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Three-dimensional cranial ultrasound and functional near-infrared spectroscopy for bedside monitoring of intraventricular hemorrhage in preterm neonates. Sci Rep 2023; 13:3730. [PMID: 36878952 PMCID: PMC9988970 DOI: 10.1038/s41598-023-30743-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 02/28/2023] [Indexed: 03/08/2023] Open
Abstract
Germinal Matrix-Intraventricular Hemorrhage (GMH-IVH) remains a significant cause of adverse neurodevelopment in preterm infants. Current management relies on 2-dimensional cranial ultrasound (2D cUS) ventricular measurements. Reliable biomarkers are needed to aid in the early detection of posthemorrhagic ventricular dilatation (PHVD) and subsequent neurodevelopment. In a prospective cohort study, we incorporated 3-dimensional (3D) cUS and functional near-infrared spectroscopy (fNIRS) to monitor neonates with GMH-IVH. Preterm neonates (≤ 32 weeks' gestation) were enrolled following a GMH-IVH diagnosis. Neonates underwent sequential measurements: 3D cUS images were manually segmented using in-house software, and the ventricle volumes (VV) were extracted. Multichannel fNIRS data were acquired using a high-density system, and spontaneous functional connectivity (sFC) was calculated. Of the 30 neonates enrolled in the study, 19 (63.3%) had grade I-II and 11 (36.7%) grade III-IV GMH-IVH; of these, 7 neonates (23%) underwent surgical interventions to divert cerebrospinal fluid (CSF). In infants with severe GMH-IVH, larger VV were significantly associated with decreased |sFC|. Our findings of increased VV and reduced sFC suggest that regional disruptions of ventricular size may impact the development of the underlying white matter. Hence, 3D cUS and fNIRS are promising bedside tools for monitoring the progression of GMH-IVH in preterm neonates.
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2
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Uchitel J, Blanco B, Collins-Jones L, Edwards A, Porter E, Pammenter K, Hebden J, Cooper RJ, Austin T. Cot-side imaging of functional connectivity in the developing brain during sleep using wearable high-density diffuse optical tomography. Neuroimage 2023; 265:119784. [PMID: 36464095 DOI: 10.1016/j.neuroimage.2022.119784] [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: 06/08/2022] [Revised: 11/16/2022] [Accepted: 11/30/2022] [Indexed: 12/03/2022] Open
Abstract
Studies of cortical function in newborn infants in clinical settings are extremely challenging to undertake with traditional neuroimaging approaches. Partly in response to this challenge, functional near-infrared spectroscopy (fNIRS) has become an increasingly common clinical research tool but has significant limitations including a low spatial resolution and poor depth specificity. Moreover, the bulky optical fibres required in traditional fNIRS approaches present significant mechanical challenges, particularly for the study of vulnerable newborn infants. A new generation of wearable, modular, high-density diffuse optical tomography (HD-DOT) technologies has recently emerged that overcomes many of the limitations of traditional, fibre-based and low-density fNIRS measurements. Driven by the development of this new technology, we have undertaken the first cot-side study of newborn infants using wearable HD-DOT in a clinical setting. We use this technology to study functional brain connectivity (FC) in newborn infants during sleep and assess the effect of neonatal sleep states, active sleep (AS) and quiet sleep (QS), on resting state FC. Our results demonstrate that it is now possible to obtain high-quality functional images of the neonatal brain in the clinical setting with few constraints. Our results also suggest that sleep states differentially affect FC in the neonatal brain, consistent with prior reports.
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Affiliation(s)
- Julie Uchitel
- DOT-HUB, Department of Medical Physics and Biomedical Engineering, UCL, London, UK; Department of Pediatrics, University of Cambridge, Cambridge, UK.
| | - Borja Blanco
- DOT-HUB, Department of Medical Physics and Biomedical Engineering, UCL, London, UK; Department of Psychology, University of Cambridge, Cambridge, UK
| | - Liam Collins-Jones
- DOT-HUB, Department of Medical Physics and Biomedical Engineering, UCL, London, UK
| | - Andrea Edwards
- Neonatal Intensive Care Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Emma Porter
- Neonatal Intensive Care Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Kelle Pammenter
- Neonatal Intensive Care Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Jem Hebden
- DOT-HUB, Department of Medical Physics and Biomedical Engineering, UCL, London, UK
| | - Robert J Cooper
- DOT-HUB, Department of Medical Physics and Biomedical Engineering, UCL, London, UK
| | - Topun Austin
- Neonatal Intensive Care Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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3
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Triplett RL, Smyser CD. Neuroimaging of structural and functional connectivity in preterm infants with intraventricular hemorrhage. Semin Perinatol 2022; 46:151593. [PMID: 35410714 PMCID: PMC9910034 DOI: 10.1016/j.semperi.2022.151593] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Preterm infants with intraventricular hemorrhage (IVH) are known to have some of the worst neurodevelopmental outcomes in all of neonatal medicine, with a growing body of evidence relating these outcomes to underlying disruptions in brain structure and function. This review begins by summarizing state-of-the-art neuroimaging techniques delineating structural and functional connectivity (diffusion and resting state functional MRI) and their application in infants with IVH, including unique technical challenges and emerging methods. We then review studies of altered structural and functional connectivity, highlighting the role of IVH severity and location. We subsequently detail investigations linking structural and functional findings in infancy to later outcomes in early childhood. We conclude with future directions including methodologic considerations for prospective and potentially interventional studies designed to mitigate disruptions to underlying structural and functional connections and improve neurodevelopmental outcomes in this high-risk population.
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Affiliation(s)
- Regina L Triplett
- Department of Neurology, Washington University in St. Louis, St. Louis, MO, USA
| | - Christopher D Smyser
- Department of Neurology, Washington University in St. Louis, St. Louis, MO, USA; Department of Pediatrics, Washington University in St. Louis, St. Louis, MO, USA; Department of Radiology, Washington University in St. Louis, St. Louis, MO, USA.
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4
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Vo Van P, Alison M, Morel B, Beck J, Bednarek N, Hertz-Pannier L, Loron G. Advanced Brain Imaging in Preterm Infants: A Narrative Review of Microstructural and Connectomic Disruption. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9030356. [PMID: 35327728 PMCID: PMC8947160 DOI: 10.3390/children9030356] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 02/21/2022] [Accepted: 03/02/2022] [Indexed: 11/16/2022]
Abstract
Preterm birth disrupts the in utero environment, preventing the brain from fully developing, thereby causing later cognitive and behavioral disorders. Such cerebral alteration occurs beneath an anatomical scale, and is therefore undetectable by conventional imagery. Prematurity impairs the microstructure and thus the histological process responsible for the maturation, including the myelination. Cerebral MRI diffusion tensor imaging sequences, based on water’s motion into the brain, allows a representation of this maturation process. Similarly, the brain’s connections become disorganized. The connectome gathers structural and anatomical white matter fibers, as well as functional networks referring to remote brain regions connected one over another. Structural and functional connectivity is illustrated by tractography and functional MRI, respectively. Their organizations consist of core nodes connected by edges. This basic distribution is already established in the fetal brain. It evolves greatly over time but is compromised by prematurity. Finally, cerebral plasticity is nurtured by a lifetime experience at microstructural and macrostructural scales. A preterm birth causes a negative and early disruption, though it can be partly mitigated by positive stimuli based on developmental neonatal care.
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Affiliation(s)
- Philippe Vo Van
- Department of Neonatology, Hospices Civils de Lyon, Femme Mère Enfant Hospital, 59 Boulevard Pinel, 69500 Bron, France
- Correspondence:
| | - Marianne Alison
- Service d’Imagerie Pédiatrique, Hôpital Robert Debré, APHP, 75019 Paris, France;
- U1141 Neurodiderot, Équipe 5 inDev, Inserm, CEA, Université de Paris, 75019 Paris, France;
| | - Baptiste Morel
- Pediatric Radiology Department, Clocheville Hospital, CHRU of Tours, 37000 Tours, France;
- UMR 1253, iB-Rain, Université de Tours, Inserm, 37000 Tours, France
| | - Jonathan Beck
- Department of Neonatology, Reims University Hospital Alix de Champagne, 51100 Reims, France; (J.B.); (N.B.); (G.L.)
