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de Groot ER, Wang X, Wojtal K, Janson E, Alderliesten T, Tataranno ML, Benders MJNL, Dudink J. Association between sleep stages and brain microstructure in preterm infants: Insights from DTI analysis. Sleep Med 2024; 121:336-342. [PMID: 39053129 DOI: 10.1016/j.sleep.2024.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 07/14/2024] [Accepted: 07/16/2024] [Indexed: 07/27/2024]
Abstract
STUDY OBJECTIVES The aim of this study was to investigate the relationship between sleep stages and neural microstructure - measured using diffusion tensor imaging - of the posterior limb of the internal capsule and corticospinal tract in preterm infants. METHODS A retrospective cohort of 50 preterm infants born between 24 + 4 and 29 + 3 weeks gestational age was included in the study. Sleep stages were continuously measured for 5-7 consecutive days between 29 + 0 and 31 + 6 weeks postmenstrual age using an in-house-developed, and recently published, automated sleep staging algorithm based on routinely measured heart rate and respiratory rate. Additionally, a diffusion tensor imaging scan was conducted at term equivalent age as part of standard care. Region of interest analysis of the posterior limb of the internal capsule was performed, and tractography was used to analyze the corticospinal tract. The association between sleep and white matter microstructure of the posterior limb of the internal capsule and corticospinal tract was examined using a multiple linear regression model, adjusted for potential confounders. RESULTS The results of the analyses revealed an interaction effect between sleep stage and days of invasive ventilation on the fractional anisotropy of the left and right posterior limb of the internal capsule (β = 0.04, FDR-adjusted p = 0.001 and β = 0.04, FDR-adjusted p = 0.02, respectively). Furthermore, an interaction effect between sleep stage and days of invasive ventilation was observed for the radial diffusivity of the mean of the left and right PLIC (β = -4.1e-05, FDR-adjusted p = 0.04). CONCLUSIONS Previous research has shown that, in very preterm infants, invasive ventilation has a negative effect on white matter tract maturation throughout the brain. A positive association between active sleep and white matter microstructure of the posterior limb of the internal capsule, may indicate a protective role of sleep in this vulnerable population.
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Affiliation(s)
- Eline R de Groot
- Department of Neonatology, University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, the Netherlands
| | - Xiaowan Wang
- Department of Neonatology, University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, the Netherlands
| | - Klaudia Wojtal
- Department of Neonatology, University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, the Netherlands
| | - Els Janson
- Department of Neonatology, University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, the Netherlands
| | - Thomas Alderliesten
- Department of Neonatology, University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, the Netherlands
| | - Maria Luisa Tataranno
- Department of Neonatology, University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, the Netherlands
| | - Manon J N L Benders
- Department of Neonatology, University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, the Netherlands; Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jeroen Dudink
- Department of Neonatology, University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, the Netherlands; Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands.
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Park S, Kim HG, Yang H, Lee M, Kim REY, Kim SH, Styner MA, Kim J, Kim JR, Kim D. A regional brain volume-based age prediction model for neonates and the derived brain maturation index. Eur Radiol 2024; 34:3892-3902. [PMID: 37971681 DOI: 10.1007/s00330-023-10408-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 09/07/2023] [Accepted: 09/18/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVE To develop a postmenstrual age (PMA) prediction model based on segmentation volume and to evaluate the brain maturation index using the proposed model. METHODS Neonatal brain MRIs without clinical illness or structural abnormalities were collected from four datasets from the Developing Human Connectome Project, the Catholic University of Korea, Hammersmith Hospital (HS), and Dankook University Hospital (DU). T1- and T2-weighted images were used to train a brain segmentation model. Another model to predict the PMA of neonates based on segmentation data was developed. Accuracy was assessed using mean absolute error (MAE), root mean square error (RMSE), and mean error (ME). The brain maturation index was calculated as the difference between the PMA predicted by the model and the true PMA, and its correlation with postnatal age was analyzed. RESULTS A total of 247 neonates (mean gestation age 37 ± 4 weeks; range 24-42 weeks) were included. Thirty-one features were extracted from each neonate and the three most contributing features for PMA prediction were the right lateral ventricle, left caudate, and corpus callosum. The predicted and true PMA were positively correlated (coefficient = 0.88, p < .001). MAE, RMSE, and ME of the external dataset of HS and DU were 1.57 and 1.33, 1.79 and 1.37, and 0.37 and 0.06 weeks, respectively. The brain maturation index negatively correlated with postnatal age (coefficient = - 0.24, p < .001). CONCLUSION A model that calculates the regional brain volume can predict the PMA of neonates, which can then be utilized to show the brain maturation degree. CLINICAL RELEVANCE STATEMENT A brain maturity index based on regional volume of neonate's brain can be used to measure brain maturation degree, which can help identify the status of early brain development. KEY POINTS • Neonatal brain MRI segmentation model could be used to assess neonatal brain maturation status. • A postmenstrual age (PMA) prediction model was developed based on a neonatal brain MRI segmentation model. • The brain maturation index, derived from the PMA prediction model, enabled the estimation of the neonatal brain maturation status.
