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Hamdule S, Kölbel M, Stotesbury H, Murdoch R, Clayden JD, Sahota S, Hood AM, Clark CA, Kirkham FJ. Effects of regional brain volumes on cognition in sickle cell anemia: A developmental perspective. Front Neurol 2023; 14:1101223. [PMID: 36860579 PMCID: PMC9968851 DOI: 10.3389/fneur.2023.1101223] [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: 11/17/2022] [Accepted: 01/18/2023] [Indexed: 02/15/2023] Open
Abstract
Background and objectives Cognitive difficulties in people with sickle cell anemia (SCA) are related to lower processing speed index (PSI) and working memory index (WMI). However, risk factors are poorly understood so preventative strategies have not been explored. Brain volumes, specifically white matter volumes (WMV) which increases through early adulthood, have been associated with better cognition in healthy typically developing individuals. In patients with SCA, the reduced WMV and total subcortical volumes noted could explain cognitive deficits. We therefore examined developmental trajectories for regional brain volumes and cognitive endpoints in patients with SCA. Methods Data from two cohorts, the Sleep and Asthma Cohort and Prevention of Morbidity in SCA, were available. MRI data included T1-weighted axial images, pre-processed before regional volumes were extracted using Free-surfer. PSI and WMI from the Weschler scales of intelligence were used to test neurocognitive performance. Hemoglobin, oxygen saturation, hydroxyurea treatment and socioeconomic status from education deciles were available. Results One hundred and twenty nine patients (66 male) and 50 controls (21 male) aged 8-64 years were included. Brain volumes did not significantly differ between patients and controls. Compared with controls, PSI and WMI were significantly lower in patients with SCA, predicted by increasing age and male sex, with lower hemoglobin in the model for PSI but no effect of hydroxyurea treatment. In male patients with SCA only, WMV, age and socioeconomic status predicted PSI, while total subcortical volumes predicted WMI. Age positively and significantly predicted WMV in the whole group (patients + controls). There was a trend for age to negatively predict PSI in the whole group. For total subcortical volume and WMI, age predicted decrease only in the patient group. Developmental trajectory analysis revealed that PSI only was significantly delayed in patients at 8 years of age; the rate of development for the cognitive and brain volume data did not differ significantly from controls. Discussion Increasing age and male sex negatively impact cognition in SCA, with processing speed, also predicted by hemoglobin, delayed by mid childhood. Associations with brain volumes were seen in males with SCA. Brain endpoints, calibrated against large control datasets, should be considered for randomized treatment trials.
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Affiliation(s)
- Shifa Hamdule
- Developmental Neurosciences Section, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Melanie Kölbel
- Developmental Neurosciences Section, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
- Sleep Education and Research Laboratory, UCL Institute of Education, London, United Kingdom
| | - Hanne Stotesbury
- Developmental Neurosciences Section, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Russell Murdoch
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Jonathan D. Clayden
- Developmental Neurosciences Section, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Sati Sahota
- Developmental Neurosciences Section, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Anna Marie Hood
- Developmental Neurosciences Section, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
- Division of Psychology and Mental Health, Manchester Centre for Health Psychology, University of Manchester, Manchester, United Kingdom
| | - Christopher A. Clark
- Developmental Neurosciences Section, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Fenella Jane Kirkham
- Developmental Neurosciences Section, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
- Clinical and Experimental Sciences, University of Southampton, Southampton, United Kingdom
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Sun B, Brown RC, Burns TG, Murdaugh D, Palasis S, Jones RA. Differences in Activation and Deactivation in Children with Sickle Cell Disease Compared with Demographically Matched Controls. AJNR Am J Neuroradiol 2017; 38:1242-1247. [PMID: 28408626 DOI: 10.3174/ajnr.a5170] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 02/06/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Declines in both functional activation and functional connectivity have been reported in patients with sickle cell disease. In this study, we derived the functional and default mode responses to a word stem paradigm in age-, ethnicity-, and background-matched subjects with sickle cell disease and control groups, with the aim of testing whether both networks were similarly attenuated and whether the changes were related to physiologic parameters that characterize sickle cell disease. MATERIALS AND METHODS Both the functional and default mode responses were obtained from age- and background-matched controls and the sickle cell population by using a visually presented word stem paradigm on a 3T scanner. RESULTS We observed an attenuated response to both activation and deactivation in the sickle cell disease group. There were no significant differences in the activation response between the 2 groups for the contrast control > sickle cell disease; however, significant differences were observed in the medial parietal cortex, the auditory cortex, and the angular gyrus for the default mode. For the sickle cell group, a significant correlation between the activation z scores and the physiologic parameters was observed; for the deactivation, the results were not significant but the trend was similar. CONCLUSIONS The results indicate that the physiologic parameters modulate the activation in the expected fashion, but that the effect was weaker for deactivation. Given that significant differences between the 2 groups were only seen for deactivation, additional factors must modulate the deactivation in sickle cell disease.
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Affiliation(s)
- B Sun
- From the Departments of Radiology (B.S., S.P., R.A.J.)
| | | | - T G Burns
- Neuropsychology (T.G.B., D.M.), Children's Healthcare of Atlanta, Atlanta, Georgia
| | - D Murdaugh
- Neuropsychology (T.G.B., D.M.), Children's Healthcare of Atlanta, Atlanta, Georgia
| | - S Palasis
- From the Departments of Radiology (B.S., S.P., R.A.J.)
| | - R A Jones
- From the Departments of Radiology (B.S., S.P., R.A.J.)