- CReSTIC EA 3804, Université de Reims Champagne Ardenne, 51100 Reims, France
| | - Nathalie Bednarek
- Department of Neonatology, Reims University Hospital Alix de Champagne, 51100 Reims, France; (J.B.); (N.B.); (G.L.)
- CReSTIC EA 3804, Université de Reims Champagne Ardenne, 51100 Reims, France
| | - Lucie Hertz-Pannier
- U1141 Neurodiderot, Équipe 5 inDev, Inserm, CEA, Université de Paris, 75019 Paris, France;
- NeuroSpin, CEA-Saclay, Université Paris-Saclay, 91191 Gif-sur-Yvette, France
| | - Gauthier Loron
- Department of Neonatology, Reims University Hospital Alix de Champagne, 51100 Reims, France; (J.B.); (N.B.); (G.L.)
- CReSTIC EA 3804, Université de Reims Champagne Ardenne, 51100 Reims, France
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5
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Dall'Orso S, Arichi T, Fitzgibbon SP, Edwards AD, Burdet E, Muceli S. Development of functional organization within the sensorimotor network across the perinatal period. Hum Brain Mapp 2022; 43:2249-2261. [PMID: 35088920 PMCID: PMC8996360 DOI: 10.1002/hbm.25785] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 12/30/2021] [Accepted: 01/10/2022] [Indexed: 11/18/2022] Open
Abstract
In the mature human brain, the neural processing related to different body parts is reflected in patterns of functional connectivity, which is strongest between functional homologs in opposite cortical hemispheres. To understand how this organization is first established, we investigated functional connectivity between limb regions in the sensorimotor cortex in 400 preterm and term infants aged across the equivalent period to the third trimester of gestation (32–45 weeks postmenstrual age). Masks were obtained from empirically derived functional responses in neonates from an independent data set. We demonstrate the early presence of a crude but spatially organized functional connectivity, that rapidly matures across the preterm period to achieve an adult‐like configuration by the normal time of birth. Specifically, connectivity was strongest between homolog regions, followed by connectivity between adjacent regions (different limbs but same hemisphere) already in the preterm brain, and increased with age. These changes were specific to the sensorimotor network. Crucially, these trajectories were strongly dependent on age more than age of birth. This demonstrates that during the perinatal period the sensorimotor cortex undergoes preprogrammed changes determining the functional movement organization that are not altered by preterm birth in absence of brain injury.
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Affiliation(s)
- Sofia Dall'Orso
- Department of Electrical Engineering, Chalmers University of Technology, Gothenburg.,Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London
| | - Tomoki Arichi
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London.,Department of Bioengineering, Imperial College of Science, Technology and Medicine, London, UK.,Paediatric Neurosciences, Evelina London Children's Hospital, St. Thomas' Hospital, London, UK.,Medical Research Council Centre for Neurodevelopmental Disorders, King's College London, London, UK
| | - Sean P Fitzgibbon
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - A David Edwards
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London.,Medical Research Council Centre for Neurodevelopmental Disorders, King's College London, London, UK
| | - Etienne Burdet
- Department of Bioengineering, Imperial College of Science, Technology and Medicine, London, UK
| | - Silvia Muceli
- Department of Electrical Engineering, Chalmers University of Technology, Gothenburg.,Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London
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6
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Abstract
Advances in neuroimaging have increasingly enabled researchers to investigate whether alterations in brain development commonly identified in preterm infants underlie their high risk of long-term neurodevelopmental impairment, including sensory, motor, cognitive, and psychiatric deficits. This review begins by examining the growing body of literature utilizing advanced magnetic resonance imaging (MRI) techniques to probe structural (via diffusion MRI) and functional (via resting state-functional MRI) connectivity development in the preterm brain during the neonatal period, both in the presence and absence of brain injury. It then details the recent work linking neonatal brain connectivity measures to neurodevelopmental and psychiatric outcomes in prematurely-born cohorts. Finally, building upon the recent substantive growth in the utilization of these neuroimaging modalities, it concludes by highlighting areas in which continued optimization of age-specific acquisition and analysis techniques for these data remains necessary, efforts fundamental to advancing the field toward establishing individual-level predictive capabilities in this high-risk population.
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Affiliation(s)
- Rebecca G Brenner
- Department of Neurology, Washington University School of Medicine, 660 South Euclid Avenue Campus Box 8111, St. Louis, MO 63110, United States
| | - Muriah D Wheelock
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, United States
| | - Jeffrey J Neil
- Department of Neurology, Washington University School of Medicine, 660 South Euclid Avenue Campus Box 8111, St. Louis, MO 63110, United States; Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, United States
| | - Christopher D Smyser
- Department of Neurology, Washington University School of Medicine, 660 South Euclid Avenue Campus Box 8111, St. Louis, MO 63110, United States; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, United States; Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, United States.
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7
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Perinatal stroke: mapping and modulating developmental plasticity. Nat Rev Neurol 2021; 17:415-432. [PMID: 34127850 DOI: 10.1038/s41582-021-00503-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2021] [Indexed: 02/04/2023]
Abstract
Most cases of hemiparetic cerebral palsy are caused by perinatal stroke, resulting in lifelong disability for millions of people. However, our understanding of how the motor system develops following such early unilateral brain injury is increasing. Tools such as neuroimaging and brain stimulation are generating informed maps of the unique motor networks that emerge following perinatal stroke. As a focal injury of defined timing in an otherwise healthy brain, perinatal stroke represents an ideal human model of developmental plasticity. Here, we provide an introduction to perinatal stroke epidemiology and outcomes, before reviewing models of developmental plasticity after perinatal stroke. We then examine existing therapeutic approaches, including constraint, bimanual and other occupational therapies, and their potential synergy with non-invasive neurostimulation. We end by discussing the promise of exciting new therapies, including novel neurostimulation, brain-computer interfaces and robotics, all focused on improving outcomes after perinatal stroke.
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8
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Eyre M, Fitzgibbon SP, Ciarrusta J, Cordero-Grande L, Price AN, Poppe T, Schuh A, Hughes E, O'Keeffe C, Brandon J, Cromb D, Vecchiato K, Andersson J, Duff EP, Counsell SJ, Smith SM, Rueckert D, Hajnal JV, Arichi T, O'Muircheartaigh J, Batalle D, Edwards AD. The Developing Human Connectome Project: typical and disrupted perinatal functional connectivity. Brain 2021; 144:2199-2213. [PMID: 33734321 PMCID: PMC8370420 DOI: 10.1093/brain/awab118] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 12/11/2020] [Accepted: 12/16/2020] [Indexed: 12/23/2022] Open
Abstract
The Developing Human Connectome Project is an Open Science project that provides the
first large sample of neonatal functional MRI data with high temporal and spatial
resolution. These data enable mapping of intrinsic functional connectivity between
spatially distributed brain regions under normal and adverse perinatal circumstances,
offering a framework to study the ontogeny of large-scale brain organization in humans.
Here, we characterize in unprecedented detail the maturation and integrity of resting
state networks (RSNs) at term-equivalent age in 337 infants (including 65 born preterm).
First, we applied group independent component analysis to define 11 RSNs in term-born
infants scanned at 43.5–44.5 weeks postmenstrual age (PMA). Adult-like topography was
observed in RSNs encompassing primary sensorimotor, visual and auditory cortices. Among
six higher-order, association RSNs, analogues of the adult networks for language and
ocular control were identified, but a complete default mode network precursor was not.
Next, we regressed the subject-level datasets from an independent cohort of infants
scanned at 37–43.5 weeks PMA against the group-level RSNs to test for the effects of age,
sex and preterm birth. Brain mapping in term-born infants revealed areas of positive
association with age across four of six association RSNs, indicating active maturation in
functional connectivity from 37 to 43.5 weeks PMA. Female infants showed increased
connectivity in inferotemporal regions of the visual association network. Preterm birth
was associated with striking impairments of functional connectivity across all RSNs in a
dose-dependent manner; conversely, connectivity of the superior parietal lobules within
the lateral motor network was abnormally increased in preterm infants, suggesting a
possible mechanism for specific difficulties such as developmental coordination disorder,
which occur frequently in preterm children. Overall, we found a robust, modular,
symmetrical functional brain organization at normal term age. A complete set of
adult-equivalent primary RSNs is already instated, alongside emerging connectivity in
immature association RSNs, consistent with a primary-to-higher order ontogenetic sequence
of brain development. The early developmental disruption imposed by preterm birth is
associated with extensive alterations in functional connectivity.
