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Coupeau P, Fasquel JB, Hertz-Pannier L, Dinomais M. GNN-based structural information to improve DNN-based basal ganglia segmentation in children following early brain lesion. Comput Med Imaging Graph 2024; 115:102396. [PMID: 38744197 DOI: 10.1016/j.compmedimag.2024.102396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 04/26/2024] [Accepted: 04/30/2024] [Indexed: 05/16/2024]
Abstract
Analyzing the basal ganglia following an early brain lesion is crucial due to their noteworthy role in sensory-motor functions. However, the segmentation of these subcortical structures on MRI is challenging in children and is further complicated by the presence of a lesion. Although current deep neural networks (DNN) perform well in segmenting subcortical brain structures in healthy brains, they lack robustness when faced with lesion variability, leading to structural inconsistencies. Given the established spatial organization of the basal ganglia, we propose enhancing the DNN-based segmentation through post-processing with a graph neural network (GNN). The GNN conducts node classification on graphs encoding both class probabilities and spatial information regarding the regions segmented by the DNN. In this study, we focus on neonatal arterial ischemic stroke (NAIS) in children. The approach is evaluated on both healthy children and children after NAIS using three DNN backbones: U-Net, UNETr, and MSGSE-Net. The results show an improvement in segmentation performance, with an increase in the median Dice score by up to 4% and a reduction in the median Hausdorff distance (HD) by up to 93% for healthy children (from 36.45 to 2.57) and up to 91% for children suffering from NAIS (from 40.64 to 3.50). The performance of the method is compared with atlas-based methods. Severe cases of neonatal stroke result in a decline in performance in the injured hemisphere, without negatively affecting the segmentation of the contra-injured hemisphere. Furthermore, the approach demonstrates resilience to small training datasets, a widespread challenge in the medical field, particularly in pediatrics and for rare pathologies.
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Affiliation(s)
- Patty Coupeau
- Universite d'Angers, LARIS, SFR MATHSTIC, F-49000 Angers, France.
| | | | - Lucie Hertz-Pannier
- UNIACT/Neurospin/JOLIOT/DRF/CEA-Saclay, and U1141 NeuroDiderot/Inserm, CEA, Paris University, France
| | - Mickaël Dinomais
- Universite d'Angers, LARIS, SFR MATHSTIC, F-49000 Angers, France; Departement de medecine physique et de readaptation, Centre Hospitalier Universitaire d'Angers, France
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2
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Chin EM. Magnetic resonance imaging sequences for children with spastic cerebral palsy: Is two better than one? Dev Med Child Neurol 2024; 66:413-414. [PMID: 37786953 DOI: 10.1111/dmcn.15772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 08/30/2023] [Indexed: 10/04/2023]
Abstract
This commentary is on the original article by Liu et al. on pages 514–522 of this issue.
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Affiliation(s)
- Eric M Chin
- Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, MD, USA
- Departments of Neurology and Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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3
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Misser SK, Mchunu N, Lotz JW, Kjonigsen L, Ulug A, Archary M. Neuroquantification enhances the radiological evaluation of term neonatal hypoxic-ischaemic cerebral injuries. SA J Radiol 2023; 27:2728. [PMID: 38223530 PMCID: PMC10784209 DOI: 10.4102/sajr.v27i1.2728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 10/28/2023] [Indexed: 01/16/2024] Open
Abstract
Background Injury patterns in hypoxic-ischaemic brain injury (HIBI) are well recognised but there are few studies evaluating cerebral injury using neuroquantification models. Objectives Quantification of brain volumes in a group of patients with clinically determined cerebral palsy. Method In this retrospective study, 297 children with cerebral palsy were imaged for suspected HIBI with analysis of various cerebral substrates. Of these, 96 children over the age of 3 years with a clinical diagnosis of cerebral palsy and abnormal MRI findings underwent volumetric analyses using the NeuroQuant® software solution. The spectrum of volumetric changes and the differences between the various subtypes (and individual subgroups) of HIBI were compared. Results Compared with the available normative NeuroQuant® database, the average intracranial volume was reduced to the 1st percentile in all patient groups (p < 0.001). Statistically significant differences were observed among the types and subgroups of HIBI. Further substrate volume reductions were identified and described involving the thalami, brainstem, hippocampi, putamina and amygdala. The combined volumes of five regions of interest (frontal pole, putamen, hippocampus, brainstem and paracentral lobule) were consistently reduced in the Rolandic basal ganglia-thalamus (RBGT) subtype. Conclusion This study determined a quantifiable reduction of intracranial volume in all subtypes of HIBI and predictable selective cerebral substrate volume reduction in subtypes and subgroups. In the RBGT subtype, a key combination of five substrate injuries was consistently noted, and thalamic, occipital lobe and brainstem volume reduction was also significant when compared to the watershed subtype. Contribution This study demonstrates the value of integrating an artificial intelligence programme into the radiologists' armamentarium serving to quantify brain injuries more accurately in HIBI. Going forward this will be an inevitable evolution of daily radiology practice in many fields of medicine, and it would be beneficial for radiologists to embrace these technological innovations.