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Kuno H, Jara H, Buch K, Qureshi MM, Chapman MN, Sakai O. Global and Regional Brain Assessment with Quantitative MR Imaging in Patients with Prior Exposure to Linear Gadolinium-based Contrast Agents. Radiology 2017; 283:195-204. [DOI: 10.1148/radiol.2016160674] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Hirofumi Kuno
- From the Departments of Radiology (H.K., H.J., K.B., M.M.Q., M.N.C., O.S.), Radiation Oncology (M.M.Q., O.S.), and Otolaryngology—Head and Neck Surgery (O.S.), Boston Medical Center, Boston University School of Medicine, FGH Building, 3rd Floor, 820 Harrison Ave, Boston, MA 02118
| | - Hernán Jara
- From the Departments of Radiology (H.K., H.J., K.B., M.M.Q., M.N.C., O.S.), Radiation Oncology (M.M.Q., O.S.), and Otolaryngology—Head and Neck Surgery (O.S.), Boston Medical Center, Boston University School of Medicine, FGH Building, 3rd Floor, 820 Harrison Ave, Boston, MA 02118
| | - Karen Buch
- From the Departments of Radiology (H.K., H.J., K.B., M.M.Q., M.N.C., O.S.), Radiation Oncology (M.M.Q., O.S.), and Otolaryngology—Head and Neck Surgery (O.S.), Boston Medical Center, Boston University School of Medicine, FGH Building, 3rd Floor, 820 Harrison Ave, Boston, MA 02118
| | - Muhammad Mustafa Qureshi
- From the Departments of Radiology (H.K., H.J., K.B., M.M.Q., M.N.C., O.S.), Radiation Oncology (M.M.Q., O.S.), and Otolaryngology—Head and Neck Surgery (O.S.), Boston Medical Center, Boston University School of Medicine, FGH Building, 3rd Floor, 820 Harrison Ave, Boston, MA 02118
| | - Margaret N. Chapman
- From the Departments of Radiology (H.K., H.J., K.B., M.M.Q., M.N.C., O.S.), Radiation Oncology (M.M.Q., O.S.), and Otolaryngology—Head and Neck Surgery (O.S.), Boston Medical Center, Boston University School of Medicine, FGH Building, 3rd Floor, 820 Harrison Ave, Boston, MA 02118
| | - Osamu Sakai
- From the Departments of Radiology (H.K., H.J., K.B., M.M.Q., M.N.C., O.S.), Radiation Oncology (M.M.Q., O.S.), and Otolaryngology—Head and Neck Surgery (O.S.), Boston Medical Center, Boston University School of Medicine, FGH Building, 3rd Floor, 820 Harrison Ave, Boston, MA 02118
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Juttukonda MR, Jordan LC, Gindville MC, Davis LT, Watchmaker JM, Pruthi S, Donahue MJ. Cerebral hemodynamics and pseudo-continuous arterial spin labeling considerations in adults with sickle cell anemia. NMR IN BIOMEDICINE 2017; 30:10.1002/nbm.3681. [PMID: 28052565 PMCID: PMC5351809 DOI: 10.1002/nbm.3681] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Revised: 10/11/2016] [Accepted: 11/12/2016] [Indexed: 05/28/2023]
Abstract
Sickle cell anemia (SCA) is a genetic disorder resulting in reduced oxygen carrying capacity and elevated stroke risk. Pseudo-continuous arterial spin labeling (pCASL) measures of cerebral blood flow (CBF) may have relevance for stroke risk assessment; however, the effects of elevated flow velocity and reduced bolus arrival time (BAT) on CBF quantification in SCA patients have not been thoroughly characterized, and pCASL model parameters used in healthy adults are often applied to patients with SCA. Here, cervical arterial flow velocities and pCASL labeling efficiencies were computed in adults with SCA (n = 19) and age- and race-matched controls without sickle trait (n = 7) using pCASL in sequence with phase contrast MR angiography (MRA). Controls (n = 7) and a subgroup of patients (n = 8) also underwent multi-post-labeling-delay pCASL for BAT assessment. Mean flow velocities were elevated in SCA adults (velocity = 28.3 ± 4.1 cm/s) compared with controls (velocity = 24.5 ± 3.8 cm/s), and mean pCASL labeling efficiency (α) was reduced in SCA adults (α = 0.72) relative to controls (α = 0.91). In patients, mean whole-brain CBF from phase contrast MRA was 91.8 ± 18.1 ml/100 g/min, while mean pCASL CBF when assuming a constant labeling efficiency of 0.86 was 75.2 ± 17.3 ml/100 g/min (p < 0.01), resulting in a mean absolute quantification error of 23% when a labeling efficiency appropriate for controls was assumed. This difference cannot be accounted for by BAT (whole-brain BAT: control, 1.13 ± 0.06 s; SCA, 1.02 ± 0.09 s) or tissue T1 variation. In conclusion, BAT variation influences pCASL quantification less than elevated cervical arterial velocity and labeling efficiency variation in SCA adults; thus, a lower labeling efficiency (α = 0.72) or subject-specific labeling efficiency should be incorporated for SCA patients.