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Affiliation(s)
- Michael Eyre
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London SE1 7EH, UK
| | - Sean P Fitzgibbon
- Wellcome Centre for Integrative Neuroimaging (WIN FMRIB), University of Oxford, Oxford OX3 9DU, UK
| | - Judit Ciarrusta
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London SE1 7EH, UK.,Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK
| | - Lucilio Cordero-Grande
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London SE1 7EH, UK
| | - Anthony N Price
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London SE1 7EH, UK
| | - Tanya Poppe
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London SE1 7EH, UK
| | - Andreas Schuh
- Biomedical Image Analysis Group, Imperial College London, London SW7 2AZ, UK
| | - Emer Hughes
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London SE1 7EH, UK
| | - Camilla O'Keeffe
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London SE1 7EH, UK
| | - Jakki Brandon
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London SE1 7EH, UK
| | - Daniel Cromb
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London SE1 7EH, UK
| | - Katy Vecchiato
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London SE1 7EH, UK.,Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK
| | - Jesper Andersson
- Wellcome Centre for Integrative Neuroimaging (WIN FMRIB), University of Oxford, Oxford OX3 9DU, UK
| | - Eugene P Duff
- Wellcome Centre for Integrative Neuroimaging (WIN FMRIB), University of Oxford, Oxford OX3 9DU, UK.,Department of Paediatrics, University of Oxford, Oxford OX3 9DU, UK
| | - Serena J Counsell
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London SE1 7EH, UK
| | - Stephen M Smith
- Wellcome Centre for Integrative Neuroimaging (WIN FMRIB), University of Oxford, Oxford OX3 9DU, UK
| | - Daniel Rueckert
- Biomedical Image Analysis Group, Imperial College London, London SW7 2AZ, UK
| | - Joseph V Hajnal
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London SE1 7EH, UK
| | - Tomoki Arichi
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London SE1 7EH, UK.,Department of Bioengineering, Imperial College London, London SW7 2AZ, UK
| | - Jonathan O'Muircheartaigh
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London SE1 7EH, UK.,Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK
| | - Dafnis Batalle
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London SE1 7EH, UK.,Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK
| | - A David Edwards
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London SE1 7EH, UK
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9
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Carlson HL, Craig BT, Hilderley AJ, Hodge J, Rajashekar D, Mouches P, Forkert ND, Kirton A. Structural and functional connectivity of motor circuits after perinatal stroke: A machine learning study. Neuroimage Clin 2020; 28:102508. [PMID: 33395997 PMCID: PMC7704459 DOI: 10.1016/j.nicl.2020.102508] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 10/19/2020] [Accepted: 11/15/2020] [Indexed: 11/15/2022]
Abstract
Developmental neuroplasticity allows young brains to adapt via experiences early in life and also to compensate after injury. Why certain individuals are more adaptable remains underexplored. Perinatal stroke is an ideal human model of neuroplasticity with focal lesions acquired near birth in a healthy brain. Machine learning can identify complex patterns in multi-dimensional datasets. We used machine learning to identify structural and functional connectivity biomarkers most predictive of motor function. Forty-nine children with perinatal stroke and 27 controls were studied. Functional connectivity was quantified by fluctuations in blood oxygen-level dependent (BOLD) signal between regions. White matter tractography of corticospinal tracts quantified structural connectivity. Motor function was assessed using validated bimanual and unimanual tests. RELIEFF feature selection and random forest regression models identified predictors of each motor outcome using neuroimaging and demographic features. Unilateral motor outcomes were predicted with highest accuracy (8/54 features r = 0.58, 11/54 features, r = 0.34) but bimanual function required more features (51/54 features, r = 0.38). Connectivity of both hemispheres had important roles as did cortical and subcortical regions. Lesion size, age at scan, and type of stroke were predictive but not highly ranked. Machine learning regression models may represent a powerful tool in identifying neuroimaging biomarkers associated with clinical motor function in perinatal stroke and may inform personalized targets for neuromodulation.
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Affiliation(s)
- Helen L Carlson
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, AB, Canada; Alberta Children's Hospital Research Institute, Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.
| | - Brandon T Craig
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, AB, Canada; Alberta Children's Hospital Research Institute, Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Alicia J Hilderley
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, AB, Canada; Alberta Children's Hospital Research Institute, Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Jacquie Hodge
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, AB, Canada
| | - Deepthi Rajashekar
- Alberta Children's Hospital Research Institute, Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada; Department of Radiology, University of Calgary, Calgary, AB, Canada; Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Pauline Mouches
- Alberta Children's Hospital Research Institute, Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada; Department of Radiology, University of Calgary, Calgary, AB, Canada; Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Nils D Forkert
- Alberta Children's Hospital Research Institute, Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada; Department of Radiology, University of Calgary, Calgary, AB, Canada; Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Adam Kirton
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, AB, Canada; Alberta Children's Hospital Research Institute, Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada; Department of Radiology, University of Calgary, Calgary, AB, Canada; Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
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10
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Imaging Developmental and Interventional Plasticity Following Perinatal Stroke. Can J Neurol Sci 2020; 48:157-171. [DOI: 10.1017/cjn.2020.166] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
ABSTRACT:Perinatal stroke occurs around the time of birth and leads to lifelong neurological disabilities including hemiparetic cerebral palsy. Magnetic resonance imaging (MRI) has revolutionized our understanding of developmental neuroplasticity following early injury, quantifying volumetric, structural, functional, and metabolic compensatory changes after perinatal stroke. Such techniques can also be used to investigate how the brain responds to treatment (interventional neuroplasticity). Here, we review the current state of knowledge of how established and emerging neuroimaging modalities are informing neuroplasticity models in children with perinatal stroke. Specifically, we review structural imaging characterizing lesion characteristics and volumetrics, diffusion tensor imaging investigating white matter tracts and networks, task-based functional MRI for localizing function, resting state functional imaging for characterizing functional connectomes, and spectroscopy examining neurometabolic changes. Key challenges and exciting avenues for future investigations are also considered.
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11
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Fleiss B, Gressens P, Stolp HB. Cortical Gray Matter Injury in Encephalopathy of Prematurity: Link to Neurodevelopmental Disorders. Front Neurol 2020; 11:575. [PMID: 32765390 PMCID: PMC7381224 DOI: 10.3389/fneur.2020.00575] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 05/19/2020] [Indexed: 12/16/2022] Open
Abstract
Preterm-born infants frequently suffer from an array of neurological damage, collectively termed encephalopathy of prematurity (EoP). They also have an increased risk of presenting with a neurodevelopmental disorder (e.g., autism spectrum disorder; attention deficit hyperactivity disorder) later in life. It is hypothesized that it is the gray matter injury to the cortex, in addition to white matter injury, in EoP that is responsible for the altered behavior and cognition in these individuals. However, although it is established that gray matter injury occurs in infants following preterm birth, the exact nature of these changes is not fully elucidated. Here we will review the current state of knowledge in this field, amalgamating data from both clinical and preclinical studies. This will be placed in the context of normal processes of developmental biology and the known pathophysiology of neurodevelopmental disorders. Novel diagnostic and therapeutic tactics required integration of this information so that in the future we can combine mechanism-based approaches with patient stratification to ensure the most efficacious and cost-effective clinical practice.
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Affiliation(s)
- Bobbi Fleiss
- School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, Australia
- Université de Paris, NeuroDiderot, Inserm, Paris, France
- PremUP, Paris, France
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Pierre Gressens
- Université de Paris, NeuroDiderot, Inserm, Paris, France
- PremUP, Paris, France
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Helen B. Stolp
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
- Comparative Biomedical Sciences, Royal Veterinary College, London, United Kingdom
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12
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Lee CW, Blanco B, Dempsey L, Chalia M, Hebden JC, Caballero-Gaudes C, Austin T, Cooper RJ. Sleep State Modulates Resting-State Functional Connectivity in Neonates. Front Neurosci 2020; 14:347. [PMID: 32362811 PMCID: PMC7180180 DOI: 10.3389/fnins.2020.00347] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 03/23/2020] [Indexed: 01/26/2023] Open
Abstract
The spontaneous cerebral activity that gives rise to resting-state networks (RSNs) has been extensively studied in infants in recent years. However, the influence of sleep state on the presence of observable RSNs has yet to be formally investigated in the infant population, despite evidence that sleep modulates resting-state functional connectivity in adults. This effect could be extremely important, as most infant neuroimaging studies rely on the neonate to remain asleep throughout data acquisition. In this study, we combine functional near-infrared spectroscopy with electroencephalography to simultaneously monitor sleep state and investigate RSNs in a cohort of healthy term born neonates. During active sleep (AS) and quiet sleep (QS) our newborn neonates show functional connectivity patterns spatially consistent with previously reported RSN structures. Our three independent functional connectivity analyses revealed stronger interhemispheric connectivity during AS than during QS. In turn, within hemisphere short-range functional connectivity seems to be enhanced during QS. These findings underline the importance of sleep state monitoring in the investigation of RSNs.