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Affiliation(s)
- Sunghwan Park
- Research Institute, NEUROPHET Inc., Seoul, 06234, Republic of Korea
| | - Hyun Gi Kim
- Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 03312, Republic of Korea.
| | - Hyeonsik Yang
- Research Institute, NEUROPHET Inc., Seoul, 06234, Republic of Korea
| | - Minho Lee
- Research Institute, NEUROPHET Inc., Seoul, 06234, Republic of Korea
| | - Regina E Y Kim
- Research Institute, NEUROPHET Inc., Seoul, 06234, Republic of Korea
| | - Sun Hyung Kim
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Martin A Styner
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Computer Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - JeeYoung Kim
- Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 03312, Republic of Korea
| | - Jeong Rye Kim
- Department of Radiology, Dankook University Hospital, Dankook University College of Medicine, Cheonan-Si, Chungcheongnam-Do, Republic of Korea
| | - Donghyeon Kim
- Research Institute, NEUROPHET Inc., Seoul, 06234, Republic of Korea.
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Selvanathan T, Guo T, Ufkes S, Chau V, Branson H, Synnes A, Ly LG, Kelly EN, Grunau RE, Miller SP. Size and Location of Preterm Brain Injury and Associations With Neurodevelopmental Outcomes. Neurology 2024; 102:e209264. [PMID: 38527245 DOI: 10.1212/wnl.0000000000209264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 02/05/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND AND OBJECTIVES We examined associations of white matter injury (WMI) and periventricular hemorrhagic infarction (PVHI) volume and location with 18-month neurodevelopment in very preterm infants. METHODS A total of 254 infants born <32 weeks' gestational age were prospectively recruited across 3 tertiary neonatal intensive care units (NICUs). Infants underwent early-life (median 33.1 weeks) and/or term-equivalent-age (median 41.9 weeks) MRI. WMI and PVHI were manually segmented for quantification in 92 infants. Highest maternal education level was included as a marker of socioeconomic status and was defined as group 1 = primary/secondary school; group 2 = undergraduate degree; and group 3 = postgraduate degree. Eighteen-month neurodevelopmental assessments were completed with Bayley Scales of Infant and Toddler Development, Third Edition. Adverse outcomes were defined as a score of less than 85 points. Multivariable linear regression models were used to examine associations of brain injury (WMI and PVHI) volume with neurodevelopmental outcomes. Voxel-wise lesion symptom maps were developed to assess relationships between brain injury location and neurodevelopmental outcomes. RESULTS Greater brain injury volume was associated with lower 18-month Motor scores (β = -5.7, 95% CI -9.2 to -2.2, p = 0.002) while higher maternal education level was significantly associated with higher Cognitive scores (group 3 compared 1: β = 14.5, 95% CI -2.1 to 26.9, p = 0.03). In voxel-wise lesion symptom maps, brain injury involving the central and parietal white matter was associated with an increased risk of poorer motor outcomes. DISCUSSION We found that brain injury volume and location were significant predictors of motor, but not cognitive outcomes, suggesting that different pathways may mediate outcomes across domains of neurodevelopment in preterm infants. Specifically, assessing lesion size and location may allow for more accurate identification of infants with brain injury at highest risk of poorer motor outcomes. These data also highlight the importance of socioeconomic status in cognitive outcomes, even in preterm infants with brain injury.
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Affiliation(s)
- Thiviya Selvanathan
- From Pediatrics (T.S., S.U., R.E.G., S.P.M.), BC Children's Hospital Research Institute and the University of British Columbia, Vancouver; Pediatrics (T.S., T.G., V.C., L.G.L., S.P.M.), The Hospital for Sick Children and University of Toronto; Diagnostic Imaging (H.B.), The Hospital for Sick Children and the University of Toronto, Ontario; Pediatrics (A.S., R.E.G.), BC Women's Hospital and the University of British Columbia, Vancouver; and Pediatrics (E.N.K.), Mount Sinai Hospital, The Hospital for Sick Children and the University of Toronto, Ontario, Canada
| | - Ting Guo
- From Pediatrics (T.S., S.U., R.E.G., S.P.M.), BC Children's Hospital Research Institute and the University of British Columbia, Vancouver; Pediatrics (T.S., T.G., V.C., L.G.L., S.P.M.), The Hospital for Sick Children and University of Toronto; Diagnostic Imaging (H.B.), The Hospital for Sick Children and the University of Toronto, Ontario; Pediatrics (A.S., R.E.G.), BC Women's Hospital and the University of British Columbia, Vancouver; and Pediatrics (E.N.K.), Mount Sinai Hospital, The Hospital for Sick Children and the University of Toronto, Ontario, Canada
| | - Steven Ufkes
- From Pediatrics (T.S., S.U., R.E.G., S.P.M.), BC Children's Hospital Research Institute and the University of British Columbia, Vancouver; Pediatrics (T.S., T.G., V.C., L.G.L., S.P.M.), The Hospital for Sick Children and University of Toronto; Diagnostic Imaging (H.B.), The Hospital for Sick Children and the University of Toronto, Ontario; Pediatrics (A.S., R.E.G.), BC Women's Hospital and the University of British Columbia, Vancouver; and Pediatrics (E.N.K.), Mount Sinai Hospital, The Hospital for Sick Children and the University of Toronto, Ontario, Canada
| | - Vann Chau
- From Pediatrics (T.S., S.U., R.E.G., S.P.M.), BC Children's Hospital Research Institute and the University of British Columbia, Vancouver; Pediatrics (T.S., T.G., V.C., L.G.L., S.P.M.), The Hospital for Sick Children and University of Toronto; Diagnostic Imaging (H.B.), The Hospital for Sick Children and the University of Toronto, Ontario; Pediatrics (A.S., R.E.G.), BC Women's Hospital and the University of British Columbia, Vancouver; and Pediatrics (E.N.K.), Mount Sinai Hospital, The Hospital for Sick Children and the University of Toronto, Ontario, Canada
| | - Helen Branson