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Affiliation(s)
- Meher R. Juttukonda
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee USA
- Institute of Imaging Science, Vanderbilt University, Nashville, Tennessee USA
| | - Lori C. Jordan
- Department of Pediatrics, Division of Pediatric Neurology, Vanderbilt Medical Center, Nashville, Tennessee USA
| | - Melissa C. Gindville
- Department of Pediatrics, Division of Pediatric Neurology, Vanderbilt Medical Center, Nashville, Tennessee USA
| | - Larry T. Davis
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee USA
| | | | - Sumit Pruthi
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee USA
| | - Manus J. Donahue
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee USA
- Institute of Imaging Science, Vanderbilt University, Nashville, Tennessee USA
- Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee USA
- Department of Psychiatry, Vanderbilt University Medical Center, Nashville, Tennessee USA
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Arterial spin labeling characterization of cerebral perfusion during normal maturation from late childhood into adulthood: normal 'reference range' values and their use in clinical studies. J Cereb Blood Flow Metab 2014; 34:776-84. [PMID: 24496173 PMCID: PMC4013758 DOI: 10.1038/jcbfm.2014.17] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Revised: 12/19/2013] [Accepted: 01/08/2014] [Indexed: 11/08/2022]
Abstract
The human brain changes structurally and functionally during adolescence, with associated alterations in cerebral perfusion. We performed dynamic arterial spin labeling (ASL) magnetic resonance imaging in healthy subjects between 8 and 32 years of age, to investigate changes in cerebral hemodynamics during normal development. In addition, an inversion recovery sequence allowed quantification of changes in longitudinal relaxation time (T₁) and equilibrium longitudinal magnetization (M₀). We present mean and reference ranges for normal values of T₁, M₀, cerebral blood flow (CBF), bolus arrival time, and bolus duration in cortical gray matter, to provide a tool for identifying age-matched perfusion abnormalities in this age range in clinical studies. Cerebral blood flow and T₁ relaxation times were negatively correlated with age, without gender or hemisphere differences. The same was true for M₀ anteriorly, but posteriorly, males but not females showed a significant decline in M₀ with increasing age. Two examples of the clinical utility of these data in identifying age-matched perfusion abnormalities, in Sturge-Weber syndrome and sickle cell anemia, are illustrated.
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Mackin RS, Insel P, Truran D, Vichinsky EP, Neumayr LD, Armstrong FD, Gold JI, Kesler K, Brewer J, Weiner MW. Neuroimaging abnormalities in adults with sickle cell anemia: associations with cognition. Neurology 2014; 82:835-41. [PMID: 24523480 DOI: 10.1212/wnl.0000000000000188] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE This study was conducted to determine the relationship of frontal lobe cortical thickness and basal ganglia volumes to measures of cognition in adults with sickle cell anemia (SCA). METHODS Participants included 120 adults with SCA with no history of neurologic dysfunction and 33 healthy controls (HCs). Participants were enrolled at 12 medical center sites, and raters were blinded to diagnostic group. We hypothesized that individuals with SCA would exhibit reductions in frontal lobe cortex thickness and reduced basal ganglia and thalamus volumes compared with HCs and that these structural brain abnormalities would be associated with measures of cognitive functioning (Wechsler Adult Intelligence Scale, 3rd edition). RESULTS After adjusting for age, sex, education level, and intracranial volume, participants with SCA exhibited thinner frontal lobe cortex (t = -2.99, p = 0.003) and reduced basal ganglia and thalamus volumes compared with HCs (t = -3.95, p < 0.001). Reduced volume of the basal ganglia and thalamus was significantly associated with lower Performance IQ (model estimate = 3.75, p = 0.004) as well as lower Perceptual Organization (model estimate = 1.44, p = 0.007) and Working Memory scores (model estimate = 1.37, p = 0.015). Frontal lobe cortex thickness was not significantly associated with any cognitive measures. CONCLUSIONS Our findings suggest that basal ganglia and thalamus abnormalities may represent a particularly salient contributor to cognitive dysfunction in adults with SCA.