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Affiliation(s)
- Chuen Wai Lee
- neoLAB, The Evelyn Perinatal Imaging Centre, The Rosie Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom.,Neonatal Intensive Care Unit, The Rosie Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Borja Blanco
- DOT-HUB, Department of Medical Physics and Biomedical Engineering, Faculty of Engineering Sciences, University College London, London, United Kingdom.,Basque Center on Cognition, Brain and Language, Donostia/San Sebastián, Spain
| | - Laura Dempsey
- neoLAB, The Evelyn Perinatal Imaging Centre, The Rosie Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom.,DOT-HUB, Department of Medical Physics and Biomedical Engineering, Faculty of Engineering Sciences, University College London, London, United Kingdom
| | - Maria Chalia
- neoLAB, The Evelyn Perinatal Imaging Centre, The Rosie Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom.,Neonatal Intensive Care Unit, The Rosie Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Jeremy C Hebden
- neoLAB, The Evelyn Perinatal Imaging Centre, The Rosie Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom.,DOT-HUB, Department of Medical Physics and Biomedical Engineering, Faculty of Engineering Sciences, University College London, London, United Kingdom
| | | | - Topun Austin
- neoLAB, The Evelyn Perinatal Imaging Centre, The Rosie Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom.,Neonatal Intensive Care Unit, The Rosie Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom.,DOT-HUB, Department of Medical Physics and Biomedical Engineering, Faculty of Engineering Sciences, University College London, London, United Kingdom
| | - Robert J Cooper
- neoLAB, The Evelyn Perinatal Imaging Centre, The Rosie Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom.,DOT-HUB, Department of Medical Physics and Biomedical Engineering, Faculty of Engineering Sciences, University College London, London, United Kingdom
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13
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Cizmeci MN, de Vries LS, Ly LG, van Haastert IC, Groenendaal F, Kelly EN, Traubici J, Whyte HE, Leijser LM. Periventricular Hemorrhagic Infarction in Very Preterm Infants: Characteristic Sonographic Findings and Association with Neurodevelopmental Outcome at Age 2 Years. J Pediatr 2020; 217:79-85.e1. [PMID: 31706634 DOI: 10.1016/j.jpeds.2019.09.081] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 09/02/2019] [Accepted: 09/30/2019] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To describe the sonographic characteristics of periventricular hemorrhagic infarction (PVHI) and their association with mortality and neurodevelopmental disability in very preterm infants born in 2008-2013. STUDY DESIGN Retrospective multicenter observational cohort study. Diagonal PVHI size was measured and severity score assessed. PVHI characteristics were scored and temporal trends were assessed. Neurodevelopmental outcome at 2 years of corrected age was assessed using either the Bayley Scales of Infant and Toddler Development, Third Edition or the Griffiths Mental Development Scales. Multigroup analyses were applied as appropriate. RESULTS We enrolled 160 infants with median gestational age of 26.6 weeks. PVHI was mostly unilateral (90%), associated with an ipsilateral grade III intraventricular hemorrhage (84%), and located in the parietal lobe (51%). Sixty-four (40%) infants with PVHI died in the neonatal period. Of the survivors assessed at 2 years of corrected age, 65% had normal cognitive and 69% had normal motor outcomes. The cerebral palsy rate was 42%. The composite outcome of death or severe neurodevelopmental disability was observed in 58%, with no trends over the study period (P = .6). Increasing PVHI severity score was associated with death (P < .001). Increasing PVHI size and severity score were negatively associated with gross motor scores (P = .01 and .03, respectively). Trigone involvement was associated with cerebral palsy (41% vs 14%; P = .004). Associated posthemorrhagic ventricular dilation (36%) was an independent risk factor for poorer cognitive and motor outcomes (P < .001 for both). CONCLUSIONS Increasing PVHI size and severity score were predictive of less optimal gross motor outcome and death in very preterm infants.
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Affiliation(s)
- Mehmet N Cizmeci
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands; Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands; Division of Neonatology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Linda S de Vries
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands; Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Linh G Ly
- Division of Neonatology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Ingrid C van Haastert
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands; Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Floris Groenendaal
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands; Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Edmond N Kelly
- Division of Neonatology, Department of Pediatrics, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | - Jeffrey Traubici
- Department of Radiology, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Hilary E Whyte
- Division of Neonatology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Lara M Leijser
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands; Division of Neonatology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Canada; Section of Neonatology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada.
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14
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Whitehead K, Jones L, Laudiano-Dray MP, Meek J, Fabrizi L. Altered cortical processing of somatosensory input in pre-term infants who had high-grade germinal matrix-intraventricular haemorrhage. NEUROIMAGE-CLINICAL 2019; 25:102095. [PMID: 31835239 PMCID: PMC6920135 DOI: 10.1016/j.nicl.2019.102095] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 11/06/2019] [Accepted: 11/15/2019] [Indexed: 12/27/2022]
Abstract
Infants who had GM-IVH recruit different cortical sources following foot stimulation. Results indicate restructuring of somatosensory processing during the weeks after GM-IVH. GM-IVH is more detrimental for lower than upper limb somatosensory processing.
High-grade (large) germinal matrix-intraventricular haemorrhage (GM-IVH) is one of the most common causes of somatomotor neurodisability in pre-term infants. GM-IVH presents during the first postnatal week and can impinge on somatosensory circuits resulting in aberrant somatosensory cortical events straight after injury. Subsequently, somatosensory circuits undergo significant plastic changes, sometimes allowing the reinstatement of a somatosensory cortical response. However, it is not known whether this restructuring results in a full recovery of somatosensory functions. To investigate this, we compared somatosensory responses to mechanical stimulation measured with 18-channels EEG between infants who had high-grade GM-IVH (with ventricular dilatation and/or intraparenchymal lesion; n = 7 studies from 6 infants; mean corrected gestational age = 33 weeks; mean postnatal age = 56 days) and age-matched controls (n = 9 studies from 8 infants; mean corrected gestational age = 32 weeks; mean postnatal age = 36 days). We showed that infants who had high-grade GM-IVH did not recruit the same cortical source configuration following stimulation of the foot, but their response to stimulation of the hand resembled that of controls. These results show that somatosensory cortical circuits are reinstated in infants who had GM-IVH, during the several weeks after injury, but remain different from those of infants without brain injury. An important next step will be to investigate whether these evidences of neural reorganisation predict neurodevelopmental outcome.
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Affiliation(s)
- Kimberley Whitehead
- Department of Neuroscience, Physiology and Pharmacology, University College London, London WC1E 6BT, United Kingdom.
| | - Laura Jones
- Department of Neuroscience, Physiology and Pharmacology, University College London, London WC1E 6BT, United Kingdom.
| | - Maria Pureza Laudiano-Dray
- Department of Neuroscience, Physiology and Pharmacology, University College London, London WC1E 6BT, United Kingdom.
| | - Judith Meek
- Department of Neuroscience, Physiology and Pharmacology, University College London, London WC1E 6BT, United Kingdom; Elizabeth Garrett Anderson Wing, University College London Hospitals, London WC1E 6BD, United Kingdom.
| | - Lorenzo Fabrizi
- Department of Neuroscience, Physiology and Pharmacology, University College London, London WC1E 6BT, United Kingdom.