- From Pediatrics (T.S., S.U., R.E.G., S.P.M.), BC Children's Hospital Research Institute and the University of British Columbia, Vancouver; Pediatrics (T.S., T.G., V.C., L.G.L., S.P.M.), The Hospital for Sick Children and University of Toronto; Diagnostic Imaging (H.B.), The Hospital for Sick Children and the University of Toronto, Ontario; Pediatrics (A.S., R.E.G.), BC Women's Hospital and the University of British Columbia, Vancouver; and Pediatrics (E.N.K.), Mount Sinai Hospital, The Hospital for Sick Children and the University of Toronto, Ontario, Canada
| | - Anne Synnes
- From Pediatrics (T.S., S.U., R.E.G., S.P.M.), BC Children's Hospital Research Institute and the University of British Columbia, Vancouver; Pediatrics (T.S., T.G., V.C., L.G.L., S.P.M.), The Hospital for Sick Children and University of Toronto; Diagnostic Imaging (H.B.), The Hospital for Sick Children and the University of Toronto, Ontario; Pediatrics (A.S., R.E.G.), BC Women's Hospital and the University of British Columbia, Vancouver; and Pediatrics (E.N.K.), Mount Sinai Hospital, The Hospital for Sick Children and the University of Toronto, Ontario, Canada
| | - Linh G Ly
- From Pediatrics (T.S., S.U., R.E.G., S.P.M.), BC Children's Hospital Research Institute and the University of British Columbia, Vancouver; Pediatrics (T.S., T.G., V.C., L.G.L., S.P.M.), The Hospital for Sick Children and University of Toronto; Diagnostic Imaging (H.B.), The Hospital for Sick Children and the University of Toronto, Ontario; Pediatrics (A.S., R.E.G.), BC Women's Hospital and the University of British Columbia, Vancouver; and Pediatrics (E.N.K.), Mount Sinai Hospital, The Hospital for Sick Children and the University of Toronto, Ontario, Canada
| | - Edmond N Kelly
- From Pediatrics (T.S., S.U., R.E.G., S.P.M.), BC Children's Hospital Research Institute and the University of British Columbia, Vancouver; Pediatrics (T.S., T.G., V.C., L.G.L., S.P.M.), The Hospital for Sick Children and University of Toronto; Diagnostic Imaging (H.B.), The Hospital for Sick Children and the University of Toronto, Ontario; Pediatrics (A.S., R.E.G.), BC Women's Hospital and the University of British Columbia, Vancouver; and Pediatrics (E.N.K.), Mount Sinai Hospital, The Hospital for Sick Children and the University of Toronto, Ontario, Canada
| | - Ruth E Grunau
- From Pediatrics (T.S., S.U., R.E.G., S.P.M.), BC Children's Hospital Research Institute and the University of British Columbia, Vancouver; Pediatrics (T.S., T.G., V.C., L.G.L., S.P.M.), The Hospital for Sick Children and University of Toronto; Diagnostic Imaging (H.B.), The Hospital for Sick Children and the University of Toronto, Ontario; Pediatrics (A.S., R.E.G.), BC Women's Hospital and the University of British Columbia, Vancouver; and Pediatrics (E.N.K.), Mount Sinai Hospital, The Hospital for Sick Children and the University of Toronto, Ontario, Canada
| | - Steven P Miller
- From Pediatrics (T.S., S.U., R.E.G., S.P.M.), BC Children's Hospital Research Institute and the University of British Columbia, Vancouver; Pediatrics (T.S., T.G., V.C., L.G.L., S.P.M.), The Hospital for Sick Children and University of Toronto; Diagnostic Imaging (H.B.), The Hospital for Sick Children and the University of Toronto, Ontario; Pediatrics (A.S., R.E.G.), BC Women's Hospital and the University of British Columbia, Vancouver; and Pediatrics (E.N.K.), Mount Sinai Hospital, The Hospital for Sick Children and the University of Toronto, Ontario, Canada
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Gruber N, Galijasevic M, Regodic M, Grams AE, Siedentopf C, Steiger R, Hammerl M, Haltmeier M, Gizewski ER, Janjic T. A deep learning pipeline for the automated segmentation of posterior limb of internal capsule in preterm neonates. Artif Intell Med 2022; 132:102384. [DOI: 10.1016/j.artmed.2022.102384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 08/08/2022] [Accepted: 08/19/2022] [Indexed: 11/15/2022]
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Nieuwets A, Cizmeci MN, Groenendaal F, Leijser LM, Koopman C, Benders MJNL, Dudink J, de Vries LS, van der Aa NE. Post-hemorrhagic ventricular dilatation affects white matter maturation in extremely preterm infants. Pediatr Res 2022; 92:225-232. [PMID: 34446847 DOI: 10.1038/s41390-021-01704-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/20/2021] [Accepted: 08/08/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Data on microstructural white matter integrity in preterm infants with post-hemorrhagic ventricular dilatation (PHVD) using diffusion tensor imaging (DTI) are limited. Also, to date, no study has focused on the DTI changes in extremely preterm (EP) infants with PHVD. METHODS A case-control study of EP infants <28 weeks' gestation with PHVD was conducted. Diffusivity and fractional anisotropy (FA) values of corticospinal tracts (CST) and corpus callosum (CC) were measured using DTI at term-equivalent age. Outcomes were assessed at 2-years-corrected age. RESULTS Twenty-one infants with PHVD and 21 matched-controls were assessed. FA values in the CC were lower in infants with PHVD compared with controls (mean difference, 0.05 [95% confidence interval (CI), 0.02-0.08], p < 0.001). In infants with periventricular hemorrhagic infarction, FA values in the CC were lower than in controls (mean difference, 0.05 [95% CI, 0.02-0.09], p = 0.005). The composite cognitive and motor scores were associated with the FA value of the CC (coefficient 114, p = 0.01 and coefficient 147, p = 0.004; respectively). CONCLUSIONS Extremely preterm infants with PHVD showed lower FA values in CC. A positive correlation was also shown between the composite cognitive and motor scores and FA value of the CC at 2-years-corrected age. IMPACT Extremely preterm infants with post-hemorrhagic ventricular dilatation showed lower fractional anisotropy values in their corpus callosum compared with controls reflecting the impaired microstructure of these commissural nerve fibers that are adjacent to the dilated ventricles. Impaired microstructure of the corpus callosum was shown to be associated with cognitive and motor scores at 2-years-corrected age.
