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Peña Pino I, Fellows E, McGovern RA, Chen CC, Sandoval-Garcia C. Structural and functional connectivity in hydrocephalus: a scoping review. Neurosurg Rev 2024; 47:201. [PMID: 38695962 DOI: 10.1007/s10143-024-02430-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 04/01/2024] [Accepted: 04/22/2024] [Indexed: 06/26/2024]
Abstract
Optimizing the treatment of hydrocephalus remains a major challenge in adult and pediatric neurosurgery. Currently, clinical treatment relies heavily on anatomic imaging of ventricular size and clinical presentation. The emergence of functional and structural brain connectivity imaging has provided the basis for a new paradigm in the management of hydrocephalus. Here we review the pertinent advances in this field. Following PRISMA-ScR guidelines for scoping reviews, we searched PubMed for relevant literature from 1994 to April 2023 using hydrocephalus and MRI-related terms. Included articles reported original MRI data on human subjects with hydrocephalus, while excluding non-English or pre-1994 publications that didn't match the study framework. The review identified 44 studies that investigated functional and/or structural connectivity using various MRI techniques across different hydrocephalus populations. While there is significant heterogeneity in imaging technology and connectivity analysis, there is broad consensus in the literature that 1) hydrocephalus is associated with disruption of functional and structural connectivity, 2) this disruption in cerebral connectivity can be further associated with neurologic compromise 3) timely treatment of hydrocephalus restores both cerebral connectivity and neurologic compromise. The robustness and consistency of these findings vary as a function of patient age, hydrocephalus etiology, and the connectivity region of interest studied. Functional and structural brain connectivity imaging shows potential as an imaging biomarker that may facilitate optimization of hydrocephalus treatment. Future research should focus on standardizing regions of interest as well as identifying connectivity analysis most pertinent to clinical outcome.
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Affiliation(s)
- Isabela Peña Pino
- Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA
| | - Emily Fellows
- University of Minnesota Medical School, Minneapolis, MN, USA
| | - Robert A McGovern
- Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA
| | - Clark C Chen
- Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA
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2
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Reddy N, Doyle M, Hanagandi P, Taranath A, Dahmoush H, Krishnan P, Oztekin O, Boltshauser E, Shroff M, Mankad K. Neuroradiological Mimics of Periventricular Leukomalacia. J Child Neurol 2022; 37:151-167. [PMID: 34937403 DOI: 10.1177/08830738211026052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIM Periventricular leukomalacia (PVL) is a term reserved to describe white matter injury in the premature brain. In this review article, the authors highlight the common and rare pathologies mimicking the chronic stage of PVL and propose practical clinico-radiological criteria that would aid in diagnosis and management. METHODS AND RESULTS The authors first describe the typical brain MRI (magnetic resonance imaging) features of PVL. Based on their clinical presentation, pathologic entities and their neuroimaging findings were clustered into distinct categories. Three clinical subgroups were identified: healthy children, children with stable/nonprogressive neurological disorder, and those with progressive neurological disorder. The neuroradiological discriminators are described in each subgroup with relevant differential diagnoses. The mimics were broadly classified into normal variants, acquired, and inherited disorders. CONCLUSIONS The term "PVL" should be used appropriately as it reflects its pathomechanism. The phrase "white matter injury of prematurity" or "brain injury of prematurity" is more specific. Discrepancies in imaging and clinical presentation must be tread with caution and warrant further investigations to exclude other possibilities.