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15
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Smyser CD, Wheelock MD, Limbrick DD, Neil JJ. Neonatal brain injury and aberrant connectivity. Neuroimage 2019; 185:609-623. [PMID: 30059733 PMCID: PMC6289815 DOI: 10.1016/j.neuroimage.2018.07.057] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 06/21/2018] [Accepted: 07/24/2018] [Indexed: 12/12/2022] Open
Abstract
Brain injury sustained during the neonatal period may disrupt development of critical structural and functional connectivity networks leading to subsequent neurodevelopmental impairment in affected children. These networks can be characterized using structural (via diffusion MRI) and functional (via resting state-functional MRI) neuroimaging techniques. Advances in neuroimaging have led to expanded application of these approaches to study term- and prematurely-born infants, providing improved understanding of cerebral development and the deleterious effects of early brain injury. Across both modalities, neuroimaging data are conducive to analyses ranging from characterization of individual white matter tracts and/or resting state networks through advanced 'connectome-style' approaches capable of identifying highly connected network hubs and investigating metrics of network topology such as modularity and small-worldness. We begin this review by summarizing the literature detailing structural and functional connectivity findings in healthy term and preterm infants without brain injury during the postnatal period, including discussion of early connectome development. We then detail common forms of brain injury in term- and prematurely-born infants. In this context, we next review the emerging body of literature detailing studies employing diffusion MRI, resting state-functional MRI and other complementary neuroimaging modalities to characterize structural and functional connectivity development in infants with brain injury. We conclude by reviewing technical challenges associated with neonatal neuroimaging, highlighting those most relevant to studying infants with brain injury and emphasizing the need for further targeted study in this high-risk population.
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Affiliation(s)
- Christopher D Smyser
- Departments of Neurology, Pediatrics and Radiology, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8111, St. Louis, MO, 63110, USA.
| | - Muriah D Wheelock
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8134, St. Louis, MO, 63110, USA.
| | - David D Limbrick
- Departments of Neurosurgery and Pediatrics, Washington University School of Medicine, One Children's Place, Suite S20, St. Louis, MO, 63110, USA.
| | - Jeffrey J Neil
- Department of Pediatric Neurology, Boston Children's Hospital, 300 Longwood Avenue, BCH3443, Boston, MA, 02115, USA.
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16
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Woodward KE, Carlson HL, Kuczynski A, Saunders J, Hodge J, Kirton A. Sensory-motor network functional connectivity in children with unilateral cerebral palsy secondary to perinatal stroke. Neuroimage Clin 2019; 21:101670. [PMID: 30642756 PMCID: PMC6412078 DOI: 10.1016/j.nicl.2019.101670] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 12/23/2018] [Accepted: 01/07/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Perinatal stroke is the most common cause of unilateral cerebral palsy. Mechanisms of post-stroke developmental plasticity in children are poorly understood. To better understand the relationship between functional connectivity and disability, we used resting-state fMRI to compare sensorimotor connectivity with clinical dysfunction. METHODS School-aged children with periventricular venous infarction (PVI) and unilateral cerebral palsy were compared to controls. Resting-state BOLD signal was acquired on 3 T MRI and analyzed using CONN in SPM12. Functional connectivity was computed between S1, M1, supplementary motor area (SMA), and thalamus of the left/non-lesioned and right/lesioned hemisphere. Primary outcome was connectivity expressed as a Fisher-transformed correlation coefficient. Motor function was measured using the Assisting Hand Assessment (AHA), and Melbourne Assessment (MA). Proprioceptive function was measured using a robotic position matching task (VarXY). RESULTS Participants included 15 PVI and 21 controls. AHA and MA in stroke patients were negatively correlated with connectivity (increased connectivity = poorer performance). Position sense was inversely correlated with connectivity (increased connectivity = improved performance) between the non-lesioned S1 and thalamus/SMA. In controls, VarXY was positively correlated with connectivity between the thalamus and bilateral sensorimotor regions. CONCLUSIONS Resting state fMRI measures of sensorimotor connectivity are associated with clinical sensorimotor function in children with unilateral cerebral palsy secondary to PVI. Greater insight into understanding reorganization of brain networks following perinatal stroke may facilitate personalized rehabilitation.
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Affiliation(s)
- K E Woodward
- Department of Clinical Neurosciences, Cumming School of Medicine, Alberta Children's Hospital Research Institute, University of Calgary, 2888 Shaganappi Trial NW, Calgary, AB T3B6A8, Canada.
| | - H L Carlson
- Department of Clinical Neurosciences, Cumming School of Medicine, Alberta Children's Hospital Research Institute, University of Calgary, 2888 Shaganappi Trial NW, Calgary, AB T3B6A8, Canada.
| | - A Kuczynski
- Department of Neurosciences and Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, AB T2N4N1, Canada.
| | - J Saunders
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, University of Calgary, 2888 Shaganappi Trial NW, Calgary, AB T3B6A8, Canada.
| | - J Hodge
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, University of Calgary, 2888 Shaganappi Trial NW, Calgary, AB T3B6A8, Canada.
| | - A Kirton
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, University of Calgary, 2888 Shaganappi Trial NW, Calgary, AB T3B6A8, Canada; Department of Clinical Neurosciences, Cumming School of Medicine, Alberta Children's Hospital Research Institute, University of Calgary, 2888 Shaganappi Trial NW, Calgary, AB T3B6A8, Canada; Department of Neurosciences and Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, AB T2N4N1, Canada.
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17
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Counsell SJ, Arichi T, Arulkumaran S, Rutherford MA. Fetal and neonatal neuroimaging. HANDBOOK OF CLINICAL NEUROLOGY 2019; 162:67-103. [PMID: 31324329 DOI: 10.1016/b978-0-444-64029-1.00004-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Magnetic resonance imaging (MRI) can provide detail of the soft tissues of the fetal and neonatal brain that cannot be obtained by any other imaging modality. Conventional T1 and T2 weighted sequences provide anatomic detail of the normally developing brain and can demonstrate lesions, including those associated with preterm birth, hypoxic ischemic encephalopathy, perinatal arterial stroke, infections, and congenital malformations. Specialized imaging techniques can be used to assess cerebral vasculature (magnetic resonance angiography and venography), cerebral metabolism (magnetic resonance spectroscopy), cerebral perfusion (arterial spin labeling), and function (functional MRI). A wealth of quantitative tools, most of which were originally developed for the adult brain, can be applied to study the developing brain in utero and postnatally including measures of tissue microstructure obtained from diffusion MRI, morphometric studies to measure whole brain and regional tissue volumes, and automated approaches to study cortical folding. In this chapter, we aim to describe different imaging approaches for the fetal and neonatal brain, and to discuss their use in a range of clinical applications.
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Affiliation(s)
- Serena J Counsell
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.
| | - Tomoki Arichi
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Sophie Arulkumaran
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Mary A Rutherford
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
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18
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Donadio A, Whitehead K, Gonzalez F, Wilhelm E, Formica D, Meek J, Fabrizi L, Burdet E. A novel sensor design for accurate measurement of facial somatosensation in pre-term infants. PLoS One 2018; 13:e0207145. [PMID: 30444872 PMCID: PMC6239299 DOI: 10.1371/journal.pone.0207145] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 10/25/2018] [Indexed: 11/18/2022] Open
Abstract
Facial somatosensory feedback is critical for breastfeeding in the first days of life. However, its development has never been investigated in humans. Here we develop a new interface to measure facial somatosensation in newborn infants. The novel system allows to measure neuronal responses to touching the face of the subject by synchronously recording scalp electroencephalography (EEG) and the force applied by the experimenter. This is based on a dedicated force transducer that can be worn on the finger underneath a clinical nitrile glove and linked to a commercial EEG acquisition system. The calibrated device measures the pressure applied by the investigator when tapping the skin concurrently with the resulting brain response. With this system, we were able to demonstrate that taps of 192 mN (mean) reliably elicited facial somatosensory responses in 7 pre-term infants. These responses had a time course similar to those following limbs stimulation, but more lateral topographical distribution consistent with body representations in primary somatosensory areas. The method introduced can therefore be used to reliably measure facial somatosensory responses in vulnerable infants.
