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van 't Westende C, Steggerda SJ, Jansen L, van den Berg-Huysmans AA, van de Pol LA, Wiggers-de Bruine FT, Stam CJ, Peeters-Scholte CMPCD. Combining advanced MRI and EEG techniques better explains long-term motor outcome after very preterm birth. Pediatr Res 2022; 91:1874-1881. [PMID: 34031571 DOI: 10.1038/s41390-021-01571-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 02/20/2021] [Accepted: 04/26/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Preterm born children are at high risk for adverse motor neurodevelopment. The aim of this study was to establish the relationship between motor outcome and advanced magnetic resonance imaging (MRI) and electroencephalography (EEG) measures. METHODS In a prospective cohort study of 64 very preterm born children, the motor outcome was assessed at 9.83 (SD 0.70) years. Volumetric MRI, diffusion tensor imaging (DTI), and EEG were acquired at 10.85 (SD 0.49) years. We investigated associations between motor outcome and brain volumes (white matter, deep gray matter, cerebellum, and ventricles), white matter integrity (fractional anisotropy and mean, axial and radial diffusivity), and brain activity (upper alpha (A2) functional connectivity and relative A2 power). The independence of associations with motor outcome was investigated with a final model. For each technique, the measure with the strongest association was selected to avoid multicollinearity. RESULTS Ventricular volume, radial diffusivity, mean diffusivity, relative A2 power, and A2 functional connectivity were significantly correlated to motor outcome. The final model showed that ventricular volume and relative A2 power were independently associated with motor outcome (B = -9.42 × 10-5, p = 0.027 and B = 28.9, p = 0.007, respectively). CONCLUSIONS This study suggests that a lasting interplay exists between brain structure and function that might underlie motor outcome at school age. IMPACT This is the first study that investigates the relationships between motor outcome and brain volumes, DTI, and brain function in preterm born children at school age. Ventricular volume and relative upper alpha power on EEG have an independent relation with motor outcome in preterm born children at school age. This suggests that there is a lasting interplay between structure and function that underlies adverse motor outcome.
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Affiliation(s)
- Charlotte van 't Westende
- Department of Child Neurology, Amsterdam University Medical Centers, AMC Site, Amsterdam, The Netherlands. .,Department of Neonatology, Leiden University Medical Center, Leiden, The Netherlands.
| | - Sylke J Steggerda
- Department of Neonatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Lisette Jansen
- Department of Psychology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Laura A van de Pol
- Department of Child Neurology, Amsterdam University Medical Centers, AMC Site, Amsterdam, The Netherlands
| | | | - Cornelis J Stam
- Department of Clinical Neurophysiology, Amsterdam University Medical Centers, VUmc Site, Amsterdam, The Netherlands
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Rosenstock T, Häni L, Grittner U, Schlinkmann N, Ivren M, Schneider H, Raabe A, Vajkoczy P, Seidel K, Picht T. Bicentric validation of the navigated transcranial magnetic stimulation motor risk stratification model. J Neurosurg 2021; 136:1194-1206. [PMID: 34534966 DOI: 10.3171/2021.3.jns2138] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 03/23/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The authors sought to validate the navigated transcranial magnetic stimulation (nTMS)-based risk stratification model. The postoperative motor outcome in glioma surgery may be preoperatively predicted based on data derived by nTMS. The tumor-to-tract distance (TTD) and the interhemispheric resting motor threshold (RMT) ratio (as a surrogate parameter for cortical excitability) emerged as major factors related to a new postoperative deficit. METHODS In this bicentric study, a consecutive prospectively collected cohort underwent nTMS mapping with diffusion tensor imaging (DTI) fiber tracking of the corticospinal tract prior to surgery of motor eloquent gliomas. The authors analyzed whether the following items were associated with the patient's outcome: patient characteristics, TTD, RMT value, and diffusivity parameters (fractional anisotropy [FA] and apparent diffusion coefficient [ADC]). The authors assessed the validity of the published risk stratification model and derived a new model. RESULTS A new postoperative motor deficit occurred in 36 of 165 patients (22%), of whom 20 patients still had a deficit after 3 months (13%; n3 months = 152). nTMS-verified infiltration of the motor cortex as well as a TTD ≤ 8 mm were confirmed as risk factors. No new postoperative motor deficit occurred in patients with TTD > 8 mm. In contrast to the previous risk stratification, the RMT ratio was not substantially correlated with the motor outcome, but high RMT values of both the tumorous and healthy hemisphere were associated with worse motor outcome. The FA value was negatively associated with worsening of motor outcome. Accuracy analysis of the final model showed a high negative predictive value (NPV), so the preoperative application may accurately predict the preservation of motor function in particular (day of discharge: sensitivity 47.2%, specificity 90.7%, positive predictive value [PPV] 58.6%, NPV 86.0%; 3 months: sensitivity 85.0%, specificity 78.8%, PPV 37.8%, NPV 97.2%). CONCLUSIONS This bicentric validation analysis further improved the model by adding the FA value of the corticospinal tract, demonstrating the relevance of nTMS/nTMS-based DTI fiber tracking for clinical decision making.