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Affiliation(s)
- R Scott Mackin
- From the Department of Psychiatry (R.S.M.), University of California, San Francisco; Center for Imaging of Neurodegenerative Diseases (R.S.M., P.I., D.T., J.B., M.W.W.), San Francisco Veterans Administration Medical Center, San Francisco; Hematology/Oncology Department (E.P.V., L.D.N.), Children's Hospital & Research Center Oakland; Keck School of Medicine (J.I.G.), University of Southern California; Departments of Anesthesiology and Pediatrics (J.I.G.), Children's Hospital Los Angeles, CA; Rho, Inc. (K.K.), Research Triangle Park, NC; Department of Pediatrics (F.D.A.), University of Miami Miller School of Medicine and Holtz Children's Hospital, Miami, FL; and Veterans Administration Medical Center (M.W.W.), and Departments of Radiology, Medicine, Psychiatry, and Neurology, University of California, San Francisco
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Deus-Silva L, Bonilha L, Damasceno BP, Costa ALF, Yasuda CL, Costa FF, Santos AO, Etchebehere ECSC, Oquendo-Nogueira R, Fockink R, de Freitas CF, Camargo EE, Li LM, Cendes F, Saad ST. Brain Perfusion Impairment in Neurologically Asymptomatic Adult Patients with Sickle-Cell Disease Shown by Voxel-Based Analysis of SPECT Images. Front Neurol 2013; 4:207. [PMID: 24391625 PMCID: PMC3869238 DOI: 10.3389/fneur.2013.00207] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Accepted: 12/08/2013] [Indexed: 11/13/2022] Open
Abstract
Cerebrovascular lesions are frequently observed in patients with sickle-cell disease (SCD) and these structural lesions are preceded by insidious perfusion deficits. Our aim was to investigate the presence of brain perfusion deficits in neurologically asymptomatic SCD patients, especially affecting microvessels. For this study, 42 SCD patients [33 sickle-cell anemia (HbSS), 6 sickle hemoglobin C disease (HbSC), and 3 sickle β-thalassemia disease (HbSβ)] with mean hematocrit of 25.1 (±4.85; 15.6–38.5) underwent brain perfusion single photon emission computerized tomography (SPECT) using the tracer 99mTc-ECD. Images from SCD patients were compared to images of a healthy control group (29 females and 20 males, mean age 31 ± 8; range 25–49 years). Images underwent voxel-wise comparison of regional tracer uptake using paired t-test to estimate the probability of each voxel to have an increased or decreased tracer uptake. When compared to controls, SCD patients exhibited significantly reduced tracer uptake in basal ganglia and thalami, the anterior frontal region and the watershed region of the temporo-parietal-occipital transition (p < 0.05). Our study showed that neurologically asymptomatic adult SCD patients exhibit a pattern of reduced 99mTc-ECD tracer uptake demonstrated by SPECT. Early diagnosis of this cerebral vasculopathy has prognostic implications and can be determinant in considering therapeutic alternatives to avoid increasing brain lesion load and progressive disability.
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Affiliation(s)
| | - Leonardo Bonilha
- Division of Neurology, Department of Neurosciences, Medical University of South Carolina , Charleston, SC , USA
| | | | - Andre L F Costa
- Department of Neurology, University of Campinas , Campinas , Brazil ; Department of Orthodontics, City University of São Paulo , São Paulo , Brazil
| | | | - Fernando F Costa
- Hematology and Hemotherapy Center, University of Campinas , Campinas , Brazil
| | - Allan O Santos
- Division of Nuclear Medicine, Department of Radiology, University of Campinas , Campinas , Brazil
| | - Elba C S C Etchebehere
- Division of Nuclear Medicine, Department of Radiology, University of Campinas , Campinas , Brazil
| | - Regis Oquendo-Nogueira
- Division of Nuclear Medicine, Department of Radiology, University of Campinas , Campinas , Brazil
| | - Renata Fockink
- Division of Nuclear Medicine, Department of Radiology, University of Campinas , Campinas , Brazil
| | | | - Edwaldo E Camargo
- Division of Nuclear Medicine, Department of Radiology, University of Campinas , Campinas , Brazil
| | - Li M Li
- Department of Neurology, University of Campinas , Campinas , Brazil
| | - Fernando Cendes
- Department of Neurology, University of Campinas , Campinas , Brazil
| | - Sara T Saad
- Hematology and Hemotherapy Center, University of Campinas , Campinas , Brazil
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Kawadler JM, Clayden JD, Kirkham FJ, Cox TC, Saunders DE, Clark CA. Subcortical and cerebellar volumetric deficits in paediatric sickle cell anaemia. Br J Haematol 2013; 163:373-6. [PMID: 23889205 DOI: 10.1111/bjh.12496] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 06/26/2013] [Indexed: 11/29/2022]
Abstract
Sickle cell anaemia (SCA) is associated with silent cerebral infarction (SCI), affecting white and cortical grey matter, but there are few data on subcortical volumes. We analysed retrospective magnetic resonance imaging (MRI) data in 26 SCA patients and 20 controls, comparing mean subcortical volumes between three groups: controls, SCA with SCI (n = 13) and SCA without visible abnormality (n = 13). Specific volumetric differences were found in the hippocampus, amygdala, pallidum, caudate, putamen, thalamus, and cerebellum. This is the first study to demonstrate subcortical volume change in SCA, with the most severe volumetric deficits occurring in children with SCI seen on MRI.
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Affiliation(s)
- Jamie M Kawadler
- Imaging & Biophysics Unit, Institute of Child Health, University College London, London, UK
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Sun B, Brown RC, Hayes L, Burns TG, Huamani J, Bearden DJ, Jones RA. White matter damage in asymptomatic patients with sickle cell anemia: screening with diffusion tensor imaging. AJNR Am J Neuroradiol 2012; 33:2043-9. [PMID: 22595904 DOI: 10.3174/ajnr.a3135] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Ischemic injury to the brain is a common complication of SCA. To better understand the neurologic impact of SCA, TBSS were applied to DTI data to investigate white matter injuries in pediatric patients with SCA. MATERIALS AND METHODS TBSS comparisons of a range of anisotropy and diffusion measures were carried out between age- and background-matched population groups: patients with SCA with no visible lesions, patients with SCA with mild gliosis, and normal controls. RESULTS TBSS analysis revealed that both SCA populations exhibited reduced anisotropy and increased diffusivity compared with normal controls in multiple brain regions, including the corpus callosum and centrum semiovale. Furthermore, the results suggest that the severity of SCA is positively correlated with the white matter changes in the corpus callosum. CONCLUSIONS The study demonstrates that TBSS is a viable technique in detecting subtle white matter damage in patients with SCA whose conventional anatomic MR imaging scans show no, or minimal, abnormalities and has the potential to evaluate the neurologic impact of the treatment of SCA.