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Affiliation(s)
- Shalendra K Misser
- Department of Radiology, Lake Smit and Partners Inc., Durban, South Africa
- Department of Radiology, Faculty of Health Sciences, University of KwaZulu-Natal, Duban, South Africa
| | - Nobuhle Mchunu
- Biostatistics Research Unit, South African Medical Research Council, Durban, South Africa
- Department of Statistics, Faculty of Science, School of Mathematics, Statistics and Computer Sciences, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - Jan W Lotz
- Department of Radiodiagnosis, Faculty of Sciences, Stellenbosch University, Cape Town, South Africa
| | | | - Aziz Ulug
- Cortechs Labs, San Diego, United States of America
| | - Moherndran Archary
- Department of Pediatrics, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Martinie O, Karan P, Traverse E, Mercier C, Descoteaux M, Robert MT. The Challenge of Diffusion Magnetic Resonance Imaging in Cerebral Palsy: A Proposed Method to Identify White Matter Pathways. Brain Sci 2023; 13:1386. [PMID: 37891755 PMCID: PMC10605121 DOI: 10.3390/brainsci13101386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 09/19/2023] [Accepted: 09/26/2023] [Indexed: 10/29/2023] Open
Abstract
Cerebral palsy (CP), a neuromotor disorder characterized by prenatal brain lesions, leads to white matter alterations and sensorimotor deficits. However, the CP-related diffusion neuroimaging literature lacks rigorous and consensual methodology for preprocessing and analyzing data due to methodological challenges caused by the lesion extent. Advanced methods are available to reconstruct diffusion signals and can update current advances in CP. Our study demonstrates the feasibility of analyzing diffusion CP data using a standardized and open-source pipeline. Eight children with CP (8-12 years old) underwent a single diffusion magnetic resonance imaging (MRI) session on a 3T scanner (Achieva 3.0T (TX), Philips Healthcare Medical Systems, Best, The Netherlands). Exclusion criteria were contraindication to MRI and claustrophobia. Anatomical and diffusion images were acquired. Data were corrected and analyzed using Tractoflow 2.3.0 version, an open-source and robust tool. The tracts were extracted with customized procedures based on existing atlases and freely accessed standardized libraries (ANTs, Scilpy). DTI, CSD, and NODDI metrics were computed for each tract. Despite lesion heterogeneity and size, we successfully reconstructed major pathways, except for a participant with a larger lesion. Our results highlight the feasibility of identifying and quantifying subtle white matter pathways. Ultimately, this will increase our understanding of the clinical symptoms to provide precision medicine and optimize rehabilitation.
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Affiliation(s)
- Ophélie Martinie
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Québec, QC G1M 2S8, Canada; (O.M.); (E.T.); (C.M.)
- Department of Rehabilitation, Université Laval, Québec, QC G1V 0A6, Canada
| | - Philippe Karan
- Department of Computer Sciences, Université de Sherbrooke, Sherbrooke, QC J1K 2R1, Canada; (P.K.); (M.D.)
| | - Elodie Traverse
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Québec, QC G1M 2S8, Canada; (O.M.); (E.T.); (C.M.)
- Department of Rehabilitation, Université Laval, Québec, QC G1V 0A6, Canada
| | - Catherine Mercier
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Québec, QC G1M 2S8, Canada; (O.M.); (E.T.); (C.M.)
- Department of Rehabilitation, Université Laval, Québec, QC G1V 0A6, Canada
| | - Maxime Descoteaux
- Department of Computer Sciences, Université de Sherbrooke, Sherbrooke, QC J1K 2R1, Canada; (P.K.); (M.D.)
| | - Maxime T. Robert
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Québec, QC G1M 2S8, Canada; (O.M.); (E.T.); (C.M.)