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Affiliation(s)
- Alessandro Donadio
- Department of Engineering, Università Campus Bio-Medico di Roma, Roma, Italy
| | - Kimberley Whitehead
- Department of Neuroscience, Physiology and Pharmacology, University College London, Gower Street, United Kingdom
| | - Franck Gonzalez
- Department of Bioengineering, Imperial College of Science, Technology and Medicine, South Kensington Campus, London, United Kingdom
| | - Elisabeth Wilhelm
- Department of Bioengineering, Imperial College of Science, Technology and Medicine, South Kensington Campus, London, United Kingdom
| | - Domenico Formica
- Department of Engineering, Università Campus Bio-Medico di Roma, Roma, Italy
| | - Judith Meek
- Elizabeth Garrett Anderson Obstetric Wing, University College London Hospitals, United Kingdom
| | - Lorenzo Fabrizi
- Department of Neuroscience, Physiology and Pharmacology, University College London, Gower Street, United Kingdom
| | - Etienne Burdet
- Department of Bioengineering, Imperial College of Science, Technology and Medicine, South Kensington Campus, London, United Kingdom
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19
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Cusack R, McCuaig O, Linke AC. Methodological challenges in the comparison of infant fMRI across age groups. Dev Cogn Neurosci 2018; 33:194-205. [PMID: 29158073 PMCID: PMC6969274 DOI: 10.1016/j.dcn.2017.11.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 09/29/2017] [Accepted: 11/07/2017] [Indexed: 01/31/2023] Open
Abstract
Functional MRI (fMRI) in infants is rapidly growing and providing fundamental insights into the origins of brain functions. Comparing brain development at different ages is particularly powerful, but there are a number of methodological challenges that must be addressed if confounds are to be avoided. With development, brains change in composition in a way that alters their tissue contrast, and in size, shape, and gyrification, requiring careful image processing strategies and age-specific standard templates. The hemodynamic response and other aspects of physiology change with age, requiring careful paradigm design and analysis methods. Infants move more, particularly around the second year of age, and move in a different way to adults. This movement can lead to distortion in fMRI images, and requires tailored techniques during acquisition and post-processing. Infants have different sleep patterns, and their sensory periphery is changing macroscopically and in its neural pathways. Finally, once data have been acquired and analyzed, there are important considerations during mapping of brain processes and cognitive functions across age groups. In summary, new methods are critical to the comparison across age groups, and key to maximizing the rate at which infant fMRI can provide insight into the fascinating questions about the origin of cognition.
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Affiliation(s)
- Rhodri Cusack
- Brain and Mind Institute, Western University, Canada; Trinity College, Dublin, Ireland.
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20
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Neil JJ, Smyser CD. Recent advances in the use of MRI to assess early human cortical development. JOURNAL OF MAGNETIC RESONANCE (SAN DIEGO, CALIF. : 1997) 2018; 293:56-69. [PMID: 29894905 PMCID: PMC6047926 DOI: 10.1016/j.jmr.2018.05.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 05/17/2018] [Accepted: 05/21/2018] [Indexed: 05/18/2023]
Abstract
Over the past decade, a number of advanced magnetic resonance-based methods have been brought to bear on questions related to early development of the human cerebral cortex. Herein, we describe studies employing analysis of cortical surface folding (cortical cartography), cortical microstructure (diffusion anisotropy), and cortically-based functional networks (resting state-functional connectivity MRI). The fundamentals of each MR method are described, followed by a discussion of application of the method to developing cortex and potential clinical uses. We use premature birth as an exemplar of how these modalities can be used to investigate the effects of medical and environmental variables on early cortical development.
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Affiliation(s)
- Jeffrey J Neil
- Department of Pediatric Neurology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, United States.
| | - Christopher D Smyser
- Departments of Neurology, Pediatrics and Radiology, Washington University School of Medicine, 660 S. Euclid Ave., Campus Box 8111, St. Louis, MO 63110, United States.
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21
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Dall'Orso S, Steinweg J, Allievi AG, Edwards AD, Burdet E, Arichi T. Somatotopic Mapping of the Developing Sensorimotor Cortex in the Preterm Human Brain. Cereb Cortex 2018; 28:2507-2515. [PMID: 29901788 PMCID: PMC5998947 DOI: 10.1093/cercor/bhy050] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 02/13/2018] [Indexed: 01/26/2023] Open
Abstract
In the mature mammalian brain, the primary somatosensory and motor cortices are known to be spatially organized such that neural activity relating to specific body parts can be somatopically mapped onto an anatomical "homunculus". This organization creates an internal body representation which is fundamental for precise motor control, spatial awareness and social interaction. Although it is unknown when this organization develops in humans, animal studies suggest that it may emerge even before the time of normal birth. We therefore characterized the somatotopic organization of the primary sensorimotor cortices using functional MRI and a set of custom-made robotic tools in 35 healthy preterm infants aged from 31 + 6 to 36 + 3 weeks postmenstrual age. Functional responses induced by somatosensory stimulation of the wrists, ankles, and mouth had a distinct spatial organization as seen in the characteristic mature homunculus map. In comparison to the ankle, activation related to wrist stimulation was significantly larger and more commonly involved additional areas including the supplementary motor area and ipsilateral sensorimotor cortex. These results are in keeping with early intrinsic determination of a somatotopic map within the primary sensorimotor cortices. This may explain why acquired brain injury in this region during the preterm period cannot be compensated for by cortical reorganization and therefore can lead to long-lasting motor and sensory impairment.
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Affiliation(s)
- S Dall'Orso
- Department of Bioengineering, Imperial College London, London, UK
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, King's Health Partners, St Thomas' Hospital, London, UK
| | - J Steinweg
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, King's Health Partners, St Thomas' Hospital, London, UK
| | - A G Allievi
- Department of Bioengineering, Imperial College London, London, UK
| | - A D Edwards
- Department of Bioengineering, Imperial College London, London, UK
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, King's Health Partners, St Thomas' Hospital, London, UK
| | - E Burdet
- Department of Bioengineering, Imperial College London, London, UK
| | - T Arichi
- Department of Bioengineering, Imperial College London, London, UK
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, King's Health Partners, St Thomas' Hospital, London, UK
- Paediatric Neurosciences, Evelina London Children's Hospital, St Thomas' Hospital, London, UK
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22
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Linke AC, Wild C, Zubiaurre-Elorza L, Herzmann C, Duffy H, Han VK, Lee DSC, Cusack R. Disruption to functional networks in neonates with perinatal brain injury predicts motor skills at 8 months. NEUROIMAGE-CLINICAL 2018; 18:399-406. [PMID: 29487797 PMCID: PMC5816024 DOI: 10.1016/j.nicl.2018.02.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 01/15/2018] [Accepted: 02/02/2018] [Indexed: 11/19/2022]
Abstract
Objective Functional connectivity magnetic resonance imaging (fcMRI) of neonates with perinatal brain injury could improve prediction of motor impairment before symptoms manifest, and establish how early brain organization relates to subsequent development. This cohort study is the first to describe and quantitatively assess functional brain networks and their relation to later motor skills in neonates with a diverse range of perinatal brain injuries. Methods Infants (n = 65, included in final analyses: n = 53) were recruited from the neonatal intensive care unit (NICU) and were stratified based on their age at birth (premature vs. term), and on whether neuropathology was diagnosed from structural MRI. Functional brain networks and a measure of disruption to functional connectivity were obtained from 14 min of fcMRI acquired during natural sleep at term-equivalent age. Results Disruption to connectivity of the somatomotor and frontoparietal executive networks predicted motor impairment at 4 and 8 months. This disruption in functional connectivity was not found to be driven by differences between clinical groups, or by any of the specific measures we captured to describe the clinical course. Conclusion fcMRI was predictive over and above other clinical measures available at discharge from the NICU, including structural MRI. Motor learning was affected by disruption to somatomotor networks, but also frontoparietal executive networks, which supports the functional importance of these networks in early development. Disruption to these two networks might be best addressed by distinct intervention strategies.
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Affiliation(s)
- Annika C Linke
- Brain and Mind Institute, Western University, London, Canada; Brain Development Imaging Lab, San Diego State University, San Diego, USA.
| | - Conor Wild
- Brain and Mind Institute, Western University, London, Canada
| | | | | | - Hester Duffy
- Brain and Mind Institute, Western University, London, Canada
| | - Victor K Han
- Children's Health Research Institute, London, Canada.
| | - David S C Lee
- Children's Health Research Institute, London, Canada.
| | - Rhodri Cusack
- Brain and Mind Institute, Western University, London, Canada; Children's Health Research Institute, London, Canada; Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland.