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Affiliation(s)
- Nihaal Reddy
- Rainbow Children's Hospital and Tenet Diagnostics, Hyderabad, India
| | - Mary Doyle
- Department of Paediatric Neurology, Great Ormond Street Hospital, London, UK
| | - Prasad Hanagandi
- Department of Neuroradiology, King Abdulaziz Medical City, Riyadh Ministry of National Guard Health Affairs, Saudi Arabia
| | - Ajay Taranath
- Department of Radiology, Women's and Children's Hospital, Adelaide, Australia
| | - Hisham Dahmoush
- Department of Radiology, Lucile Packard Children's Hospital, Stanford, CA, USA
| | - Pradeep Krishnan
- Department of Pediatric Neuroradiology, The Hospital for Sick Children, Toronto, Canada
| | - Ozgur Oztekin
- Tepecik Research and Education Hospital, Health Science University, Izmir, Turkey
| | - Eugen Boltshauser
- Department of Pediatric Neurology, University Children's Hospital, Zurich, Steinwiesstrasse, Switzerland
| | - Manohar Shroff
- Department of Pediatric Neuroradiology, The Hospital for Sick Children, Toronto, Canada
| | - Kshitij Mankad
- Department of Radiology, Great Ormond Street Hospital, London, UK
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3
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Obeid R, Jacobs M, Chang T, Massaro AN, Bluth E, Murnick JG, Bulas D, Bandarkar A, Oluigbo C, Penn AA. The utility of the fronto-temporal horn ratio on cranial ultrasound in premature newborns: a ventriculomegaly marker. Pediatr Res 2021; 89:1715-1723. [PMID: 33504959 DOI: 10.1038/s41390-020-01337-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/30/2020] [Accepted: 12/09/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND The aims of this study were to find the normal value of fronto-temporal horn ratio (FTHR) as a marker of ventriculomegaly on cranial ultrasound (CUS) in premature newborns and the relation to white matter injury (WMI) and cerebral palsy (CP). METHODS This is a retrospective study of newborns admitted between 2011 and 2014. Inclusion criteria were: (1) gestation <29 weeks, (2) birth weight ≤1500 g, (3) referred within 7 days of life, (4) at least two CUS preformed, (5) brain magnetic resonance imaging (MRI) at term age-equivalent. Intraventricular hemorrhage (IVH) grade was identified and FTHR was measured on all CUS. WMI on MRI was evaluated through (1) injury score (Kidokoro 2013) and (2) fractional anisotropy (FA) on the MRI diffusion tensor imaging. CP was estimated using the gross motor function classification system (GMFCS). RESULTS One hundred neonates met the inclusion criteria: 37 with no IVH, 36 with IVH grade 1-2, and 27 with IVH grade 3-4. The FTHR cut-point of 0.51 had the highest sensitivity and specificity for moderate-to-severe WMI. In the IVH grade 3-4 group, the elevated FTHR correlated with lower FA and higher GMFCS. CONCLUSIONS FTHR is a useful quantitative biomarker of ventriculomegaly in preterm newborns. It may help standardize ventricular measurement and direct intervention. IMPACT The fronto-temporal horn ratio has the potential to become a standardized tool that can provide an actionable measure to direct intervention for post-hemorrhagic ventricular dilation. This current study will provide the basis of a future clinical trial to optimize intervention timing to decrease the risk of white matter injury in this vulnerable population.
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Affiliation(s)
- Rawad Obeid
- Neurology, Beaumont Children Hospital/Oakland University School of Medicine, Royal Oak, MI, USA.
| | - Marni Jacobs
- Children's Research Institute, Children's National Hospital, George Washington University School of Medicine, Washington, DC, USA
| | - Taeun Chang
- Neurology, Children's National Hospital, George Washington University School of Medicine, Washington, DC, USA
| | - An N Massaro
- Neonatology, Children's National Hospital, George Washington University School of Medicine, Washington, DC, USA.,Center for Neuroscience Research, Children's Research Institute, Washington, DC, USA.,Fetal and Translational Medicine, Children's National Hospital, Washington, DC, USA
| | - Eresha Bluth
- Center for Neuroscience Research, Children's Research Institute, Washington, DC, USA
| | - Jonathan G Murnick
- Radiology, Children's National Hospital, George Washington University School of Medicine, Washington, DC, USA
| | - Dorothy Bulas
- Radiology, Children's National Hospital, George Washington University School of Medicine, Washington, DC, USA
| | - Anjum Bandarkar
- Radiology, Children's National Hospital, George Washington University School of Medicine, Washington, DC, USA
| | - Chima Oluigbo
- Pediatric Neurosurgery, Children's National Hospital, George Washington University School of Medicine, Washington, DC, USA
| | - Anna A Penn