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Affiliation(s)
- Astrid Nieuwets
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, and Utrecht University, Utrecht, The Netherlands.,Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Mehmet N Cizmeci
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, and Utrecht University, Utrecht, The Netherlands.,Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands.,Division of Neonatology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Floris Groenendaal
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, and Utrecht University, Utrecht, The Netherlands.,Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Lara M Leijser
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, and Utrecht University, Utrecht, The Netherlands.,Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands.,Section of Neonatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Corine Koopman
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, and Utrecht University, Utrecht, The Netherlands.,Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Manon J N L Benders
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, and Utrecht University, Utrecht, The Netherlands.,Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jeroen Dudink
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, and Utrecht University, Utrecht, The Netherlands.,Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Linda S de Vries
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, and Utrecht University, Utrecht, The Netherlands.,Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Niek E van der Aa
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, and Utrecht University, Utrecht, The Netherlands. .,Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands.
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Stegeman R, Sprong MCA, Breur JMPJ, Groenendaal F, de Vries LS, Haas F, van der Net J, Jansen NJG, Benders MJNL, Claessens NHP. Early motor outcomes in infants with critical congenital heart disease are related to neonatal brain development and brain injury. Dev Med Child Neurol 2022; 64:192-199. [PMID: 34416027 PMCID: PMC9290970 DOI: 10.1111/dmcn.15024] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 07/19/2021] [Accepted: 07/20/2021] [Indexed: 01/23/2023]
Abstract
AIM To assess the relationship between neonatal brain development and injury with early motor outcomes in infants with critical congenital heart disease (CCHD). METHOD Neonatal brain magnetic resonance imaging was performed after open-heart surgery with cardiopulmonary bypass. Cortical grey matter (CGM), unmyelinated white matter, and cerebellar volumes, as well as white matter motor tract fractional anisotropy and mean diffusivity were assessed. White matter injury (WMI) and arterial ischaemic stroke (AIS) with corticospinal tract (CST) involvement were scored. Associations with motor outcomes at 3, 9, and 18 months were corrected for repeated cardiac surgery. RESULTS Fifty-one infants (31 males, 20 females) were included prospectively. Median age at neonatal surgery and postoperative brain magnetic resonance imaging was 7 days (interquartile range [IQR] 5-11d) and 15 days (IQR 12-21d) respectively. Smaller CGM and cerebellar volumes were associated with lower fine motor scores at 9 months (CGM regression coefficient=0.51, 95% confidence interval [CI]=0.15-0.86; cerebellum regression coefficient=3.08, 95% CI=1.07-5.09) and 18 months (cerebellum regression coefficient=2.08, 95% CI=0.47-5.12). The fractional anisotropy and mean diffusivity of white matter motor tracts were not related with motor scores. WMI was related to lower gross motor scores at 9 months (mean difference -0.8SD, 95% CI=-1.5 to -0.2). AIS with CST involvement increased the risk of gross motor problems and muscle tone abnormalities. Cerebral palsy (n=3) was preceded by severe ischaemic brain injury. INTERPRETATION Neonatal brain development and injury are associated with fewer favourable early motor outcomes in infants with CCHD.