- Department of Rehabilitation, Université Laval, Québec, QC G1V 0A6, Canada
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Predicting motor and cognitive outcomes from MRIs of brain structure in children with acquired brain injury: A pilot study. Pediatr Neonatol 2022; 64:297-305. [PMID: 36456422 DOI: 10.1016/j.pedneo.2022.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 06/12/2022] [Accepted: 07/07/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Acquired Brain Injury (ABI) describes a range of brain injuries occurring after birth, including tumor, traumatic brain injury or stroke. Although MRIs are routinely used for diagnosis, prediction of outcome following brain injury is challenging. Quantitative structural information from brain images may provide an opportunity to predict patient outcomes; however, due to the high prevalence of severe pathology in children with ABI, quantitative approaches must be robust to injury severity. METHODS In this pilot cross-sectional study, automated quantitative measures were extracted from the MRIs of a cohort of children with ABI (n = 30, 8-16 years, follow up MRI taken 1.8-13.4 years after time of injury) as well as 36 typically developing controls with no brain injury (7-17 years) using a pathology-robust technique. Measures of brain volume, lesion volume and cortical morphology were associated with concurrent motor, behavioral, visual and communicative function using Least Absolute Shrinkage and Selection Operator (LASSO) regression. RESULTS These regression models were validated on a separate test set (n = 8 of the ABI cohort), which revealed significant correlations between measures of brain structure with motor, cognitive, visual and communicative function (r = 0.65-0.85, all p < 0.01). Furthermore, comparisons of the structural measures to the typically developing cohort revealed overall reductions in global grey matter volume among the ABI cohort, as well as cortical thinning in several cortical areas. CONCLUSIONS These preliminary associations reveal that motor and behavioral function can be estimated from MRI alone, highlighting the potential utility of the proposed pathology-robust MRI quantification tools to provide estimates of long-term clinical prognosis of children with ABI following injury.
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Damiano DL, Pekar JJ, Mori S, Faria AV, Ye X, Stashinko E, Stanley CJ, Alter KE, Hoon AH, Chin EM. Functional and Structural Brain Connectivity in Children With Bilateral Cerebral Palsy Compared to Age-Related Controls and in Response to Intensive Rapid-Reciprocal Leg Training. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:811509. [PMID: 36189020 PMCID: PMC9397804 DOI: 10.3389/fresc.2022.811509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 02/24/2022] [Indexed: 11/13/2022]
Abstract
Background Compared to unilateral cerebral palsy (CP), less is known about brain reorganization and plasticity in bilateral CP especially in relation or response to motor training. The few trials that reported brain imaging results alongside functional outcomes include a handful of studies in unilateral CP, and one pilot trial of three children with bilateral CP. This study is the first locomotor training randomized controlled trial (RCT) in bilateral CP to our knowledge reporting brain imaging outcomes. Methods Objective was to compare MRI brain volumes, resting state connectivity and white matter integrity using DTI in children with bilateral CP with PVL and preterm birth history (<34 weeks), to age-related controls, and from an RCT of intensive 12 week rapid-reciprocal locomotor training using an elliptical or motor-assisted cycle. We hypothesized that connectivity in CP compared to controls would be greater across sensorimotor-related brain regions and that functional (resting state) and structural (fractional anisotropy) connectivity would improve post intervention. We further anticipated that baseline and post-intervention imaging and functional measures would correlate. Results Images were acquired with a 3T MRI scanner for 16/27 children with CP in the trial, and 18 controls. No conclusive evidence of training-induced neuroplastic effects were seen. However, analysis of shared variance revealed that greater increases in precentral gyrus connectivity with the thalamus and pons may be associated with larger improvements in the trained device speed. Exploratory analyses also revealed interesting potential relationships between brain integrity and multiple functional outcomes in CP, with functional connectivity between the motor cortex and midbrain showing the strongest potential relationship with mobility. Decreased posterior white matter, corpus callosum and thalamic volumes, and FA in the posterior thalamic radiation were the most prominent group differences with corticospinal tract differences notably not found. Conclusions Results reinforce the involvement of sensory-related brain areas in bilateral CP. Given the wide individual variability in imaging results and clinical responses to training, a greater focus on neural and other mechanisms related to better or worse outcomes is recommended to enhance rehabilitation results on a patient vs. group level.