- Neonatology, Children's National Hospital, George Washington University School of Medicine, Washington, DC, USA.,Center for Neuroscience Research, Children's Research Institute, Washington, DC, USA.,Fetal and Translational Medicine, Children's National Hospital, Washington, DC, USA.,Chief, Division of Neonatology, Department of Pediatrics, Columbia University, New York-Presbyterian Morgan Stanley Children's Hospital, New York, NY, 10032, USA
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4
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Morales DM, Smyser CD, Han RH, Kenley JK, Shimony JS, Smyser TA, Strahle JM, Inder TE, Limbrick DD. Tract-Specific Relationships Between Cerebrospinal Fluid Biomarkers and Periventricular White Matter in Posthemorrhagic Hydrocephalus of Prematurity. Neurosurgery 2021; 88:698-706. [PMID: 33313901 PMCID: PMC7884147 DOI: 10.1093/neuros/nyaa466] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 08/12/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Posthemorrhagic hydrocephalus (PHH) is associated with neurological morbidity and complex neurosurgical care. Improved tools are needed to optimize treatments and to investigate the developmental sequelae of PHH. OBJECTIVE To examine the relationship between diffusion magnetic resonance imaging (dMRI) and cerebrospinal fluid (CSF) biomarkers of PHH. METHODS A total of 14 preterm (PT) infants with PHH and 46 controls were included. PT CSF was collected at temporizing surgery in PHH infants (PHH PT CSF) or lumbar puncture in controls. Term-equivalent age (TEA) CSF was acquired via implanted device or at permanent CSF diversion surgery in PHH (PHH-TEA-CSF) or lumbar puncture in controls. TEA dMRI scans were used to measure fractional anisotropy (FA) and mean diffusivity (MD) in the genu of corpus callosum (gCC), posterior limb of internal capsule (PLIC), and optic radiations (OPRA). Associations between dMRI measures and CSF amyloid precursor protein (APP), neural cell adhesion-1 (NCAM-1), and L1 cell adhesion molecule (L1CAM) were assessed using Pearson correlations. RESULTS APP, NCAM-1, and L1CAM were elevated over controls in PHH-PT-CSF and PHH-TEA-CSF. dMRI FA and MD differed between control and PHH infants across all tracts. PHH-PT-CSF APP levels correlated with gCC and OPRA FA and PLIC MD, while L1CAM correlated with gCC and OPRA FA. In PHH-TEA-CSF, only L1CAM correlated with OPRA MD. CONCLUSION Tract-specific associations were observed between dMRI and CSF biomarkers at the initiation of PHH treatment. dMRI and CSF biomarker analyses provide innovative complementary methods for examining PHH-related white matter injury and associated developmental sequelae.
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Affiliation(s)
- Diego M Morales
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Christopher D Smyser
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Rowland H Han
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Jeanette K Kenley
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri
| | - Joshua S Shimony
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Tara A Smyser
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Jennifer M Strahle
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Terrie E Inder
- Department of Pediatric Newborn Medicine, Brigham and Womens Hospital, Harvard Medical School, Boston, Massachusetts
| | - David D Limbrick
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
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5
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Brain Magnetic Resonance Findings in 117 Children with Autism Spectrum Disorder under 5 Years Old. Brain Sci 2020; 10:brainsci10100741. [PMID: 33081247 PMCID: PMC7602717 DOI: 10.3390/brainsci10100741] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 10/11/2020] [Accepted: 10/13/2020] [Indexed: 12/30/2022] Open
Abstract
We examined the potential benefits of neuroimaging measurements across the first 5 years of life in detecting early comorbid or etiological signs of autism spectrum disorder (ASD). In particular, we analyzed the prevalence of neuroradiologic findings in routine magnetic resonance imaging (MRI) scans of a group of 117 ASD children younger than 5 years old. These data were compared to those reported in typically developing (TD) children. MRI findings in children with ASD were analyzed in relation to their cognitive level, severity of autistic symptoms, and the presence of electroencephalogram (EEG) abnormalities. The MRI was rated abnormal in 55% of children with ASD with a significant prevalence in the high-functioning subgroup compared to TD children. We report significant incidental findings of mega cisterna magna, ventricular anomalies and abnormal white matter signal intensity in ASD without significant associations between these MRI findings and EEG features. Based on these results we discuss the role that brain MRI may play in the diagnostic procedure of ASD.