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Affiliation(s)
- B Sun
- Departments of Radiology, Children’s Healthcare of Atlanta, Atlanta, GA 30342, USA
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Martinez-Saez E, Shah S, Costa C, Fleminger S, Connor S, Bodi I. Adult onset leukodystrophy with neuroaxonal spheroids and demyelinating plaque-like lesions. Neuropathology 2011; 32:285-92. [PMID: 22007734 DOI: 10.1111/j.1440-1789.2011.01257.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Adult onset leukodystrophy with neuroaxonal spheroids is an uncommon cause of dementia. Both hereditary (autosomal dominant) and sporadic cases have been described. A 41-year-old African woman presented with inappropriate behavior and personality change consistent with frontal lobe dysfunction. MRI demonstrated diffuse frontoparietal white matter signal abnormality and volume loss, as well as focal enhancing white matter lesions, while CT scan showed white matter calcifications. She had been gradually deteriorating over the last 5 years, diagnosed as having progressive demyelinating illness. She died of recurrent chest infections. There was no familial history. The brain showed prominent symmetrical white matter changes with greyish discolorization mainly affecting the frontal and parietal lobes, with less involvement of the temporal lobe and only mildly affecting the occipital white matter. Histology revealed deep white matter atrophy with many neuroaxonal spheroids labelled by neurofilament and β-amyloid precursor protein. In addition, scattered inactive demyelinating plaque-like lesions were found in the periventricular areas, brainstem and the cervical spinal cord. This case had typical features of an adult onset leukodystrophy with neuroaxonal spheroids. However, we also demonstrated demyelinating plaque-like lesions, which has not been previously described. The possibility of a demyelinating origin contributing to the changes may be considered in the pathogenesis of this condition.
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Affiliation(s)
- Elena Martinez-Saez
- Department of Clinical Neuropathology, King's College Hospital, NHS Foundation Trust, London, UK
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Cazettes F, Tsui WH, Johnson G, Steen RG, Convit A. Systematic differences between lean and obese adolescents in brain spin-lattice relaxation time: a quantitative study. AJNR Am J Neuroradiol 2011; 32:2037-42. [PMID: 21960489 DOI: 10.3174/ajnr.a2698] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Emerging evidence suggests that obese adolescents show changes in brain structure compared with lean adolescents. In addition, obesity impacts body development during adolescence. We tested a hypothesis that T1, a marker of brain maturation, can show brain differences associated with obesity. MATERIALS AND METHODS Adolescents similar in sex, family income, and school grade were recruited by using strict entry criteria. We measured brain T1 in 48 obese and 31 lean adolescents by quantitative MR imaging at 1.5T. We combined MPRAGE and inversion-recovery sequences with normalization to standard space and automated skull stripping to obtain T1 maps with a symmetric voxel volume of 1 mm(3). RESULTS Sex, income, triglycerides, total cholesterol, and fasting glucose did not differ between groups, but obese adolescents had significantly lower HDL, higher LDL, and higher fasting insulin levels than lean adolescents. Intracranial vault volume did not differ between groups, but obese adolescents had smaller intracranial vault-adjusted brain parenchymal volumes. Obese adolescents had 4 clusters (>100 contiguous voxels) of T1 relaxation that were significantly different (P < .005) from those in lean adolescents. Three of these clusters had longer T1s in obese adolescents (in the orbitofrontal and parietal regions), and 1 cluster had shorter T1s, compared with lean adolescents. CONCLUSIONS Our results suggest that obesity may have a significant impact on brain development, especially in the frontal and parietal lobes. It is unclear if these changes persist into adulthood or whether they indicate that obese subjects follow a different developmental trajectory during adolescence.
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Affiliation(s)
- F Cazettes
- Department of Psychiatry, NYU School of Medicine, New York, NY, USA
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Kirk GR, Haynes MR, Palasis S, Brown C, Burns TG, McCormick M, Jones RA. Regionally specific cortical thinning in children with sickle cell disease. ACTA ACUST UNITED AC 2008; 19:1549-56. [PMID: 18996911 DOI: 10.1093/cercor/bhn193] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Sickle cell disease (SCD) is a chronic disease with a significant rate of neurological complications in the first decade of life. In this retrospective study, cortical thickness was examined in children with SCD who had no detectable abnormalities on conventional magnetic resonance imaging/magnetic resonance angiography. Regional differences in cortical thickness from SCD were explored using age-matched healthy controls as comparison. A comparison analysis was done for SCD (n = 28) and controls (n = 29) based on age (5-11; 12-21 years), due to the age-dependent variation in cortex maturation. Distinct regions of thinning were found in SCD patients in both age groups. The number, spatial extent, and significance (P < 0.001) of these areas of thinning were increased in the older SCD group. Regions of interest (ROIs) were defined on the areas of highly significant thinning in the older group and then mapped onto the younger cohort; a multiparametric linear regression analysis of the ROI data demonstrated significant (P < 0.001) cortical thinning in SCD subjects, with the largest regions of thinning in the precuneus and the posterior cingulate. The regionally specific differences suggest that cortical thickness may serve as a marker for silent insults in SCD and hence may be a useful tool for identifying SCD patients at risk for neurological sequelae.
