocephalus due to hemorrhage caused by the rupture of a right middle cerebral artery bifurcation aneurysm. Three longitudinal DTIs were acquired from the patient (pre-shunt, post-shunt 2 weeks, and post-shunt 8 weeks). The fractional anisotrophy values in the adjacent structures of the lateral ventricle, which were increased before the shunt operation, were decreased after the shunt operation. We think that DTI could be a useful tool for the evaluation of hydrocephalus.
Collapse
Affiliation(s)
- Sung Ho Jang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu, Korea
| | | |
Collapse
|
48
|
Cognitive functions correlate with diffusion tensor imaging metrics in patients with spina bifida cystica. Childs Nerv Syst 2011; 27:723-8. [PMID: 21080174 DOI: 10.1007/s00381-010-1329-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2010] [Accepted: 10/26/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE Spina bifida cystica (SBC) is a group of neurodevelopmental defects caused by improper neural tube closure, which may be responsible for deficits in cognitive functions. The purpose of this study was to examine changes in normal appearing deep gray and white matter brain regions in SBC patients compared with controls through diffusion tensor imaging (DTI) and correlate these changes with neuropsychometric tests. METHODS Conventional magnetic resonance imaging and neuropsychometric tests were performed on 13 patients and ten controls. DTI-derived fractional anisotropy (FA) and mean diffusivity (MD) were quantified in different brain regions in controls and patients. RESULTS Significantly decreased FA was observed in caudate nuclei, putamen, genu, splenium, and increased FA was found in middle cerebellar peduncle (MCP) in patients compared with controls. We observed significantly increased MD in genu and splenium. However, increased MD was found in fornix of patients compared with controls. Majority of neuropsychological tests were found to be significantly impaired and some of these showed significant correlation with DTI metrics in genu, splenium, and MCP in these patients. CONCLUSIONS We conclude that DTI metrics are significantly abnormal in deep gray matter nuclei, genu, splenium, and MCP in SBC patients and may provide microstructural basis for neuropsychological abnormalities in these patients.
Collapse
|
49
|
Abstract
Spina bifida meningomyelocele (SBM), a congenital neurodevelopmental disorder, involves dysmorphology of the cerebellum, and its most obvious manifestations are motor deficits. This paper reviews cerebellar neuropathology and motor function across several motor systems well studied in SBM in relation to current models of cerebellar motor and timing function. Children and adults with SBM have widespread motor deficits in trunk, upper limbs, eyes, and speech articulators that are broadly congruent with those observed in adults with cerebellar lesions. The structure and function of the cerebellum are correlated with a range of motor functions. While motor learning is generally preserved in SBM, those motor functions requiring predictive signals and precise calibration of the temporal features of movement are impaired, resulting in deficits in smooth movement coordination as well as in the classical cerebellar triad of dysmetria, ataxia, and dysarthria. That motor function in individuals with SBM is disordered in a manner phenotypically similar to that in adult cerebellar lesions, and appears to involve similar deficits in predictive cerebellar motor control, suggests that age-based cerebellar motor plasticity is limited in individuals with this neurodevelopmental disorder.
Collapse
|
50
|
Salman MS. Posterior fossa decompression and the cerebellum in Chiari type II malformation: a preliminary MRI study. Childs Nerv Syst 2011; 27:457-62. [PMID: 21221976 PMCID: PMC3074439 DOI: 10.1007/s00381-010-1359-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2010] [Accepted: 12/06/2010] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Chiari type II malformation (CII) is a congenital deformity of the hindbrain. The posterior fossa and cerebellum are small in CII. The cerebellar atrophy is associated with cognitive and motor deficits. Brainstem compression occurs in some patients with CII for whom posterior fossa decompression may be life saving. The aim was to determine whether posterior fossa decompression can prevent or reduce the cerebellar atrophy in CII. METHODS Cerebellar volumes and their tissue types (gray matter, white matter, and CSF volumes) from brain MRI were compared among four CII patients, aged 9.5 to 16.5 years, who had had posterior fossa decompression in infancy, 28 CII patients who had not had posterior fossa decompression, and ten age-matched normal controls. Parametric and non-parametric tests investigated group differences. RESULTS Compared to controls, mean cerebellar volume was significantly smaller in CII patients (p<0.0001). Mean CSF volume within the cerebellar fissures and fourth ventricle was significantly smaller in patients without posterior fossa decompression compared to the CII patients who had the decompression, p=0.043. Mean CSF volume of the latter group was similar to the controls. Other cerebellar volumetric measurements did not differ between the CII groups. CONCLUSIONS Posterior fossa decompression normalizes CSF spaces within the posterior fossa in CII but does not prevent the cerebellar atrophy. The author proposes that surgical expansion of the posterior fossa should be considered in infants with CII who have a significantly small posterior fossa, to prevent or reduce the deficits associated with the cerebellar atrophy.
Collapse
Affiliation(s)
- Michael S Salman
- Section of Pediatric Neurology, Children's Hospital, AE 308, 820 Sherbrook Street, Winnipeg, MB, R3A 1R9, Canada.
| |
Collapse
|