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Hale AT, Gannon SR, Zhao S, Dewan MC, Bhatia R, Bezzerides M, Stanton AN, Naftel RP, Shannon CN, Pruthi S, Wellons JC. Graft dural closure is associated with a reduction in CSF leak and hydrocephalus in pediatric patients undergoing posterior fossa brain tumor resection. J Neurosurg Pediatr 2019; 25:228-234. [PMID: 31783365 DOI: 10.3171/2019.9.peds1939] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Accepted: 09/16/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The authors aimed to evaluate clinical, radiological, and surgical factors associated with posterior fossa tumor resection (PFTR)-related outcomes, including postoperative complications related to dural augmentation (CSF leak and wound infection), persistent hydrocephalus ultimately requiring permanent CSF diversion after PFTR, and 90-day readmission rate. METHODS Pediatric patients (0-17 years old) undergoing PFTR between 2000 and 2016 at Monroe Carell Jr. Children's Hospital of Vanderbilt University were retrospectively reviewed. Descriptive statistics included the Wilcoxon signed-rank test to compare means that were nonnormally distributed and the chi-square test for categorical variables. Variables that were nominally associated (p < 0.05) with each outcome by univariate analysis were included as covariates in multivariate linear regression models. Statistical significance was set a priori at p < 0.05. RESULTS The cohort consisted of 186 patients with a median age at surgery of 6.62 years (range 3.37-11.78 years), 55% male, 83% Caucasian, and average length of follow-up of 3.87 ± 0.25 years. By multivariate logistic regression, the variables primary dural closure (PDC; odds ratio [OR] 8.33, 95% confidence interval [CI] 1.07-100, p = 0.04), pseudomeningocele (OR 7.43, 95% CI 2.23-23.76, p = 0.0007), and hydrocephalus ultimately requiring permanent CSF diversion within 90 days of PFTR (OR 9.25, 95% CI 2.74-31.2, p = 0.0003) were independently associated with CSF leak. PDC versus graft dural closure (GDC; 35% vs 7%, OR 5.88, 95% CI 2.94-50.0, p = 0.03) and hydrocephalus ultimately requiring permanent CSF diversion (OR 3.30, 95% CI 1.07-10.19, p = 0.0007) were associated with wound infection requiring surgical debridement. By multivariate logistic regression, GDC versus PDC (23% vs 37%, OR 0.13, 95% CI 0.02-0.87, p = 0.04) was associated with persistent hydrocephalus ultimately requiring permanent CSF diversion, whereas pre- or post-PFTR ventricular size, placement of peri- or intraoperative extraventricular drain (EVD), and radiation therapy were not. Furthermore, the addition of perioperative EVD placement and dural closure method to a previously validated predictive model of post-PFTR hydrocephalus improved its performance from area under the receiver operating characteristic curve of 0.69 to 0.74. Lastly, the authors found that autologous (vs synthetic) grafts may be protective against persistent hydrocephalus (p = 0.02), but not CSF leak, pseudomeningocele, or wound infection. CONCLUSIONS These results suggest that GDC, independent of potential confounding factors, may be protective against CSF leak, wound infection, and hydrocephalus in patients undergoing PFTR. Additional studies are warranted to further evaluate clinical and surgical factors impacting PFTR-associated complications.
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Affiliation(s)
- Andrew T Hale
- 1Medical Scientist Training Program, and
- 2Surgical Outcomes Center for Kids, and
| | - Stephen R Gannon
- 2Surgical Outcomes Center for Kids, and
- 4Division of Pediatric Neurosurgery, Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Shilin Zhao
- 3Department of Biostatistics, Vanderbilt University School of Medicine
| | - Michael C Dewan
- 2Surgical Outcomes Center for Kids, and
- 4Division of Pediatric Neurosurgery, Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | | | | | - Robert P Naftel
- 2Surgical Outcomes Center for Kids, and
- 4Division of Pediatric Neurosurgery, Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Chevis N Shannon
- 2Surgical Outcomes Center for Kids, and
- 4Division of Pediatric Neurosurgery, Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sumit Pruthi
- 5Department of Radiology, Monroe Carell Jr. Children's Hospital of Vanderbilt University; and
| | - John C Wellons
- 2Surgical Outcomes Center for Kids, and
- 4Division of Pediatric Neurosurgery, Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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7
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Isaacs AM, Smyser CD, Lean RE, Alexopoulos D, Han RH, Neil JJ, Zimbalist SA, Rogers CE, Yan Y, Shimony JS, Limbrick DD. MR diffusion changes in the perimeter of the lateral ventricles demonstrate periventricular injury in post-hemorrhagic hydrocephalus of prematurity. NEUROIMAGE-CLINICAL 2019; 24:102031. [PMID: 31795043 PMCID: PMC6909338 DOI: 10.1016/j.nicl.2019.102031] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 10/01/2019] [Accepted: 10/04/2019] [Indexed: 12/14/2022]
Abstract
Diffusion MRI demonstrates PHH is associated with LVP microstructural injury. The greatest PHH-associated disruption occurs at the frontal and occipital horns. Greater ventricular size is associated with greater disruption. dMRI may provide useful biomarkers for PHH monitoring and intervention. The region of LVP injury encompasses neuroprogenitor regions.