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Affiliation(s)
- Gregory R Kirk
- Department of Radiology, Children's Healthcare of Atlanta, 1001 Johnson Ferry Road, Atlanta, GA 30342, USA
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Hogan AM, Pit-ten Cate IM, Vargha-Khadem F, Prengler M, Kirkham FJ. Physiological correlates of intellectual function in children with sickle cell disease: hypoxaemia, hyperaemia and brain infarction. Dev Sci 2006; 9:379-87. [PMID: 16764611 DOI: 10.1111/j.1467-7687.2006.00503.x] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Lowered intelligence relative to controls is evident by mid-childhood in children with sickle cell disease. There is consensus that brain infarct contributes to this deficit, but the subtle lowering of IQ in children with normal MRI scans might be accounted for by chronic systemic complications leading to insufficient oxygen delivery to the brain. We investigated the relationship between daytime oxyhaemoglobin saturation (SpO2), cerebral blood flow velocity (CBFV) and intellectual function (IQ) using path-analysis in 30 adolescents with sickle cell disease (mean age 17.4 years, SD 4.2). Initial analyses revealed that the association between SpO2 and Full Scale IQ (FSIQ) was fully mediated by increased CBFV, whereby SpO2 was negatively correlated with CBFV and CBFV was negatively correlated with FSIQ, i.e. decreases in oxygen saturation are associated with increases in velocity, and increased velocity is associated with lowered IQ scores. The mediated relationship suggests that lowered IQ may be a function of abnormal oxygen delivery to the brain. Further analyses showed that the association between CBFV and IQ was significant for verbal but not for performance IQ. The pathophysiology characteristic of SCD can interfere with brain function and constrain intellectual development, even in the absence of an infarct. This supports the hypothesis that lowered intellectual function is partly explained by chronic hypoxia, and has wider implications for our understanding of SCD pathophysiology.
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Affiliation(s)
- Alexandra M Hogan
- Developmental Cognitive Neuroscience Unit, Institute of Child Health, University College London, UK.
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Baldeweg T, Hogan AM, Saunders DE, Telfer P, Gadian DG, Vargha-Khadem F, Kirkham FJ. Detecting white matter injury in sickle cell disease using voxel-based morphometry. Ann Neurol 2006; 59:662-72. [PMID: 16450382 DOI: 10.1002/ana.20790] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Sickle cell disease (SCD) is associated with cerebrovascular disease, cerebral infarction, and cognitive dysfunction. This study aimed to detect the presence and extent of white matter abnormalities in individuals with SCD using voxel-based morphometry (VBM). METHODS Thirty-six children and adolescents with SCD (age range, 9-24 years) and 31 controls (8-25 years) underwent magnetic resonance investigations using T1- and T2-weighted protocols. White and gray matter density maps were obtained from three-dimensional magnetic resonance imaging (MRI) data sets. Using VBM, we compared the maps between controls and SCD individuals with silent white matter infarct lesions (SCD+L; n = 16), and those without visible abnormality (SCD-L; n = 20). RESULTS In comparison with controls, intelligence quotients (IQs) were lower in both SCD groups irrespective of presence of visible lesions. VBM showed widespread bilateral white matter abnormalities in the SCD+L group, extending beyond the regions of focal infarction in the deep anterior and posterior white matter borderzones. Bilateral white matter abnormalities were also observed in the SCD-L group, in locations similar to those in the SCD+L group. INTERPRETATION VBM is sensitive to detection of widespread white matter injury in SCD patients in borderzones between arterial territories even in the absence of evidence of infarction. Those changes may contribute to cognitive deficits in this population.
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Affiliation(s)
- Torsten Baldeweg
- Developmental Cognitive Neuroscience Unit, Institute of Child Health, University College, London, United Kingdom.
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Steen RG, Emudianughe T, Hankins GM, Wynn LW, Wang WC, Xiong X, Helton KJ. Brain imaging findings in pediatric patients with sickle cell disease. Radiology 2003; 228:216-25. [PMID: 12775848 DOI: 10.1148/radiol.2281020943] [Citation(s) in RCA: 110] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To determine prevalence of imaging abnormalities in the brain of children with sickle cell disease (SCD) and to identify clinical and methodological factors that influence prevalence estimate. MATERIALS AND METHODS Magnetic resonance (MR) imaging and MR angiographic findings for 185 patients with SCD examined at St Jude Children's Research Hospital since 1993 were reviewed. At least two readers independently reviewed images. Standard MR imaging criteria were used to identify lacunae, loss of white matter volume, encephalomalacia, or leukoencephalopathy. Patients were assigned grades to indicate limited or extensive abnormalities. Standard MR angiographic criteria were used to identify arterial tortuosity (limited vasculopathy) and stenosis or occlusion (extensive vasculopathy). Findings were evaluated as a function of patient clinical status (including stroke) and diagnosis. Recent methods (T1- and T2-weighted MR imaging plus fluid-attenuated inversion recovery [FLAIR] at 3-mm section thickness) were compared with older methods (T1- and T2-weighted MR imaging without FLAIR at 5-mm section thickness). RESULTS At mean age of 10 years, overall prevalence of infarction, ischemia, or atrophy in patients with SCD was 44% (82 of 185), and prevalence of vasculopathy was 55% (102 of 185), without evidence of a significant referral bias. Twenty-six of 27 patients with clinical stroke had abnormal findings at imaging, but even if patients with stroke were excluded, 35% (56 of 158) had a "silent infarction" (MR imaging-visible injury without clinical stroke), and 49% (78 of 158) had abnormal findings at MR angiography. Patients with clinically severe disease had more abnormalities at MR imaging (P <.001) and MR angiography (P <.004) than did patients with milder disease. Severe vasculopathy was more prevalent in patients with hemoglobin SS than in those with hemoglobin SC (P <.001). Recent imaging methods showed more abnormalities than did older methods (P <.01). With newer methods, 43% (29 of 67) of patients had extensive abnormalities, whereas with older methods, 28% (33 of 116) had extensive abnormalities. CONCLUSION Prevalence of ischemic brain injury in pediatric patients with SCD is substantially higher than was previously reported, in part because of improvements in imaging methods.