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23
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Arichi T, Whitehead K, Barone G, Pressler R, Padormo F, Edwards AD, Fabrizi L. Localization of spontaneous bursting neuronal activity in the preterm human brain with simultaneous EEG-fMRI. eLife 2017; 6. [PMID: 28893378 PMCID: PMC5595428 DOI: 10.7554/elife.27814] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Accepted: 08/03/2017] [Indexed: 12/21/2022] Open
Abstract
Electroencephalographic recordings from the developing human brain are characterized by spontaneous neuronal bursts, the most common of which is the delta brush. Although similar events in animal models are known to occur in areas of immature cortex and drive their development, their origin in humans has not yet been identified. Here, we use simultaneous EEG-fMRI to localise the source of delta brush events in 10 preterm infants aged 32–36 postmenstrual weeks. The most frequent patterns were left and right posterior-temporal delta brushes which were associated in the left hemisphere with ipsilateral BOLD activation in the insula only; and in the right hemisphere in both the insular and temporal cortices. This direct measure of neural and hemodynamic activity shows that the insula, one of the most densely connected hubs in the developing cortex, is a major source of the transient bursting events that are critical for brain maturation.
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Affiliation(s)
- Tomoki Arichi
- Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom.,Department of Bioengineering, Imperial College London, London, United Kingdom
| | - Kimberley Whitehead
- Department of Neuroscience, Physiology and Pharmacology, University College London, London, United Kingdom
| | - Giovanni Barone
- Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom.,Department of Pediatrics, Catholic University of Sacred Heart, Rome, Italy
| | - Ronit Pressler
- Clinical Neurosciences, UCL-Institute of Child Health, London, United Kingdom
| | - Francesco Padormo
- Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom.,Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, United States
| | - A David Edwards
- Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom.,Department of Bioengineering, Imperial College London, London, United Kingdom
| | - Lorenzo Fabrizi
- Department of Neuroscience, Physiology and Pharmacology, University College London, London, United Kingdom
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24
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Hinojosa-Rodríguez M, Harmony T, Carrillo-Prado C, Van Horn JD, Irimia A, Torgerson C, Jacokes Z. Clinical neuroimaging in the preterm infant: Diagnosis and prognosis. Neuroimage Clin 2017; 16:355-368. [PMID: 28861337 PMCID: PMC5568883 DOI: 10.1016/j.nicl.2017.08.015] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Revised: 08/11/2017] [Accepted: 08/12/2017] [Indexed: 01/30/2023]
Abstract
Perinatal care advances emerging over the past twenty years have helped to diminish the mortality and severe neurological morbidity of extremely and very preterm neonates (e.g., cystic Periventricular Leukomalacia [c-PVL] and Germinal Matrix Hemorrhage - Intraventricular Hemorrhage [GMH-IVH grade 3-4/4]; 22 to < 32 weeks of gestational age, GA). However, motor and/or cognitive disabilities associated with mild-to-moderate white and gray matter injury are frequently present in this population (e.g., non-cystic Periventricular Leukomalacia [non-cystic PVL], neuronal-axonal injury and GMH-IVH grade 1-2/4). Brain research studies using magnetic resonance imaging (MRI) report that 50% to 80% of extremely and very preterm neonates have diffuse white matter abnormalities (WMA) which correspond to only the minimum grade of severity. Nevertheless, mild-to-moderate diffuse WMA has also been associated with significant affectations of motor and cognitive activities. Due to increased neonatal survival and the intrinsic characteristics of diffuse WMA, there is a growing need to study the brain of the premature infant using non-invasive neuroimaging techniques sensitive to microscopic and/or diffuse lesions. This emerging need has led the scientific community to try to bridge the gap between concepts or ideas from different methodologies and approaches; for instance, neuropathology, neuroimaging and clinical findings. This is evident from the combination of intense pre-clinical and clinicopathologic research along with neonatal neurology and quantitative neuroimaging research. In the following review, we explore literature relating the most frequently observed neuropathological patterns with the recent neuroimaging findings in preterm newborns and infants with perinatal brain injury. Specifically, we focus our discussions on the use of neuroimaging to aid diagnosis, measure morphometric brain damage, and track long-term neurodevelopmental outcomes.
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Affiliation(s)
- Manuel Hinojosa-Rodríguez
- Unidad de Investigación en Neurodesarrollo, Departamento de Neurobiología Conductual y Cognitiva, Instituto de Neurobiología, Universidad Nacional Autónoma de México (UNAM), Campus Juriquilla, Mexico
| | - Thalía Harmony
- Unidad de Investigación en Neurodesarrollo, Departamento de Neurobiología Conductual y Cognitiva, Instituto de Neurobiología, Universidad Nacional Autónoma de México (UNAM), Campus Juriquilla, Mexico
| | - Cristina Carrillo-Prado
- Unidad de Investigación en Neurodesarrollo, Departamento de Neurobiología Conductual y Cognitiva, Instituto de Neurobiología, Universidad Nacional Autónoma de México (UNAM), Campus Juriquilla, Mexico
| | - John Darrell Van Horn
- USC Mark and Mary Stevens Neuroimaging and Informatics Institute, 2025 Zonal Avenue, SHN, Los Angeles, California 90033, USA
| | - Andrei Irimia
- USC Mark and Mary Stevens Neuroimaging and Informatics Institute, 2025 Zonal Avenue, SHN, Los Angeles, California 90033, USA
| | - Carinna Torgerson
- USC Mark and Mary Stevens Neuroimaging and Informatics Institute, 2025 Zonal Avenue, SHN, Los Angeles, California 90033, USA
| | - Zachary Jacokes
- USC Mark and Mary Stevens Neuroimaging and Informatics Institute, 2025 Zonal Avenue, SHN, Los Angeles, California 90033, USA
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25
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Understanding Brain Reorganization in Infants With Perinatal Stroke Through Neuroexcitability and Neuroimaging. Pediatr Phys Ther 2017; 29:173-178. [PMID: 28350777 PMCID: PMC5560124 DOI: 10.1097/pep.0000000000000365] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE The primary aim of this proposed study is to evaluate brain reorganization patterns in infants with perinatal stroke between 3 and 5 months of age using transcranial magnetic stimulation and magnetic resonance imaging, with the addition of the General Movements Assessment. A secondary aim is to demonstrate feasibility and safety of infant-appropriate brain assessment protocols. METHODS Ten infants with perinatal stroke will be enrolled. In this exploratory study, infants will first receive magnetic resonance imaging scanning during natural sleep to examine their corticospinal tract integrity. Infants will then receive transcranial magnetic stimulation to assess their corticomotor excitability. A General Movements Assessment video of at least 5 minutes will also be recorded. DISCUSSION Study results will enhance our understanding of brain reorganization in infants with perinatal stroke. We expect these results will also guide the development of early interventions designed to mitigate maladaptive neuroplastic changes and improve long-term motor outcomes.
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26
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Raybaud C. MR assessment of pediatric hydrocephalus: a road map. Childs Nerv Syst 2016; 32:19-41. [PMID: 26337698 DOI: 10.1007/s00381-015-2888-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 08/11/2015] [Indexed: 12/12/2022]
Abstract
PURPOSE This study was conducted to design a rational approach to the MR diagnosis of hydrocephalus based on a pathophysiologic reevaluation of its possible mechanisms and to apply it to the different etiological contexts. METHOD A review of the literature reports describing new physiologic models of production and absorption and of the hydrodynamics of the CSF was made. RESULTS Besides the secretion of CSF by the choroid plexuses, and its passive, pressure-dependent transdural absorption (arachnoid villi, dural clefts, cranial, and spinal nerve sheaths), water transporters, aquaporins, allow water (if not ions and organic molecules) to exchange freely between the brain parenchyma and the CSF spaces across the ependymal and the pial interfaces (including the Virchow-Robin spaces). Consequently, the CSF bulk flow is not necessarily global, and situations of balanced absorption-secretion may occur separately in different CSF compartments such as the ventricular, intracranial, or intraspinal CSF spaces. This means that rather than from a hypothetical pressure gradient from the plexuses to the dural sinuses, the dynamics of the CSF depend on the force provided in those different compartments by the arterial systolic pulsation of the pericerebral (mostly), intracerebral, and intraventricular (choroid plexuses) vascular beds. CONCLUSION Using MR imaging, diverse varieties of hydrocephalus may tentatively be explained by applying those concepts to the correspondingly diverse causal diseases. Hopefully, this may have an impact on the choice of the treatment strategies also.