Objectives Injury to the preterm lateral ventricular perimeter (LVP), which contains the neural stem cells responsible for brain development, may contribute to the neurological sequelae of intraventricular hemorrhage (IVH) and post-hemorrhagic hydrocephalus of prematurity (PHH). This study utilizes diffusion MRI (dMRI) to characterize the microstructural effects of IVH/PHH on the LVP and segmented frontal-occipital horn perimeters (FOHP). Study design Prospective study of 56 full-term infants, 72 very preterm infants without brain injury (VPT), 17 VPT infants with high-grade IVH without hydrocephalus (HG-IVH), and 13 VPT infants with PHH who underwent dMRI at term equivalent. LVP and FOHP dMRI measures and ventricular size-dMRI correlations were assessed. Results In the LVP, PHH had consistently lower FA and higher MD and RD than FT and VPT (p<.050). However, while PHH FA was lower, and PHH RD was higher than their respective HG-IVH measures (p<.050), the MD and AD values did not differ. In the FOHP, PHH infants had lower FA and higher RD than FT and VPT (p<.010), and a lower FA than the HG-IVH group (p<.001). While the magnitude of AD in both the LVP and FOHP were consistently less in the PHH group on pairwise comparisons to the other groups, the differences were not significant (p>.050). Ventricular size correlated negatively with FA, and positively with MD and RD (p<.001) in both the LVP and FOHP. In the PHH group, FA was lower in the FOHP than in the LVP, which was contrary to the observed findings in the healthy infants (p<.001). Nevertheless, there were no regional differences in AD, MD, and RD in the PHH group. Conclusion HG-IVH and PHH results in aberrant LVP/FOHP microstructure, with prominent abnormalities among the PHH group, most notably in the FOHP. Larger ventricular size was associated with greater magnitude of abnormality. LVP/FOHP dMRI measures may provide valuable biomarkers for future studies directed at improving the management and neurological outcomes of IVH/PHH.
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Affiliation(s)
- Albert M Isaacs
- Department of Biology and Biomedical Sciences, Washington University in St. Louis, St. Louis, MO, United States; Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.
| | - Christopher D Smyser
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, United States; Department of Neurology, Washington University School of Medicine, St. Louis, MO, United States; Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, United States
| | - Rachel E Lean
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
| | - Dimitrios Alexopoulos
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, United States
| | - Rowland H Han
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, United States
| | - Jeffrey J Neil
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, United States
| | - Sophia A Zimbalist
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, United States
| | - Cynthia E Rogers
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, United States; Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
| | - Yan Yan
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, United States
| | - Joshua S Shimony
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, United States
| | - David D Limbrick
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, United States; Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, United States
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Lean RE, Han RH, Smyser TA, Kenley JK, Shimony JS, Rogers CE, Limbrick DD, Smyser CD. Altered neonatal white and gray matter microstructure is associated with neurodevelopmental impairments in very preterm infants with high-grade brain injury. Pediatr Res 2019; 86:365-374. [PMID: 31212303 PMCID: PMC6702093 DOI: 10.1038/s41390-019-0461-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 06/04/2019] [Accepted: 06/08/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND This study examines relationships between neonatal white and gray matter microstructure and neurodevelopment in very preterm (VPT) infants (≤30 weeks gestation) with high-grade brain injury (BI). METHODS Term-equivalent diffusion tensor magnetic resonance imaging data were obtained in 32 VPT infants with high-grade BI spanning grade III/IV intraventricular hemorrhage, post-hemorrhagic hydrocephalus (PHH), and cystic periventricular leukomalacia (BI group); 69 VPT infants without high-grade injury (VPT group); and 55 term-born infants. The Bayley-III assessed neurodevelopmental outcomes at age 2 years. RESULTS BI infants had lower fractional anisotropy (FA) in the posterior limb of the internal capsule (PLIC), cingulum, and corpus callosum, and higher mean diffusivity (MD) in the optic radiations and cingulum than VPT infants. PHH was associated with higher MD in the optic radiations and left PLIC, and higher FA in the right caudate. For BI infants, higher MD in the right optic radiation and lower FA in the right cingulum, PLIC, and corpus callosum were related to motor impairments. CONCLUSIONS BI infants demonstrated altered white and gray matter microstructure in regions affected by injury in a manner dependent upon injury type. PHH infants demonstrated the greatest impairments. Aberrant white matter microstructure was related to motor impairment in BI infants.
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Affiliation(s)
- Rachel E Lean
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Rowland H Han
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Tara A Smyser
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Jeanette K Kenley
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Joshua S Shimony
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Cynthia E Rogers
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - David D Limbrick
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Christopher D Smyser
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA.