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Affiliation(s)
- R Grant Steen
- Department of Diagnostic Imaging, St Jude Children's Research Hosp, 332 N Lauderdale St, Memphis, TN 38105-2794, USA.
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Oguz KK, Golay X, Pizzini FB, Freer CA, Winrow N, Ichord R, Casella JF, van Zijl PCM, Melhem ER. Sickle cell disease: continuous arterial spin-labeling perfusion MR imaging in children. Radiology 2003; 227:567-74. [PMID: 12663827 DOI: 10.1148/radiol.2272020903] [Citation(s) in RCA: 99] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Cerebral blood flow (CBF) was measured with continuous arterial spin-labeling perfusion magnetic resonance (MR) imaging in 14 children with sickle cell disease and seven control subjects. Mean CBF values were higher in patients (P <.005) than in control subjects in all cerebral artery territories. Three patients had decreased CBF in right anterior and middle cerebral artery territories compared with CBF on the left, and one patient had a profound decrease in CBF in all three territories in the right hemisphere. Baseline CBF was significantly decreased in territories seen as unaffected on conventional MR images and MR angiograms in four children with sickle cell disease.
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Affiliation(s)
- Kader K Oguz
- Dept of Radiology, Johns Hopkins Med Insts, Baltimore, Md, USA
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Steen RG, Schroeder J. Age-related changes in the pediatric brain: proton T1 in healthy children and in children with sickle cell disease. Magn Reson Imaging 2003; 21:9-15. [PMID: 12620541 DOI: 10.1016/s0730-725x(02)00635-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The goal of this study was to characterize the expected range of variation in T1 (spin-lattice relaxation time) of brain tissue in vivo, as a function of age, and to use these maturational norms to study children with sickle cell disease (SCD). A well-validated method (TurboPAIR) was used to measure T1 in 10 tissues in a study group of 200 healthy subjects (ages 4.5 to 79.3; 101 male and 99 female), in a transverse slice at the level of the basal ganglia. Brain T1 was significantly related to age in every tissue characterized (p < 0.001), including the splenium (p < 0.01). Quantitative MRI suggests that brain T1 continues to change throughout the lifespan of healthy subjects free of neurologic complaints. Age-related changes follow a different schedule in each tissue, and age is a stronger determinant of T1 in gray matter than in white matter. Analysis of 141 patients with SCD shows that patients have lower T1 than normal, in both the caudate and the cortex (p < 0.001).
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Affiliation(s)
- R Grant Steen
- Department of Diagnostic Imaging, St Jude Children's Research Hospital, Memphis, TN, USA.
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Kovacevic N, Lobaugh NJ, Bronskill MJ, Levine B, Feinstein A, Black SE. A robust method for extraction and automatic segmentation of brain images. Neuroimage 2002; 17:1087-100. [PMID: 12414252 DOI: 10.1006/nimg.2002.1221] [Citation(s) in RCA: 114] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A new protocol is introduced for brain extraction and automatic tissue segmentation of MR images. For the brain extraction algorithm, proton density and T2-weighted images are used to generate a brain mask encompassing the full intracranial cavity. Segmentation of brain tissues into gray matter (GM), white matter (WM), and cerebral spinal fluid (CSF) is accomplished on a T1-weighted image after applying the brain mask. The fully automatic segmentation algorithm is histogram-based and uses the Expectation Maximization algorithm to model a four-Gaussian mixture for both global and local histograms. The means of the local Gaussians for GM, WM, and CSF are used to set local thresholds for tissue classification. Reproducibility of the extraction procedure was excellent, with average variation in intracranial capacity (TIC) of 0.13 and 0.66% TIC in 12 healthy normal and 33 Alzheimer brains, respectively. Repeatability of the segmentation algorithm, tested on healthy normal images, indicated scan-rescan differences in global tissue volumes of less than 0.30% TIC. Reproducibility at the regional level was established by comparing segmentation results within the 12 major Talairach subdivisions. Accuracy of the algorithm was tested on a digital brain phantom, and errors were less than 1% of the phantom volume. Maximal Type I and Type II classification errors were low, ranging between 2.2 and 4.3% of phantom volume. The algorithm was also insensitive to variation in parameter initialization values. The protocol is robust, fast, and its success in segmenting normal as well as diseased brains makes it an attractive clinical application.