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Affiliation(s)
- Raymond Stegeman
- NeonatologyWilhelmina Children’s HospitalUniversity Medical Center Utrecht, Utrecht UniversityUtrechtthe Netherlands,Pediatric CardiologyWilhelmina Children’s HospitalUniversity Medical Center Utrecht, Utrecht UniversityUtrechtthe Netherlands,Pediatric Intensive CareWilhelmina Children’s HospitalUniversity Medical Center Utrecht, Utrecht UniversityUtrechtthe Netherlands,Congenital Cardiothoracic SurgeryWilhelmina Children’s HospitalUniversity Medical Center Utrecht, Utrecht UniversityUtrechtthe Netherlands,Brain CenterUniversity Medical Center UtrechtUtrecht UniversityUtrechtthe Netherlands
| | - Maaike C A Sprong
- Center for Child Development, Exercise and Physical LiteracyUniversity Medical Center Utrecht, Utrecht UniversityUtrechtthe Netherlands
| | - Johannes M P J Breur
- Pediatric CardiologyWilhelmina Children’s HospitalUniversity Medical Center Utrecht, Utrecht UniversityUtrechtthe Netherlands
| | - Floris Groenendaal
- NeonatologyWilhelmina Children’s HospitalUniversity Medical Center Utrecht, Utrecht UniversityUtrechtthe Netherlands
| | - Linda S de Vries
- NeonatologyWilhelmina Children’s HospitalUniversity Medical Center Utrecht, Utrecht UniversityUtrechtthe Netherlands
| | - Felix Haas
- Congenital Cardiothoracic SurgeryWilhelmina Children’s HospitalUniversity Medical Center Utrecht, Utrecht UniversityUtrechtthe Netherlands
| | - Janjaap van der Net
- Center for Child Development, Exercise and Physical LiteracyUniversity Medical Center Utrecht, Utrecht UniversityUtrechtthe Netherlands
| | - Nicolaas J G Jansen
- Pediatric Intensive CareWilhelmina Children’s HospitalUniversity Medical Center Utrecht, Utrecht UniversityUtrechtthe Netherlands,Department of PediatricsUniversity Medical Center GroningenGroningenthe Netherlands
| | - Manon J N L Benders
- NeonatologyWilhelmina Children’s HospitalUniversity Medical Center Utrecht, Utrecht UniversityUtrechtthe Netherlands,Brain CenterUniversity Medical Center UtrechtUtrecht UniversityUtrechtthe Netherlands
| | - Nathalie H P Claessens
- NeonatologyWilhelmina Children’s HospitalUniversity Medical Center Utrecht, Utrecht UniversityUtrechtthe Netherlands,Pediatric CardiologyWilhelmina Children’s HospitalUniversity Medical Center Utrecht, Utrecht UniversityUtrechtthe Netherlands,Pediatric Intensive CareWilhelmina Children’s HospitalUniversity Medical Center Utrecht, Utrecht UniversityUtrechtthe Netherlands,Congenital Cardiothoracic SurgeryWilhelmina Children’s HospitalUniversity Medical Center Utrecht, Utrecht UniversityUtrechtthe Netherlands,Brain CenterUniversity Medical Center UtrechtUtrecht UniversityUtrechtthe Netherlands
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Yu N, Kim JY, Han D, Kim SY, Lee HM, Kim DH, Kim HG. Three-Dimensional Magnetic Resonance Fingerprinting in Neonates: Quantifying Regional Difference and Maturation in the Brain. Invest Radiol 2022; 57:44-51. [PMID: 34101674 DOI: 10.1097/rli.0000000000000800] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Magnetic resonance fingerprinting (MRF) allows the simultaneous measurement of multiple tissue properties in a single acquisition. Three-dimensional (3D) MRF with high spatial resolution can be used for neonatal brain imaging. The aim of this study is to apply 3D MRF to neonates and show regional differences and maturation in the brain. MATERIALS AND METHODS In this prospective study, 3D MRF using hybrid radial-interleaved acquisition was performed on phantoms and neonates from December 2019 to October 2020. For the reconstruction of 3D MRF, singular value decomposition was applied to reduce reconstruction time, and the iterative reconstruction technique was applied to improve image quality. The accuracies of T1 and T2 values derived from 3D MRF were evaluated in a phantom experiment. Regional T1 and T2 values were obtained from neonates' brain T1 and T2 maps derived from 3D MRF. Regional T1 and T2 values were compared, and their changes according to corrected gestational age were evaluated. RESULTS The acquisition time for 3D MRF with a spatial resolution of 0.7 × 0.7 × 2 mm3 was less than 5 minutes. The phantom study showed high correlation between T1 and T2 values derived from 3D MRF and those from conventional spin echo sequences (T1, R2 = 0.998, P < 0.001; T2, R2 = 0.998, P < 0.001). Three-dimensional MRF was performed in 25 neonates (15 boys, 10 girls; median corrected gestational age, 263 days; interquartile range, 10 days). In neonates, T1 and T2 values differed in the frontal (median [interquartile range], 2785 [2684-2888] milliseconds and 189.8 [176.7-222.9] milliseconds), parietal (2849 [2741-2950] milliseconds and 191.6 [167.5-232.9] milliseconds), and occipital white matter (2621 [2513-2722] milliseconds and 162.9 [143.5-186.1] milliseconds), showing lower values in occipital white matter (P < 0.001). Regional T1 values showed a negative relationship with corrected gestational age (coefficient, -0.775 to -0.480; P < 0.05). CONCLUSIONS Fast and high spatial resolution 3D MRF was applied to neonates. T1 and T2 maps derived from 3D MRF enabled the quantification of regional differences and maturation in the neonatal brain.