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA.
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA.
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9
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Isaacs AM, Shimony JS, Morales DM, Castaneyra-Ruiz L, Hartman A, Cook M, Smyser CD, Strahle J, Smyth MD, Yan Y, McAllister JP, McKinstry RC, Limbrick DD. Feasibility of fast brain diffusion MRI to quantify white matter injury in pediatric hydrocephalus. J Neurosurg Pediatr 2019; 24:461-468. [PMID: 31323624 PMCID: PMC6982356 DOI: 10.3171/2019.5.peds18596] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 05/14/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Traditionally, diffusion MRI (dMRI) has been performed in parallel with high-resolution conventional MRI, which requires long scan times and may require sedation or general anesthesia in infants and young children. Conversely, fast brain MRI permits image acquisition without the need for sedation, although its short pulse sequences, susceptibility to motion artifact, and contrast resolution have limited its use to assessing ventricular size or major structural variations. Here, the authors demonstrate the feasibility of leveraging a 3-direction fast brain MRI protocol to obtain reliable dMRI measures. METHODS Fast brain MRI with 3-direction dMRI was performed in infants and children before and after hydrocephalus treatment. Regions of interest in the posterior limbs of the internal capsules (PLICs) and the genu of the corpus callosum (gCC) were drawn on diffusion-weighted images, and mean diffusivity (MD) data were extracted. Ventricular size was determined by the frontal occipital horn ratio (FOHR). Differences between and within groups pre- and posttreatment, and FOHR-MD correlations were assessed. RESULTS Of 40 patients who met inclusion criteria (median age 27.5 months), 15 (37.5%), 17 (42.5%), and 8 (20.0%) had posthemorrhagic hydrocephalus (PHH), congenital hydrocephalus (CH), or no intracranial abnormality (controls), respectively. A hydrocephalus group included both PHH and CH patients. Prior to treatment, the FOHR (p < 0.001) and PLIC MD (p = 0.027) were greater in the hydrocephalus group than in the controls. While the mean gCC MD in the hydrocephalus group (1.10 × 10-3 mm2/sec) was higher than that of the control group (0.98), the difference was not significant (p = 0.135). Following a median follow-up duration of 14 months, decreases in FOHR, PLIC MD, and gCC MD were observed in the hydrocephalus group and were similar to those in the control group (p = 0.107, p = 0.702, and p = 0.169, respectively). There were no correlations identified between FOHR and MDs at either time point. CONCLUSIONS The utility of fast brain MRI can be extended beyond anatomical assessments to obtain dMRI measures. A reduction in PLIC and gCC MD to levels similar to those of controls was observed within 14 months following shunt surgery for hydrocephalus in PHH and CH infants. Further studies are required to assess the role of fast brain dMRI for assessing clinical outcomes in pediatric hydrocephalus patients.
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Affiliation(s)
- Albert M. Isaacs
- Department of Neuroscience, Washington University School of Medicine, St. Louis, Missouri
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Joshua S. Shimony
- Department of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Diego M. Morales
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri
| | | | - Alexis Hartman
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri
| | - Madison Cook
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri
| | - Christopher D. Smyser
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri
| | - Jennifer Strahle
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri
| | - Matthew D. Smyth
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri
| | - Yan Yan
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - James P. McAllister
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri
| | - Robert C. McKinstry
- Department of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - David D. Limbrick
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri
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10
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Preterm neuroimaging and neurodevelopmental outcome: a focus on intraventricular hemorrhage, post-hemorrhagic hydrocephalus, and associated brain injury. J Perinatol 2018; 38:1431-1443. [PMID: 30166622 PMCID: PMC6215507 DOI: 10.1038/s41372-018-0209-5] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 07/23/2018] [Accepted: 08/06/2018] [Indexed: 12/29/2022]
Abstract
Intraventricular hemorrhage in the setting of prematurity remains the most common cause of acquired hydrocephalus. Neonates with progressive post-hemorrhagic hydrocephalus are at risk for adverse neurodevelopmental outcomes. The goal of this review is to describe the distinct and often overlapping types of brain injury in the preterm neonate, with a focus on neonatal hydrocephalus, and to connect injury on imaging to neurodevelopmental outcome risk. Head ultrasound and magnetic resonance imaging findings are described separately. The current state of the literature is imprecise and we end the review with recommendations for future radiologic and neurodevelopmental research.