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Affiliation(s)
- Diane L. Damiano
- Department of Rehabilitation Medicine, NIH, Bethesda, MD, United States
- *Correspondence: Diane L. Damiano
| | - James J. Pekar
- FM Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, United States
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Susumu Mori
- Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Andreia Vasconcellos Faria
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - X. Ye
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Elaine Stashinko
- Johns Hopkins School of Medicine, Baltimore, MD, United States
- Kennedy Krieger Institute, Baltimore, MD, United States
| | | | | | - Alec H. Hoon
- Johns Hopkins School of Medicine, Baltimore, MD, United States
- Kennedy Krieger Institute, Baltimore, MD, United States
| | - Eric M. Chin
- Johns Hopkins School of Medicine, Baltimore, MD, United States
- Kennedy Krieger Institute, Baltimore, MD, United States
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7
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Ni ZH, Ding S, Wu JH, Zhang S, Liu CY. Family Caregivers’ Experiences of Caring for Children With Cerebral Palsy in China: A Qualitative Descriptive Study. INQUIRY: THE JOURNAL OF HEALTH CARE ORGANIZATION, PROVISION, AND FINANCING 2022; 59:469580221121510. [PMID: 36062607 PMCID: PMC9449510 DOI: 10.1177/00469580221121510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study aimed to investigate family caregivers’ experiences of caring for
children with cerebral palsy in China. This study used a descriptive qualitative
design. We selected 18 family caregivers from 3 children’s hospitals in Jiangsu
Province, China, using a purposive sampling method. The following 5 themes
emerged as needs of family caregivers’ experiences of caring for children with
cerebral palsy: overall responsibility, being alone, exhaustion from caring,
being a prisoner of life, and uncertainty regarding the future. The findings of
our research contribute to a better understanding of the life situation of
family caregivers of children with cerebral palsy as we identify the
difficulties they experience as well as their specific needs.
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Affiliation(s)
- Zhi Hong Ni
- Children’s Hospital of Soochow University, Suzhou, China
| | - Sheng Ding
- Children’s Hospital of Soochow University, Suzhou, China
| | - Jin Hua Wu
- Children’s Hospital of Soochow University, Suzhou, China
| | - Shuo Zhang
- Children’s Hospital of Soochow University, Suzhou, China
| | - Chun Yan Liu
- Children’s Hospital of Soochow University, Suzhou, China
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Pagnozzi AM, Pannek K, Fripp J, Fiori S, Boyd RN, Rose S. Understanding the impact of bilateral brain injury in children with unilateral cerebral palsy. Hum Brain Mapp 2020; 41:2794-2807. [PMID: 32134174 PMCID: PMC7294067 DOI: 10.1002/hbm.24978] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 01/27/2020] [Accepted: 02/23/2020] [Indexed: 11/29/2022] Open
Abstract
The presence of bilateral brain injury in patients with unilateral cerebral palsy (CP) may impact neuroplasticity in the ipsilateral hemisphere; however, this pattern of injury is typically under‐analyzed due to the lack of methods robust to severe injury. In this study, injury‐robust methods have been applied to structural brain magnetic resonance imaging (MRI) data of a cohort of 91 children with unilateral CP (37 with unilateral and 54 with bilateral brain injury, 4–17 years) and 44 typically developing controls (5–17 years), to determine how brain structure is associated with concurrent motor function, and if these associations differ between patients with unilateral or bilateral injury. Regression models were used to associate these measures with two clinical scores of hand function, with patient age, gender, brain injury laterality, and interaction effects included. Significant associations with brain structure and motor function were observed (Pearson's r = .494–.716), implicating several regions of the motor pathway, and demonstrating an accurate prediction of hand function from MRI, regardless of the extent of brain injury. Reduced brain volumes were observed in patients with bilateral injury, including volumes of the thalamus and corpus callosum splenium, compared to those with unilateral injury, and the healthy controls. Increases in cortical thickness in several cortical regions were observed in cohorts with unilateral and bilateral injury compared to controls, potentially suggesting neuroplasticity might be occurring in the inferior frontal gyrus and the precuneus. These findings identify prospective useful target regions for transcranial magnetic stimulation intervention.