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Affiliation(s)
- Tizian Rosenstock
- 1Department of Neurosurgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin.,2Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Germany
| | - Levin Häni
- 3Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Ulrike Grittner
- 4Institute of Biometry and Clinical Epidemiology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; and
| | - Nicolas Schlinkmann
- 1Department of Neurosurgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin
| | - Meltem Ivren
- 1Department of Neurosurgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin
| | - Heike Schneider
- 1Department of Neurosurgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin
| | - Andreas Raabe
- 3Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Peter Vajkoczy
- 1Department of Neurosurgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin
| | - Kathleen Seidel
- 3Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Thomas Picht
- 1Department of Neurosurgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin.,5Cluster of Excellence: "Matters of Activity. Image Space Material," Humboldt University, Berlin, Germany
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Lakatos A, Kolossváry M, Szabó M, Jermendy Á, Barta H, Gyebnár G, Rudas G, Kozák LR. Neurodevelopmental effect of intracranial hemorrhage observed in hypoxic ischemic brain injury in hypothermia-treated asphyxiated neonates - an MRI study. BMC Pediatr 2019; 19:430. [PMID: 31718607 PMCID: PMC6849254 DOI: 10.1186/s12887-019-1777-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 10/09/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Identification of early signs of hypoxic ischemic encephalopathy (HIE) with magnetic resonance imaging (MRI) has proven of prognostic significance. Yet, the importance of intracranial hemorrhage (ICH), being present concomitantly had not been investigated yet, despite the known influence of hypothermia on hemostasis. We aimed to determine whether presence of ICH on MRI alongside the signs of HIE have an impact on prognosis in neonates with the clinical diagnosis of HIE. METHODS A retrospective study of consecutively sampled 108 asphyxiated term infants admitted to a tertiary neonatal intensive care unit (between 2007 and 2016), treated with whole body hypothermia and having brain MRI within 1 week of life was conducted. Presence or absence of HIE signs on MRI (basal ganglia-thalamus, watershed pattern and total brain injury) and on MR spectroscopy (lactate peak with decreased normal metabolites measured by Lac/NAA ratio) and/or of the five major types of ICH were recorded. Neurodevelopmental outcome was measured with Bayley Scales of Infant Development-II (BSID-II) test. Death or abnormal neurodevelopment (BSID-II score < 85) was defined as poor outcome in Chi-square test. Multivariate logistic regression analysis was performed on survivors. RESULTS MRI and MR-spectroscopy (MRS) signs of HIE were present in 72% (n = 78). 36% (n = 39) of neonates had ICH, being mainly small in size. Chi-square test showed a relationship between neurodevelopmental outcome and initial MRI. Unadjusted logistic regression showed that neonates presenting MRI and MRS signs of HIE have 6.23 times higher odds for delayed mental development (OR = 6.2292; CI95% = [1.2642; 30.6934], p = 0.0246), than infants without imaging alterations; with no ICH effect on outcome. Adjustment for clinical and imaging parameters did not change the pattern of results, i.e. HIE remained an independent risk factor for delayed neurodevelopment (OR = 6.2496; CI95% = [1.2018; 32.4983], p = 0.0294), while ICH remained to have no significant effect. CONCLUSION HIE related MRI abnormalities proved to be important prognostic factors of poor outcome in cooled asphyxiated infants when present, suggesting that early MRI with MRS is beneficial for prognostication. Interestingly, ICHs present in about one third of all cases had no significant effect on neurodevelopmental outcome, despite the known hemostasis altering effects of hypothermia.
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Affiliation(s)
- Andrea Lakatos
- Department of Neuroradiology, Medical Imaging Centre, Semmelweis University, Balassa u. 6, Budapest, 1083, Hungary
| | - Márton Kolossváry
- MTA-SE "Lendület" Cardiovascular Imaging Research Group, Semmelweis University, Városmajor u. 68, Budapest, 1122, Hungary
| | - Miklós Szabó
- First Department of Paediatrics, Semmelweis University, Bókay u. 53-54, Budapest, 1083, Hungary
| | - Ágnes Jermendy
- First Department of Paediatrics, Semmelweis University, Bókay u. 53-54, Budapest, 1083, Hungary
| | - Hajnalka Barta
- First Department of Paediatrics, Semmelweis University, Bókay u. 53-54, Budapest, 1083, Hungary
| | - Gyula Gyebnár
- Department of Neuroradiology, Medical Imaging Centre, Semmelweis University, Balassa u. 6, Budapest, 1083, Hungary
| | - Gábor Rudas
- Department of Neuroradiology, Medical Imaging Centre, Semmelweis University, Balassa u. 6, Budapest, 1083, Hungary
| | - Lajos R Kozák
- Department of Neuroradiology, Medical Imaging Centre, Semmelweis University, Balassa u. 6, Budapest, 1083, Hungary.