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11
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Yuan W, Meller A, Shimony JS, Nash T, Jones BV, Holland SK, Altaye M, Barnard H, Phillips J, Powell S, McKinstry RC, Limbrick DD, Rajagopal A, Mangano FT. Left hemisphere structural connectivity abnormality in pediatric hydrocephalus patients following surgery. NEUROIMAGE-CLINICAL 2016; 12:631-639. [PMID: 27722087 PMCID: PMC5048110 DOI: 10.1016/j.nicl.2016.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 08/19/2016] [Accepted: 09/02/2016] [Indexed: 01/03/2023]
Abstract
Neuroimaging research in surgically treated pediatric hydrocephalus patients remains challenging due to the artifact caused by programmable shunt. Our previous study has demonstrated significant alterations in the whole brain white matter structural connectivity based on diffusion tensor imaging (DTI) and graph theoretical analysis in children with hydrocephalus prior to surgery or in surgically treated children without programmable shunts. This study seeks to investigate the impact of brain injury on the topological features in the left hemisphere, contratelateral to the shunt placement, which will avoid the influence of shunt artifacts and makes further group comparisons feasible for children with programmable shunt valves. Three groups of children (34 in the control group, 12 in the 3-month post-surgery group, and 24 in the 12-month post-surgery group, age between 1 and 18 years) were included in the study. The structural connectivity data processing and analysis were performed based on DTI and graph theoretical analysis. Specific procedures were revised to include only left brain imaging data in normalization, parcellation, and fiber counting from DTI tractography. Our results showed that, when compared to controls, children with hydrocephalus in both the 3-month and 12-month post-surgery groups had significantly lower normalized clustering coefficient, lower small-worldness, and higher global efficiency (all p < 0.05, corrected). At a regional level, both patient groups showed significant alteration in one or more regional connectivity measures in a series of brain regions in the left hemisphere (8 and 10 regions in the 3-month post-surgery and the 12-month post-surgery group, respectively, all p < 0.05, corrected). No significant correlation was found between any of the global or regional measures and the contemporaneous neuropsychological outcomes [the General Adaptive Composite (GAC) from the Adaptive Behavior Assessment System, Second Edition (ABAS-II)]. However, one global network measure (global efficiency) and two regional network measures in the insula (local efficiency and between centrality) tested at 3-month post-surgery were found to correlate with GAC score tested at 12-month post-surgery with statistical significance (all p < 0.05, corrected). Our data showed that the structural connectivity analysis based on DTI and graph theory was sensitive in detecting both global and regional network abnormality when the analysis was conducted in the left hemisphere only. This approach provides a new avenue enabling the application of advanced neuroimaging analysis methods in quantifying brain damage in children with hydrocephalus surgically treated with programmable shunts. We studied the structural connectivity of left hemisphere brain network in children with hydrocephalus post-surgery Children with hydrocephalus post-surgery had significantly abnormal structural connectivity in the left hemisphere based on graph analysis Significant correlation was found between graph measures at 3-months post-surgery and developmental outcome at 12-month post-surgery
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Affiliation(s)
- Weihong Yuan
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Artur Meller
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Joshua S Shimony
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, MO, United States
| | - Tiffany Nash
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Blaise V Jones
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Scott K Holland
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Mekibib Altaye
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Holly Barnard
- Division of Developmental and Behavioral Pediatrics - Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Jannel Phillips
- Division of Developmental and Behavioral Pediatrics - Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Stephanie Powell
- Department of Neurology, Washington University School of Medicine, Saint Louis, MO, United States; Department of Psychology, St. Louis Children's Hospital, St. Louis, MO, United States
| | - Robert C McKinstry
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, MO, United States
| | - David D Limbrick
- Department of Neurological Surgery, Washington University School of Medicine, Saint Louis, MO, United States
| | - Akila Rajagopal
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Francesco T Mangano
- Division of Pediatric Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; University of Cincinnati College of Medicine, Cincinnati, OH, United States
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12