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Affiliation(s)
- Alex M Pagnozzi
- CSIRO Health and Biosecurity, The Australian e-Health Research Centre, Brisbane, Australia
| | - Kerstin Pannek
- CSIRO Health and Biosecurity, The Australian e-Health Research Centre, Brisbane, Australia
| | - Jurgen Fripp
- CSIRO Health and Biosecurity, The Australian e-Health Research Centre, Brisbane, Australia
| | | | - Roslyn N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, Centre for Children's Health Research, The University of Queensland, Brisbane, Australia
| | - Stephen Rose
- CSIRO Health and Biosecurity, The Australian e-Health Research Centre, Brisbane, Australia
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Liu H, Jiang H, Wang X, Zheng J, Zhao H, Cheng Y, Tao X, Wang M, Liu C, Huang T, Wu L, Jin C, Li X, Wang H, Yang J. Treatment response prediction of rehabilitation program in children with cerebral palsy using radiomics strategy: protocol for a multicenter prospective cohort study in west China. Quant Imaging Med Surg 2019; 9:1402-1412. [PMID: 31559169 DOI: 10.21037/qims.2019.04.04] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background Cerebral palsy (CP) is a major cause of chronic childhood disability worldwide, causing activity limitation as well as impairments in sensation, cognition, and communication. Leveraging biomarkers to establish individualized predictions of future treatment responses will be of great value. We aim to develop and validate a model that can be used to predict the individualized treatment response in Children with CP. Methods A multicenter prospective cohort study will be conducted in 4 hospitals in west China. One hundred and thirty children with CP will be recruited and undergo clinical assessment using the Peabody Developmental Motor Scales, Manual Ability Classification System (MACS), Hand Assessment for Infants (HAI), Assisting Hand Assessment (AHA), and Gross Motor Function Classification System (GMFCS). The data collected will include MRI image, clinical status, and socioeconomic status. The clinical information and MRI features extracted using radiomics strategy will be combined for exploratory analysis. The accuracy, sensitivity, and specificity of the model will be assessed using multiple modeling methodologies. Internal and external validation will be used to evaluate the performance of the radiomics model. Discussion We hypothesized that the findings from this study could provide a critical step towards the prediction of treatment response in children with CP, which could also complement other biomarkers in the development of precision medicine approaches for this severe disorder. Trial registration The study was registered with clinicaltrials.gov (NCT02979743).
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Affiliation(s)
- Heng Liu
- Department of Diagnostic Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China.,The Key Laboratory of Biomedical Information Engineering, Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an 710054, China.,Medical Imaging Center of Guizhou Province, Department of Radiology, the Affiliated Hospital of Zunyi Medical University, Zunyi 563000, China
| | - Haoxiang Jiang
- Department of Diagnostic Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China.,The Key Laboratory of Biomedical Information Engineering, Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an 710054, China
| | - Xiaoyu Wang
- Department of Diagnostic Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - Jie Zheng
- Clinical Research Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - Huifang Zhao
- Department of Diagnostic Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - Yannan Cheng
- Department of Diagnostic Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - Xingxing Tao
- Department of Diagnostic Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - Miaomiao Wang
- Department of Diagnostic Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - Congcong Liu
- Department of Diagnostic Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - Ting Huang
- Department of Radiology, the First Affiliated Hospital of Henan University of TCM, Zhengzhou 450046, China
| | - Liang Wu
- Department of Diagnostic Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China.,The Key Laboratory of Biomedical Information Engineering, Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an 710054, China
| | - Chao Jin
- Department of Diagnostic Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - Xianjun Li
- Department of Diagnostic Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - Hui Wang
- Department of Brain Disease, Xi'an Brain Disease Hospital of Traditional Chinese Medicine, Xi'an 710032, China
| | - Jian Yang
- Department of Diagnostic Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China.,The Key Laboratory of Biomedical Information Engineering, Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an 710054, China
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10
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Hilderley AJ, Taylor MJ, Fehlings D, Chen JL, Wright FV. Optimization of fMRI methods to determine laterality of cortical activation during ankle movements of children with unilateral cerebral palsy. Int J Dev Neurosci 2018; 66:54-62. [PMID: 29413879 DOI: 10.1016/j.ijdevneu.2018.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 01/20/2018] [Accepted: 01/22/2018] [Indexed: 10/18/2022] Open
Abstract