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Affiliation(s)
- Charles Raybaud
- Division of Neuroradiology, Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
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27
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Pavaine J, Young JM, Morgan BR, Shroff M, Raybaud C, Taylor MJ. Diffusion tensor imaging-based assessment of white matter tracts and visual-motor outcomes in very preterm neonates. Neuroradiology 2015; 58:301-10. [PMID: 26687071 DOI: 10.1007/s00234-015-1625-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 11/09/2015] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The purpose of this study was to assess the impact of brain injury on white matter development and long-term outcomes in very preterm (VPT) neonates. METHODS Eighty-five VPT neonates (born <32/40 weeks gestational age (GA)) scanned within 2 weeks of birth were divided into three groups based on the presence of perinatal cerebral injury: (i) no injury, (ii) mild/moderate injury and (iii) severe injury. Diffusion tensor imaging (DTI) was acquired for each neonate and fractional anisotropy (FA), and diffusivity measures were calculated in the posterior limb of the internal capsule (PLIC) and optic radiation (OR). At 2 and 4 years of age, 41 and 44 children were assessed for motor and visual-motor abilities. Analyses determined the relation between GA and DTI measures, injury groups and DTI measures as well as developmental assessments. RESULTS GA was related to all DTI measures within the PLIC bilaterally, FA in the OR bilaterally and AD in the left OR. The severely injured group had significantly different DTI measures in the left PLIC compared to the other two groups, independent of lateralization of lesions. Group differences in the left OR were also found, due to higher incidence of the white matter injury in the left hemisphere. No differences were found between groups and outcome measures at 2 and 4 years, with the exception of destructive periventricular venous haemorrhagic infarction (PVHI). CONCLUSIONS DTI measures of the PLIC and OR were affected by injury in VPT neonates. These findings seen shortly after birth did not always translate into long-term motor and visual-motor impairments suggesting compensatory mechanisms.
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Affiliation(s)
- Julia Pavaine
- Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada. .,Department of Medical Imaging, University of Toronto, Toronto, ON, Canada.
| | - Julia M Young
- Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.,Department of Psychology, University of Toronto, Toronto, ON, Canada
| | - Benjamin R Morgan
- Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Manohar Shroff
- Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.,Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Charles Raybaud
- Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.,Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Margot J Taylor
- Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.,Department of Medical Imaging, University of Toronto, Toronto, ON, Canada.,Department of Psychology, University of Toronto, Toronto, ON, Canada
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28
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Neonatal DTI early after birth predicts motor outcome in preterm infants with periventricular hemorrhagic infarction. Pediatr Res 2015; 78:298-303. [PMID: 25978802 DOI: 10.1038/pr.2015.94] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Accepted: 02/05/2015] [Indexed: 12/23/2022]
Abstract
BACKGROUND To determine the association between early neonatal diffusion tensor imaging (DTI) and the development of unilateral spastic cerebral palsy (USCP) in preterm infants with periventricular hemorrhagic infarction (PVHI). METHODS Preterm infants with PVHI were assessed with early (≤4 wk after birth) and term-equivalent age MRI-DTI. Involvement of corticospinal tracts was assessed by visual assessment of the posterior limb of the internal capsule (PLIC) on DTI (classified asymmetrical, equivocal, or symmetrical) and by an atlas-based approach calculating fractional anisotropy asymmetry index in the PLIC. Motor outcome was assessed at ≥15 mo corrected age. RESULTS Seven out of 23 infants with PVHI developed USCP. Their PLIC was visually scored as asymmetrical in 6 and equivocal in 1 on the early DTI. Thirteen out of 16 infants with a symmetrical motor development had a symmetrical PLIC on early DTI, the remaining 3 were equivocal. All infants with USCP had a fractional anisotropy asymmetry index of >0.05 (optimal cut-off value) on early DTI. In infants with a symmetrical motor development (n = 16), 14 had an asymmetry index ≤0.05 while 2 had an index >0.05. CONCLUSION DTI in preterm infants with PVHI within a few weeks after birth is associated with later motor development.
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29
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Abstract
Advances in methodology have led to expanded application of resting-state functional MRI (rs-fMRI) to the study of term and prematurely born infants during the first years of life, providing fresh insight into the earliest forms of functional cerebral development. In this review, we detail our evolving understanding of the use of rs-fMRI for studying neonates. We initially focus on the biological processes of cortical development related to resting-state network development. We then review technical issues principally affecting neonatal investigations, including the effects of subject motion during acquisition and image distortions related to magnetic susceptibility effects. We next summarize the literature in which rs-fMRI is used to study normal brain development during the early postnatal period, the effects of prematurity, and the effects of cerebral injury. Finally, we review potential future directions for the field, such as the use of complementary imaging modalities and advanced analysis techniques.
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Affiliation(s)
- Christopher D. Smyser
- Division of Pediatric Neurology, Department of Neurology, Washington University School of Medicine, St. Louis, MO
| | - Jeffrey J. Neil
- Department of Neurology, Boston Children’s Hospital, Boston, MA,Corresponding author. Jeff Neil, MD, PhD, Neurology, Boston Children's Hospital, 333 Longwood Avenue, LO 450, Boston, MA 02115, phone (617) 355-6388, fax (617) 730-0284,
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30
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Allievi AG, Arichi T, Gordon AL, Burdet E. Technology-aided assessment of sensorimotor function in early infancy. Front Neurol 2014; 5:197. [PMID: 25324827 PMCID: PMC4181230 DOI: 10.3389/fneur.2014.00197] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 09/17/2014] [Indexed: 01/31/2023] Open
Abstract
There is a pressing need for new techniques capable of providing accurate information about sensorimotor function during the first 2 years of childhood. Here, we review current clinical methods and challenges for assessing motor function in early infancy, and discuss the potential benefits of applying technology-assisted methods. We also describe how the use of these tools with neuroimaging, and in particular functional magnetic resonance imaging (fMRI), can shed new light on the intra-cerebral processes underlying neurodevelopmental impairment. This knowledge is of particular relevance in the early infant brain, which has an increased capacity for compensatory neural plasticity. Such tools could bring a wealth of knowledge about the underlying pathophysiological processes of diseases such as cerebral palsy; act as biomarkers to monitor the effects of possible therapeutic interventions; and provide clinicians with much needed early diagnostic information.
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Affiliation(s)
- Alessandro G Allievi
- Human Robotics Group, Department of Bioengineering, Imperial College London , London , UK
| | - Tomoki Arichi
- Human Robotics Group, Department of Bioengineering, Imperial College London , London , UK ; Department of Perinatal Imaging and Health, King's College London , London , UK
| | - Anne L Gordon
- Paediatric Neurosciences, Evelina London Children's Hospital, Guy's and St Thomas' NHS Trust , London , UK ; Institute of Psychiatry, Psychology and Neuroscience, Kings College London , London , UK
| | - Etienne Burdet
- Human Robotics Group, Department of Bioengineering, Imperial College London , London , UK
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31
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Allievi AG, Arichi T, Gordon AL, Burdet E. Technology-aided assessment of sensorimotor function in early infancy. Front Neurol 2014; 5:197. [PMID: 25324827 DOI: 10.3389/fneur.2014.00197/abstract] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 09/17/2014] [Indexed: 05/23/2023] Open
Abstract
There is a pressing need for new techniques capable of providing accurate information about sensorimotor function during the first 2 years of childhood. Here, we review current clinical methods and challenges for assessing motor function in early infancy, and discuss the potential benefits of applying technology-assisted methods. We also describe how the use of these tools with neuroimaging, and in particular functional magnetic resonance imaging (fMRI), can shed new light on the intra-cerebral processes underlying neurodevelopmental impairment. This knowledge is of particular relevance in the early infant brain, which has an increased capacity for compensatory neural plasticity. Such tools could bring a wealth of knowledge about the underlying pathophysiological processes of diseases such as cerebral palsy; act as biomarkers to monitor the effects of possible therapeutic interventions; and provide clinicians with much needed early diagnostic information.
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Affiliation(s)
- Alessandro G Allievi
- Human Robotics Group, Department of Bioengineering, Imperial College London , London , UK
| | - Tomoki Arichi
- Human Robotics Group, Department of Bioengineering, Imperial College London , London , UK ; Department of Perinatal Imaging and Health, King's College London , London , UK
| | - Anne L Gordon
- Paediatric Neurosciences, Evelina London Children's Hospital, Guy's and St Thomas' NHS Trust , London , UK ; Institute of Psychiatry, Psychology and Neuroscience, Kings College London , London , UK
| | - Etienne Burdet
- Human Robotics Group, Department of Bioengineering, Imperial College London , London , UK
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