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Barkovich MJ, Li Y, Desikan RS, Barkovich AJ, Xu D. Challenges in pediatric neuroimaging. Neuroimage 2019; 185:793-801. [PMID: 29684645 PMCID: PMC6197938 DOI: 10.1016/j.neuroimage.2018.04.044] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 04/13/2018] [Accepted: 04/19/2018] [Indexed: 02/04/2023] Open
Abstract
Pediatric neuroimaging is challenging due the rapid structural, metabolic, and functional changes that occur in the developing brain. A specially trained team is needed to produce high quality diagnostic images in children, due to their small physical size and immaturity. Patient motion, cooperation and medical condition dictate the methods and equipment used. A customized approach tailored to each child's age and functional status with the appropriate combination of dedicated staff, imaging hardware, and software is key; these range from low-tech techniques, such as feed and swaddle, to specialized small bore MRI scanners, MRI compatible incubators and neonatal head coils. New pre-and post-processing techniques can also compensate for the motion artifacts and low signal that often degrade neonatal scans.
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Affiliation(s)
- Matthew J Barkovich
- Department of Radiology and Diagnostic Imaging, University of California, San Francisco 505 Parnassus Avenue, Room L352, San Francisco, CA 94143-0628, United States.
| | - Yi Li
- Department of Radiology and Diagnostic Imaging, University of California, San Francisco 505 Parnassus Avenue, Room L352, San Francisco, CA 94143-0628, United States
| | - Rahul S Desikan
- Department of Radiology and Diagnostic Imaging, University of California, San Francisco 505 Parnassus Avenue, Room L352, San Francisco, CA 94143-0628, United States
| | - A James Barkovich
- Department of Radiology and Diagnostic Imaging, University of California, San Francisco 505 Parnassus Avenue, Room L352, San Francisco, CA 94143-0628, United States; UCSF-Benioff Children's Hospital, 1975 4th St, San Francisco, CA 94158, United States
| | - Duan Xu
- Department of Radiology and Diagnostic Imaging, University of California, San Francisco 505 Parnassus Avenue, Room L352, San Francisco, CA 94143-0628, United States; UCSF-Benioff Children's Hospital, 1975 4th St, San Francisco, CA 94158, United States
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Diffusion tensor imaging predicts motor outcome in children with acquired brain injury. Brain Imaging Behav 2018; 11:1373-1384. [PMID: 27734299 DOI: 10.1007/s11682-016-9637-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Rehabilitation in children with acquired brain injury is a challenging endeavour. There is a large variability in motor recovery between patients, and a need to optimize therapies by exploiting cerebral plasticity and recovery mechanisms. This retrospective study aims to identify tract-based markers that could serve as predictors of functional outcome following rehabilitation. METHODS Twenty-nine children with traumatic brain injury (n = 14) or stroke (n = 15) underwent a 3 T Magnetic Resonance Imaging (MRI) measurement, including Diffusion Tensor Imaging (DTI) between admission to the Hospital and onset of rehabilitation therapy at the Rehabilitation Centre. The Functional Independence Measure for Children (WeeFIM) was routinely applied at admission and discharge from the Rehabilitation Centre. Distinguishing between children with good versus poor functional independence was performed using ROC-analysis. A non-parametric partial correlation analysis between the DTI and WeeFIM motor scores was performed with age, time in rehabilitation, and time of MRI scan after injury as covariates. RESULTS Mean fractional anisotropy (FA) from the DTI in the ipsilesional corticospinal-tract provided the highest predictive accuracy (sensitivity = 95 %, specificity = 78 %, Youden Index = 0.73, Area under the curve = 0.9), in comparison to the lesion volume or other clinical variables. Mean FA of the ipsilesional corticospinal-tract correlated positively with the WeeFIM discharge motor scores (ρ = 0.547, p = 0.004). Prediction was poorer for the lesion volume or Glasgow Coma Scale. CONCLUSION The results suggest that DTI data could improve the prediction of functional outcome after rehabilitation in children and adolescents with stroke or traumatic brain injury. Specifically, mean FA shows the highest predictive accuracy in comparison to lesion volume or clinical scales.