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Affiliation(s)
- Nali Yu
- From the Departments of Pediatrics
| | - Jee Young Kim
- Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea
| | | | | | | | - Dong-Hyun Kim
- Department of Electrical and Electronic Engineering, College of Engineering, Yonsei University, Seoul, Republic of Korea
| | - Hyun Gi Kim
- Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea
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8
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de Vareilles H, Rivière D, Sun Z, Fischer C, Leroy F, Neumane S, Stopar N, Eijsermans R, Ballu M, Tataranno ML, Benders M, Mangin JF, Dubois J. Shape variability of the central sulcus in the developing brain: a longitudinal descriptive and predictive study in preterm infants. Neuroimage 2021; 251:118837. [PMID: 34965455 DOI: 10.1016/j.neuroimage.2021.118837] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 11/17/2021] [Accepted: 12/18/2021] [Indexed: 02/04/2023] Open
Abstract
Despite growing evidence of links between sulcation and function in the adult brain, the folding dynamics, occurring mostly before normal-term-birth, is vastly unknown. Looking into the development of cortical sulci in infants can give us keys to address fundamental questions: what is the sulcal shape variability in the developing brain? When are the shape features encoded? How are these morphological parameters related to further functional development? In this study, we aimed to investigate the shape variability of the developing central sulcus, which is the frontier between the primary somatosensory and motor cortices. We studied a cohort of 71 extremely preterm infants scanned twice using MRI - once around 30 weeks post-menstrual age (w PMA) and once at term-equivalent age, around 40w PMA -, in order to quantify the sulcus's shape variability using manifold learning, regardless of age-group or hemisphere. We then used these shape descriptors to evaluate the sulcus's variability at both ages and to assess hemispheric and age-group specificities. This led us to propose a description of ten shape features capturing the variability in the central sulcus of preterm infants. Our results suggested that most of these features (8/10) are encoded as early as 30w PMA. We unprecedentedly observed hemispheric asymmetries at both ages, and the one captured at term-equivalent age seems to correspond with the asymmetry pattern previously reported in adults. We further trained classifiers in order to explore the predictive value of these shape features on manual performance at 5 years of age (handedness and fine motor outcome). The central sulcus's shape alone showed a limited but relevant predictive capacity in both cases. The study of sulcal shape features during early neurodevelopment may participate to a better comprehension of the complex links between morphological and functional organization of the developing brain.
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Affiliation(s)
- H de Vareilles
- Université Paris-Saclay, NeuroSpin-BAOBAB, CEA, Gif-sur-Yvette, France.
| | - D Rivière
- Université Paris-Saclay, NeuroSpin-BAOBAB, CEA, Gif-sur-Yvette, France
| | - Z Sun
- Université Paris-Saclay, NeuroSpin-BAOBAB, CEA, Gif-sur-Yvette, France
| | - C Fischer
- Université Paris-Saclay, NeuroSpin-BAOBAB, CEA, Gif-sur-Yvette, France
| | - F Leroy
- Université Paris-Saclay, NeuroSpin-BAOBAB, CEA, Gif-sur-Yvette, France; Université Paris-Saclay, NeuroSpin-UNICOG, Inserm, CEA, Gif-sur-Yvette, France
| | - S Neumane
- Université de Paris, NeuroDiderot, Inserm, Paris, France; Université Paris-Saclay, NeuroSpin-UNIACT, CEA, Gif-sur-Yvette, France
| | - N Stopar
- Utrecht University, University Medical Center Utrecht, Department of Neonatology, Utrecht, the Netherlands
| | - R Eijsermans
- Utrecht University, University Medical Center Utrecht, Department of Neonatology, Utrecht, the Netherlands
| | - M Ballu
- Department of Pure Mathematics and Mathematical Statistics, University of Cambridge, Cambridge, United Kingdom
| | - M L Tataranno
- Utrecht University, University Medical Center Utrecht, Department of Neonatology, Utrecht, the Netherlands
| | - Mjnl Benders
- Utrecht University, University Medical Center Utrecht, Department of Neonatology, Utrecht, the Netherlands
| | - J F Mangin
- Université Paris-Saclay, NeuroSpin-BAOBAB, CEA, Gif-sur-Yvette, France
| | - J Dubois
- Université de Paris, NeuroDiderot, Inserm, Paris, France; Université Paris-Saclay, NeuroSpin-UNIACT, CEA, Gif-sur-Yvette, France
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9
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Abstract
There are many neuro-imaging studies on the presence of brain lesions in the preterm infant, using cranial ultrasound (cUS) and/or term equivalent age MRI (TEA-MRI). These studies however tend to focus on germinal matrix-intraventricular hemorrhage (GMH-IVH) and white matter injury. Data about perinatal arterial ischemic stroke (PAIS) or cerebral sinovenous thrombosis (CSVT) in the preterm infant are very limited. In fact, several large cohort studies on neuro-imaging in preterm infants do not even mention neonatal stroke.1-4 Most studies about PAIS exclude preterm infants.5 The aim of this review was to provide an update on neonatal stroke in the preterm infant, with a focus on neuro-imaging findings.
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10
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Roy B, Walker K, Morgan C, Finch-Edmondson M, Galea C, Epi M, Badawi N, Novak I. Epidemiology and pathogenesis of stroke in preterm infants: A systematic review. J Neonatal Perinatal Med 2021; 15:11-18. [PMID: 34219672 PMCID: PMC8842753 DOI: 10.3233/npm-200597] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Perinatal stroke is one of the principal causes of cerebral palsy (CP) in preterm infants. Stroke in preterm infants is different from stroke in term infants, given the differences in brain maturation and the mechanisms of injury exclusive to the immature brain. We conducted a systematic review to explore the epidemiology and pathogenesis of periventricular hemorrhagic infarction (PVHI), perinatal arterial ischemic stroke (PAIS) and cerebral sinovenous thrombosis (CSVT) in preterm infants. METHODS: Studies were identified based on predefined study criteria from MEDLINE, EMBASE, SCOPUS and WEB OF SCIENCE electronic databases from 2000 –2019. Results were combined using descriptive statistics. RESULTS: Fourteen studies encompassed 546 stroke cases in preterm infants between 23 –36 weeks gestational ages and birth weights between 450 –3500 grams. Eighty percent (436/546) of the stroke cases were PVHI, 17%(93/546) were PAIS and 3%(17/546) were CSVT. Parietal PVHI was more common than temporal and frontal lobe PVHI. For PAIS, left middle cerebral artery (MCA) was more common than right MCA or cerebellar stroke. For CSVT partial or complete thrombosis in the transverse sinus was universal. All cases included multiple possible risk factors, but the data were discordant precluding aggregation within a meta-analysis. CONCLUSION: This systematic review confirms paucity of data regarding the etiology and the precise causal pathway of stroke in preterm infants. Moreover, the preterm infants unlike the term infants do not typically present with seizures. Hence high index of clinical suspicion and routine cUS will assist in the timely diagnosis and understanding of stroke in this population.