Measurement of laterality of motor cortical activations may provide valuable information about lower limb control in children with unilateral cerebral palsy (UCP). Evidence from upper limb research suggests that increased contralateral activity may accompany functional gains. However, lower limb areas of activation and associated changes have been underexplored due to challenges with imaging motor cortical leg representations. In this study, methods for a task-based functional magnetic resonance imaging (fMRI) ankle dorsiflexion paradigm were refined with three pilot groups of participants: (i) adults (n = 5); (ii) typically developing (TD) children (n = 5) and; (iii) children with UCP (n = 4). Parameters of experimental design, task resistance, reproducibility, and pre-scan procedures were tested/refined using a staged development approach with additions or changes introduced if image quality did not meet pre-defined standards. When image quality was acceptable for two consecutive participants, the next participant group was recruited to test/refine the next parameter. The final paradigm involved an event-related design of a single dorsiflexion movement against individualized resistance, with two runs per leg. It included a pre-scan session to increase child comfort and determine task resistance. This paradigm produced valid data for laterality index (LI) calculations to determine the ratio of activity in each hemisphere. Ventricle and lesion masks were used in non-linear image registration, and individual thresholds were used for extent-based LI calculations. LI of dominant ankle movements were contralateral (LI ≥ +0.2) for TD children (mean LI = +0.89, std = 0.27) and children with UCP (mean LI = +0.86, std = 0.26). For the affected ankle of children with UCP, LI values indicated ipsilateral and/or contralateral activation (mean LI = +0.02, std = 0.71, range -0.92 to +1.00). This fMRI paradigm will support investigations of cortical activation and mechanisms of skill improvement following lower limb interventions.
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Affiliation(s)
- A J Hilderley
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, 150 Kilgour Rd, Toronto, M4K 1E1, Canada; Rehabilitation Sciences Institute, University of Toronto, 500 University Ave, Toronto, M5G 1V7, Canada.
| | - M J Taylor
- Diagnostic Imaging, Hospital for Sick Children, 555 University Avenue, Toronto, M5G 1X8, Canada; Department of Medical Imaging, University of Toronto, 263 McCaul Street, Toronto, M5T 1W7, Canada; Department of Psychology, University of Toronto, 100 St. George Street, Toronto, M5S 3G3, Canada.
| | - D Fehlings
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, 150 Kilgour Rd, Toronto, M4K 1E1, Canada; Rehabilitation Sciences Institute, University of Toronto, 500 University Ave, Toronto, M5G 1V7, Canada; Department of Developmental Paediatrics, University of Toronto, 1 King's College Circle, Toronto, M5S 1A8, Canada.
| | - J L Chen
- Rehabilitation Sciences Institute, University of Toronto, 500 University Ave, Toronto, M5G 1V7, Canada; Hurvitz Brain Sciences Program, Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, 2075 Bayview Ave, Toronto, M4N 3M5, Canada; Department of Physical Therapy, University of Toronto, 500 University Ave, Toronto, M5G 1V7, Canada.
| | - F V Wright
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, 150 Kilgour Rd, Toronto, M4K 1E1, Canada; Rehabilitation Sciences Institute, University of Toronto, 500 University Ave, Toronto, M5G 1V7, Canada; Department of Physical Therapy, University of Toronto, 500 University Ave, Toronto, M5G 1V7, Canada.
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11
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How does the interaction of presumed timing, location and extent of the underlying brain lesion relate to upper limb function in children with unilateral cerebral palsy? Eur J Paediatr Neurol 2017; 21:763-772. [PMID: 28606752 DOI: 10.1016/j.ejpn.2017.05.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 03/28/2017] [Accepted: 05/18/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Upper limb (UL) function in children with unilateral cerebral palsy (CP) vary largely depending on presumed timing, location and extent of brain lesions. These factors might exhibit a complex interaction and the combined prognostic value warrants further investigation. This study aimed to map lesion location and extent and assessed whether these differ according to presumed lesion timing and to determine the impact of structural brain damage on UL function within different lesion timing groups. MATERIALS AND METHODS Seventy-three children with unilateral CP (mean age 10 years 2 months) were classified according to lesion timing: malformations (N = 2), periventricular white matter (PWM, N = 42) and cortical and deep grey matter (CDGM, N = 29) lesions. Neuroanatomical damage was scored using a semi-quantitative MRI scale. UL function was assessed at body function and activity level. RESULTS CDGM lesions were more pronounced compared to PWM lesions (p = 0.0003). Neuroanatomical scores were correlated with a higher degree to UL function in the CDGM group (rs = -0.39 to rs = -0.84) compared to the PWM group (rrb = -0.42 to rs = -0.61). Regression analysis found lesion location and extent to explain 75% and 65% (p < 0.02) respectively, of the variance in AHA performance in the CDGM group, but only 24% and 12% (p < 0.03) in the PWM group. CONCLUSIONS In the CDGM group, lesion location and extent seems to impact more on UL function compared to the PWM group. In children with PWM lesions, other factors like corticospinal tract (re)organization and structural connectivity may play an additional role.