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Roberts RM, Mathias JL, Rose SE. Diffusion Tensor Imaging (DTI) findings following pediatric non-penetrating TBI: a meta-analysis. Dev Neuropsychol 2015; 39:600-37. [PMID: 25470224 PMCID: PMC4270261 DOI: 10.1080/87565641.2014.973958] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
This study meta-analyzed research examining Diffusion Tensor Imaging following pediatric non-penetrating traumatic brain injury to identify the location and extent of white matter changes. Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) data from 20 studies were analyzed. FA increased and ADC decreased in most white matter tracts in the short-term (moderate-to-large effects), and FA decreased and ADC increased in the medium- to long-term (moderate-to-very-large effects). Whole brain (short-term), cerebellum and corpus callosum (medium- to long-term) FA values have diagnostic potential, but the impact of age/developmental stage and injury severity on FA/ADC, and the predictive value, is unclear.
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Affiliation(s)
- R M Roberts
- a School of Psychology , University of Adelaide , Adelaide , Australia
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Skiöld B, Wu Q, Hooper SB, Davis PG, McIntyre R, Tolcos M, Pearson J, Vreys R, Egan GF, Barton SK, Cheong JLY, Polglase GR. Early detection of ventilation-induced brain injury using magnetic resonance spectroscopy and diffusion tensor imaging: an in vivo study in preterm lambs. PLoS One 2014; 9:e95804. [PMID: 24759765 PMCID: PMC3997476 DOI: 10.1371/journal.pone.0095804] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 03/31/2014] [Indexed: 11/18/2022] Open
Abstract
Background and Aim High tidal volume (VT) ventilation during resuscitation of preterm lambs results in brain injury evident histologically within hours after birth. We aimed to investigate whether magnetic resonance spectroscopy (MRS) and/or diffusion tensor imaging (DTI) can be used for early in vivo detection of ventilation-induced brain injury in preterm lambs. Methods Newborn lambs (0.85 gestation) were stabilized with a “protective ventilation” strategy (PROT, n = 7: prophylactic Curosurf, sustained inflation, VT 7 mL/kg, positive end expiratory pressure (PEEP) 5 cmH2O) or an initial 15 minutes of “injurious ventilation” (INJ, n = 10: VT 12 mL/kg, no PEEP, late Curosurf) followed by PROT ventilation for the remainder of the experiment. At 1 hour, lambs underwent structural magnetic resonance imaging (Siemens, 3 Tesla). For measures of mean/axial/radial diffusivity (MD, AD, RD) and fractional anisotropy (FA), 30 direction DTI was performed. Regions of interests encompassed the thalamus, internal capsule, periventricular white matter and the cerebellar vermis. MRS was performed using a localized single-voxel (15×15×20 mm3, echo time 270 ms) encompassing suptratentorial deep nuclear grey matter and central white matter. Peak-area ratios for lactate (Lac) relative to N-acetylaspartate (NAA), choline (Cho) and creatine (Cr) were calculated. Groups were compared using 2-way RM-ANOVA, Mann-Whitney U-test and Spearman's correlations. Results No cerebral injury was seen on structural MR images. Lambs in the INJ group had higher mean FA and lower mean RD in the thalamus compared to PROT lambs, but not in the other regions of interest. Peak-area lactate ratios >1.0 was only seen in INJ lambs. A trend of higher mean peak-area ratios for Lac/Cr and Lac/Cho was seen, which correlated with lower pH in both groups. Conclusion Acute changes in brain diffusion measures and metabolite peak-area ratios were observed after injurious ventilation. Early MRS/DTI is able to detect the initiation of ventilation-induced brain injury.
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Affiliation(s)
- Béatrice Skiöld
- Neonatal Services, The Royal Women's Hospital, Melbourne, Victoria, Australia
- * E-mail:
| | - Qizhu Wu
- Monash Biomedical Imaging, Monash University, Clayton, Victoria, Australia
- CSIRO Materials Science and Engineering, Clayton, Victoria, Australia
| | - Stuart B. Hooper
- The Ritchie Centre, Monash Institute of Medical Research, Monash University, Clayton, Victoria, Australia
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Peter G. Davis
- Neonatal Services, The Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Richard McIntyre
- Monash Biomedical Imaging, Monash University, Clayton, Victoria, Australia
| | - Mary Tolcos
- The Ritchie Centre, Monash Institute of Medical Research, Monash University, Clayton, Victoria, Australia
| | - James Pearson
- Monash Biomedical Imaging, Monash University, Clayton, Victoria, Australia
| | - Ruth Vreys
- Monash Biomedical Imaging, Monash University, Clayton, Victoria, Australia
| | - Gary F. Egan
- Monash Biomedical Imaging, Monash University, Clayton, Victoria, Australia
| | - Samantha K. Barton
- The Ritchie Centre, Monash Institute of Medical Research, Monash University, Clayton, Victoria, Australia
| | - Jeanie L. Y. Cheong
- Neonatal Services, The Royal Women's Hospital, Melbourne, Victoria, Australia
- Victorian Infant Brain Studies, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
| | - Graeme R. Polglase
- The Ritchie Centre, Monash Institute of Medical Research, Monash University, Clayton, Victoria, Australia
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
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