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Affiliation(s)
- N Kovacevic
- Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario, Canada
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Prengler M, Pavlakis SG, Prohovnik I, Adams RJ. Sickle cell disease: the neurological complications. Ann Neurol 2002; 51:543-52. [PMID: 12112099 DOI: 10.1002/ana.10192] [Citation(s) in RCA: 124] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The genetic cause of sickle cell disease has been known for decades, yet the reasons for its clinical variability are not fully understood. The neurological complications result from one point mutation that causes vasculopathy of both large and small vessels. Anemia and the resultant cerebral hyperemia produce conditions of hemodynamic insufficiency. Sickled cells adhere to the endothelium, contributing to a cascade of activated inflammatory cells and clotting factors, which result in a nidus for thrombus formation. Because the cerebrovascular reserve becomes exhausted, the capacity for compensatory cerebral mechanisms is severely limited. There is evidence of small-vessel sludging, and a relative deficiency of nitric oxide in these vessels further reduces compensatory vasodilatation. Both clinical strokes and silent infarcts occur, affecting motor and cognitive function. New data suggest that, in addition to sickle cell disease, other factors, both environmental (eg, hypoxia and inflammation) and genetic (eg, mutations resulting in thrombogenesis), may contribute to a patient's stroke risk. The stroke risk is polygenic, and sickle cell disease can be considered a model for all cerebrovascular disease. This complex disease underscores the potential intellectual and practical distance between the determination of molecular genetics and effective clinical application and therapeutics.
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Affiliation(s)
- Mara Prengler
- Neurosciences Unit, Institute of Child Health, University College and Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom
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Abstract
Sickle cell anemia (SCA) is a disease caused by production of abnormal hemoglobin, which binds with other abnormal hemoglobin molecules within the red blood cell to cause rigid deformation of the cell. This deformation impairs the ability of the cell to pass through small vascular channels; sludging and congestion of vascular beds may result, followed by tissue ischemia and infarction. Infarction is common throughout the body in the patient with SCA, and it is responsible for the earliest clinical manifestation, the acute pain crisis, which is thought to result from marrow infarction. Over time, such insults result in medullary bone infarcts and epiphyseal osteonecrosis. In the brain, white matter and gray matter infarcts are seen, causing cognitive impairment and functional neurologic deficits. The lungs are also commonly affected, with infarcts, emboli (from marrow infarcts and fat necrosis), and a markedly increased propensity for pneumonia. The liver, spleen, and kidney may experience infarction as well. An unusual but life-threatening complication of SCA is sequestration syndrome, wherein a considerable amount of the intravascular volume is sequestered in an organ (usually the spleen), causing vascular collapse; its pathogenesis is unknown. Finally, because the red blood cells are abnormal, they are removed from the circulation, resulting in a hemolytic anemia. For the patient with SCA, however, the ischemic complications of the disease far outweigh the anemia in clinical importance.
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Affiliation(s)
- G J Lonergan
- Department of Radiology and Nuclear Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
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Kingsley PB, Monahan WG. Effect of increased repetition time TR on precision of inversion-recovery T 1 measurements. Magn Reson Imaging 2001; 19:279-82. [PMID: 11358666 DOI: 10.1016/s0730-725x(01)00294-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The effect of increased repetition time, TR, on the precision of inversion-recovery measurements of the spin-lattice relaxation time, T(1), was calculated theoretically, simulated numerically, and measured experimentally. All three methods yielded similar results. With constant inversion times, the T(1) precision was independent of TR. Therefore, 1) multiple-slice inversion-recovery fast-spin-echo T(1) maps should be made one slice at a time, not with interleaved acquisition, and 2) once the longest inversion time t(i) has been set, TR should be set just enough longer than the longest t(i) to allow data acquisition.
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Affiliation(s)
- P B Kingsley
- Department of Radiology, North Shore University Hospital, 300 Community Drive, Manhasset, NY 11030, USA.
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Steen RG, Reddick WE, Ogg RJ. More than meets the eye: significant regional heterogeneity in human cortical T1. Magn Reson Imaging 2000; 18:361-8. [PMID: 10788712 DOI: 10.1016/s0730-725x(00)00123-5] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Segmented k-space acquisition of data was used to decrease the acquisition time and to increase the imaging resolution of the precise and accurate inversion recovery (PAIR) method of measuring T(1). We validated the new TurboPAIR method by measuring T(1) in 158 regions of interest in 12 volunteers, using both PAIR and TurboPAIR. We found a 3% difference between methods, which could be corrected by linear regression. After validation, the TurboPAIR method was used to test a hypothesis that there is significant regional heterogeneity in cortical T(1). We measured cortical gray matter T(1) in 11 right-handed volunteers, in 48 regions of interest scattered over frontal and parietal cortex, and in 46 ROIs along the central sulcus (CS). We found that T(1) in the CS is less than T(1) elsewhere in the cortex (p<0.001), and that there is considerable hemispheric asymmetry in T(1) in gray matter, but not in white matter. In central gray structures (caudate, thalamus, nucleus pulvinarus), and in the posterior CS (sensory cortex), right hemisphere T(1) was significantly greater than left hemisphere T(1) (p< or =0.004). In cortical gray matter of the frontal lobe and anterior CS (motor cortex), left hemisphere T(1) was significantly greater than right hemisphere T(1) (p< or =0.003). These findings demonstrate that there is considerable regional heterogeneity in human cortical T(1) that is unexplained by differences in tissue iron content, but may be evidence of an inherent anatomic asymmetry of the brain.
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Affiliation(s)
- R G Steen
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, 332 N. Lauderdale, Memphis, TN 38105-2794, USA
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Affiliation(s)
- D R Powars
- Department of Paediatrics, Hematology/Oncology Division, University of Southern California School of Medicine, Los Angeles, CA 90033, USA.
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