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Reid LB, Pagnozzi AM, Fiori S, Boyd RN, Dowson N, Rose SE. Measuring neuroplasticity associated with cerebral palsy rehabilitation: An MRI based power analysis. Int J Dev Neurosci 2017; 58:17-25. [DOI: 10.1016/j.ijdevneu.2017.01.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 01/23/2017] [Accepted: 01/23/2017] [Indexed: 10/20/2022] Open
Affiliation(s)
- Lee B. Reid
- The Australian e‐Health Research Centre, CSIROBrisbaneAustralia
- Queensland Cerebral Palsy and Rehabilitation Research CentreFaculty of MedicineThe University of QueenslandBrisbaneAustralia
| | - Alex M. Pagnozzi
- The Australian e‐Health Research Centre, CSIROBrisbaneAustralia
- Queensland Cerebral Palsy and Rehabilitation Research CentreFaculty of MedicineThe University of QueenslandBrisbaneAustralia
| | - Simona Fiori
- Department of Clinical and Experimental MedicineUniversità di PisaPisaItaly
| | - Roslyn N. Boyd
- Queensland Cerebral Palsy and Rehabilitation Research CentreFaculty of MedicineThe University of QueenslandBrisbaneAustralia
| | - Nicholas Dowson
- The Australian e‐Health Research Centre, CSIROBrisbaneAustralia
| | - Stephen E. Rose
- The Australian e‐Health Research Centre, CSIROBrisbaneAustralia
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Lodygensky GA, Thompson DK. Toward quantitative MRI analysis: A smart approach to characterize neonatal white matter injury. Neurology 2017; 88:610-611. [PMID: 28100729 DOI: 10.1212/wnl.0000000000003621] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Gregory A Lodygensky
- From the Department of Pediatrics and Pharmacology (G.A.L), CHU Research Center, University of Montréal; Montreal Heart Institute (G.A.L), Canada; Murdoch Childrens Research Institute (D.K.T); Florey Institute of Neuroscience and Mental Health (D.K.T), Parkville; and Department of Paediatrics (D.K.T), University of Melbourne, Australia.
| | - Deanne K Thompson
- From the Department of Pediatrics and Pharmacology (G.A.L), CHU Research Center, University of Montréal; Montreal Heart Institute (G.A.L), Canada; Murdoch Childrens Research Institute (D.K.T); Florey Institute of Neuroscience and Mental Health (D.K.T), Parkville; and Department of Paediatrics (D.K.T), University of Melbourne, Australia
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Automated Robust Image Segmentation: Level Set Method Using Nonnegative Matrix Factorization with Application to Brain MRI. Bull Math Biol 2016; 78:1450-76. [PMID: 27417984 DOI: 10.1007/s11538-016-0190-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 06/16/2016] [Indexed: 10/21/2022]
Abstract
We address the problem of fully automated region discovery and robust image segmentation by devising a new deformable model based on the level set method (LSM) and the probabilistic nonnegative matrix factorization (NMF). We describe the use of NMF to calculate the number of distinct regions in the image and to derive the local distribution of the regions, which is incorporated into the energy functional of the LSM. The results demonstrate that our NMF-LSM method is superior to other approaches when applied to synthetic binary and gray-scale images and to clinical magnetic resonance images (MRI) of the human brain with and without a malignant brain tumor, glioblastoma multiforme. In particular, the NMF-LSM method is fully automated, highly accurate, less sensitive to the initial selection of the contour(s) or initial conditions, more robust to noise and model parameters, and able to detect as small distinct regions as desired. These advantages stem from the fact that the proposed method relies on histogram information instead of intensity values and does not introduce nuisance model parameters. These properties provide a general approach for automated robust region discovery and segmentation in heterogeneous images. Compared with the retrospective radiological diagnoses of two patients with non-enhancing grade 2 and 3 oligodendroglioma, the NMF-LSM detects earlier progression times and appears suitable for monitoring tumor response. The NMF-LSM method fills an important need of automated segmentation of clinical MRI.
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