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Affiliation(s)
- B Roy
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Australia.,School of Medicine, The University of Notre Dame Australia, Sydney, Australia.,The Mater Hospital, Sydney, Australia
| | - K Walker
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Australia.,The George Institute for Global Health, Sydney, Australia.,Newborn Care, Royal Prince Alfred Hospital, Sydney, Australia
| | - C Morgan
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Australia.,Cerebral Palsy Alliance Research Institute, Sydney, Australia
| | - M Finch-Edmondson
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Australia.,Cerebral Palsy Alliance Research Institute, Sydney, Australia
| | - C Galea
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Australia.,Cerebral Palsy Alliance Research Institute, Sydney, Australia
| | | | - N Badawi
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Australia.,Cerebral Palsy Alliance Research Institute, Sydney, Australia.,Grace Centre for Newborn Intensive Care, Sydney Children's Hospital Network, Westmead, Australia
| | - I Novak
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Australia.,Cerebral Palsy Alliance Research Institute, Sydney, Australia
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11
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Abd Elmagid DS, Magdy H. Evaluation of risk factors for cerebral palsy. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2021. [DOI: 10.1186/s41983-020-00265-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Cerebral palsy (CP) has been identified as one of the most important and common causes of childhood disabilities worldwide and is often accompanied by multiple comorbidities. CP is defined as a group of disorders of the development of movement and posture, causing activity limitation that are attributed to non-progressive disturbances that occurred in the developing fetal or infant brain. The objective of our study was to describe main clinical pattern and motor impairments of our patients, and to evaluate the presence of risk factors and if there is a relation to the type of cerebral palsy.
Methods
Children with cerebral palsy were retrospectively enrolled over 2 years from the neurology outpatient clinics. Cerebral palsy risk factors and motor impairments were determined through caregiver interviews, review of medical records, and direct physical examination.
Results
One thousand children with cerebral palsy were enrolled. Subjects were 64.4% male, with a median age of 2.5 years. The risk factors for cerebral palsy in our study were antenatal (21%), natal and post-natal (30.5%), post-neonatal (17.1%), and unidentified (31.4%). Antenatal as CNS malformation (26.6%), maternal DM (17.6%), prolonged rupture of membrane (11.9%), maternal hemorrhage (10.4%), and pre-eclampsia (4.7%). Natal and post-natal as hypoxic ischemic encephalopathy (28.5%), infection (16.3%), hyperbilirubinemia (12.7%), cerebrovascular accidents (8.8%), meconium aspiration (6.2%), and intracranial hemorrhage. Post-neonatal as CNS infection (34.5%), cerebrovascular accidents (28.6%), sepsis (23.9%), and intracranial hemorrhage (8.7%).
Conclusions
Cerebral palsy has different etiologies and risk factors. Further studies are necessary to determine optimal preventative strategies in these patients.
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12
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Fronto-temporal horn ratio: yet another marker of ventriculomegaly? Pediatr Res 2021; 89:1602-1603. [PMID: 33531678 DOI: 10.1038/s41390-021-01379-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 01/01/2021] [Indexed: 11/08/2022]
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13
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White matter injury in infants with intraventricular haemorrhage: mechanisms and therapies. Nat Rev Neurol 2021; 17:199-214. [PMID: 33504979 PMCID: PMC8880688 DOI: 10.1038/s41582-020-00447-8] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2020] [Indexed: 01/31/2023]
Abstract
Intraventricular haemorrhage (IVH) continues to be a major complication of prematurity that can result in cerebral palsy and cognitive impairment in survivors. No optimal therapy exists to prevent IVH or to treat its consequences. IVH varies in severity and can present as a bleed confined to the germinal matrix, small-to-large IVH or periventricular haemorrhagic infarction. Moderate-to-severe haemorrhage dilates the ventricle and damages the periventricular white matter. This white matter injury results from a constellation of blood-induced pathological reactions, including oxidative stress, glutamate excitotoxicity, inflammation, perturbed signalling pathways and remodelling of the extracellular matrix. Potential therapies for IVH are currently undergoing investigation in preclinical models and evidence from clinical trials suggests that stem cell treatment and/or endoscopic removal of clots from the cerebral ventricles could transform the outcome of infants with IVH. This Review presents an integrated view of new insights into the mechanisms underlying white matter injury in premature infants with IVH and highlights the importance of early detection of disability and immediate intervention in optimizing the outcomes of IVH survivors.