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Mangano FT, Altaye M, McKinstry RC, Shimony JS, Powell SK, Phillips JM, Barnard H, Limbrick DD, Holland SK, Jones BV, Dodd J, Simpson S, Deanna M, Rajagopal A, Bidwell S, Yuan W. Diffusion tensor imaging study of pediatric patients with congenital hydrocephalus: 1-year postsurgical outcomes. J Neurosurg Pediatr 2016; 18:306-19. [PMID: 27203134 PMCID: PMC5035704 DOI: 10.3171/2016.2.peds15628] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE The purpose of this study was to investigate white matter (WM) structural abnormalities using diffusion tensor imaging (DTI) in children with hydrocephalus before CSF diversionary surgery (including ventriculoperitoneal shunt insertion and endoscopic third ventriculostomy) and during the course of recovery after surgery in association with neuropsychological and behavioral outcome. METHODS This prospective study included 54 pediatric patients with congenital hydrocephalus (21 female, 33 male; age range 0.03-194.5 months) who underwent surgery and 64 normal controls (30 female, 34 male; age range 0.30-197.75 months). DTI and neurodevelopmental outcome data were collected once in the control group and 3 times (preoperatively and at 3 and 12 months postoperatively) in the patients with hydrocephalus. DTI measures, including fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) values were extracted from the genu of the corpus callosum (gCC) and the posterior limb of internal capsule (PLIC). Group analysis was performed first cross-sectionally to quantify DTI abnormalities at 3 time points by comparing the data obtained in the hydrocephalus group for each of the 3 time points to data obtained in the controls. Longitudinal comparisons were conducted pairwise between different time points in patients whose data were acquired at multiple time points. Neurodevelopmental data were collected and analyzed using the Adaptive Behavior Assessment System, Second Edition, and the Bayley Scales of Infant Development, Third Edition. Correlation analyses were performed between DTI and behavioral measures. RESULTS Significant DTI abnormalities were found in the hydrocephalus patients in both the gCC (lower FA and higher MD, AD, and RD) and the PLIC (higher FA, lower AD and RD) before surgery. The DTI measures in the gCC remained mostly abnormal at 3 and 12 months after surgery. The DTI abnormalities in the PLIC were significant in FA and AD at 3 months after surgery but did not persist when tested at 12 months after surgery. Significant longitudinal DTI changes in the patients with hydrocephalus were found in the gCC when findings at 3 and 12 months after surgery were compared. In the PLIC, trend-level longitudinal changes were observed between preoperative findings and 3-month postoperative findings, as well as between 3- and 12-month postoperative findings. Significant correlation between DTI and developmental outcome was found at all 3 time points. Notably, a significant correlation was found between DTI in the PLIC at 3 months after surgery and developmental outcome at 12 months after surgery. CONCLUSIONS The data showed significant WM abnormality based on DTI in both the gCC and the PLIC in patients with congenital hydrocephalus before surgery, and the abnormalities persisted in both the gCC and the PLIC at 3 months after surgery. The DTI values remained significantly abnormal in the gCC at 12 months after surgery. Longitudinal analysis showed signs of recovery in both WM structures between different time points. Combined with the significant correlation found between DTI and neuropsychological measures, the findings of this study suggest that DTI can serve as a sensitive imaging biomarker for underlying neuroanatomical changes and postsurgical developmental outcome and even as a predictor for future outcomes.
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Affiliation(s)
- Francesco T. Mangano
- Division of Pediatric Neurosurgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio,University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Mekibib Altaye
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio,University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Robert C. McKinstry
- Mallinckrodt Institute of Radiology, Saint Louis, MO,Washington University School of Medicine, Saint Louis, MO
| | - Joshua S. Shimony
- Mallinckrodt Institute of Radiology, Saint Louis, MO,Washington University School of Medicine, Saint Louis, MO
| | - Stephanie K. Powell
- Department of Neurology, Saint Louis, MO,Washington University School of Medicine, Saint Louis, MO,Department of Psychology, St. Louis Children’s Hospital, St. Louis, MO
| | - Jannel M. Phillips
- Division of Developmental and Behavioral Pediatrics – Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio,University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Holly Barnard
- Division of Developmental and Behavioral Pediatrics – Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio,University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - David D. Limbrick
- Department of Neurological Surgery, Saint Louis, MO,Washington University School of Medicine, Saint Louis, MO
| | - Scott K. Holland
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio,University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Blaise V. Jones
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio,University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Jonathon Dodd
- Department of Neurology, Saint Louis, MO,Washington University School of Medicine, Saint Louis, MO,Department of Psychology, St. Louis Children’s Hospital, St. Louis, MO
| | - Sarah Simpson
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Mercer Deanna
- Department of Neurological Surgery, Saint Louis, MO,Washington University School of Medicine, Saint Louis, MO
| | | | - Sarah Bidwell
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Weihong Yuan
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio,University of Cincinnati College of Medicine, Cincinnati, Ohio
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