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14
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Shin Y, Nam Y, Shin T, Choi JW, Lee JH, Jung DE, Lim J, Kim HG. Brain MRI radiomics analysis may predict poor psychomotor outcome in preterm neonates. Eur Radiol 2021; 31:6147-6155. [PMID: 33758957 DOI: 10.1007/s00330-021-07836-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 02/08/2021] [Accepted: 02/24/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVES This study aimed to apply a radiomics approach to predict poor psychomotor development in preterm neonates using brain MRI. METHODS Prospectively enrolled preterm neonates underwent brain MRI near or at term-equivalent age and neurodevelopment was assessed at a corrected age of 12 months. Two radiologists visually assessed the degree of white matter injury. The radiomics analysis on white matter was performed using T1-weighted images (T1WI) and T2-weighted images (T2WI). A total of 1906 features were extracted from the images and the minimum redundancy maximum relevance algorithm was used to select features. A prediction model for the binary classification of the psychomotor developmental index was developed and eightfold cross-validation was performed. The diagnostic performance of the model was evaluated using the AUC with and without including significant clinical and DTI parameters. RESULTS A total of 46 preterm neonates (median gestational age, 29 weeks; 26 males) underwent brain MRI (median corrected gestational age, 37 weeks). Thirteen of 46 (28.3%) neonates showed poor psychomotor outcomes. There was one neonate among 46 with moderate to severe white matter injury on visual assessment. For the radiomics analysis, twenty features were selected for each analysis. The AUCs of prediction models based on T1WI, T2WI, and both T1WI and T2WI were 0.925, 0.834, and 0.902. Including gestational age or DTI parameters did not improve the prediction performance of T1WI. CONCLUSIONS A radiomics analysis of white matter using early T1WI or T2WI could predict poor psychomotor outcomes in preterm neonates. KEY POINTS • Radiomics analysis on T1-weighted images of preterm neonates showed the highest diagnostic performance (AUC, 0.925) for predicting poor psychomotor outcomes. • In spite of 45 of 46 neonates having no significant white matter injury on visual assessment, the radiomics analysis of early brain MRI showed good diagnostic performance (sensitivity, 84.6%; specificity, 78.8%) for predicting poor psychomotor outcomes. • Radiomics analysis on early brain MRI can help to predict poor neurodevelopmental outcomes in preterm neonates.
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Affiliation(s)
- Youwon Shin
- Division of Mechanical and Biomedical Engineering, Ewha Womans University, Seoul, Republic of Korea
| | - Yoonho Nam
- Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Division of Biomedical Engineering, Hankuk University of Foreign Studies, Yongin-si, Gyeonggi-do, Republic of Korea
| | - Taehoon Shin
- Division of Mechanical and Biomedical Engineering, Ewha Womans University, Seoul, Republic of Korea
- Department of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Jin Wook Choi
- Department of Radiology, Ajou University School of Medicine, Ajou University Medical Center, Suwon, Republic of Korea
| | - Jang Hoon Lee
- Department of Pediatrics, Ajou University School of Medicine, Ajou University Medical Center, Suwon, Republic of Korea
| | - Da Eun Jung
- Department of Pediatrics, Ajou University School of Medicine, Ajou University Medical Center, Suwon, Republic of Korea
| | - Jiseon Lim
- Division of Biomedical Engineering, Hankuk University of Foreign Studies, Yongin-si, Gyeonggi-do, Republic of Korea
| | - Hyun Gi Kim
- Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
- Department of Radiology, Ajou University School of Medicine, Ajou University Medical Center, Suwon, Republic of Korea.
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15
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Panceri C, Valentini NC, Silveira RC, Smith BA, Procianoy RS. Neonatal Adverse Outcomes, Neonatal Birth Risks, and Socioeconomic Status: Combined Influence on Preterm Infants' Cognitive, Language, and Motor Development in Brazil. J Child Neurol 2020; 35:989-998. [PMID: 32787744 DOI: 10.1177/0883073820946206] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND This study extended previous research by investigating the combined effects of neonatal birth risks, neonatal adverse outcomes, and socioeconomic status on preterm neurodevelopment. METHOD A total of 184 preterm infants were assessed using the Bayley Scales of Infant Development III in a follow-up clinic in southern Brazil. Structural equation modeling was conducted with 3 latent variables (neonatal birth risks, neonatal adverse outcomes, and socioeconomic status) and 3 outcomes (cognitive, language, and motor development). RESULTS The analyses showed that neonatal adverse outcomes were associated with infants' cognitive (b = -0.45, P < .001), language (b = -0.23, P = .001), and motor (b = -0.51, P < .001) development. Socioeconomic status also explained the variances (cognitive: b = 0.20, P = .006; language: b = 0.28, P = .001; and motor: b = 0.21, P = .004), whereas neonatal birth risks remained significant only in the motor development (b = 0.15, P = .040). CONCLUSION This study suggests that the most evident contributors to poor neurodevelopment were adverse outcomes and socioeconomic risk factors.
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Affiliation(s)
| | | | - Rita C Silveira
- 28124Universidade Federal do Rio Grande do Sul (UFRGS), Brazil.,37895Hospital de Clínicas de Porto Alegre, Brazil
| | - Beth A Smith
- 5116University of Southern California, CA, USA.,Children's Hospital Los Angeles, CA, USA
| | - Renato S Procianoy
- 28124Universidade Federal do Rio Grande do Sul (UFRGS), Brazil.,37895Hospital de Clínicas de Porto Alegre, Brazil
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16
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Gano D, Cowan FM, de Vries LS. Cerebral palsy after very preterm birth - an imaging perspective. Semin Fetal Neonatal Med 2020; 25:101106. [PMID: 32317152 DOI: 10.1016/j.siny.2020.101106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Neonatal brain imaging undoubtedly can provide the most accurate information from which to determine whether cerebral palsy is likely to affect an individual infant born preterm. The sensitivity and specificity of that information is different between cranial ultrasound and MRI, depending on what approaches and sequences are used and the timing of the examinations. In this chapter we highlight the changing incidence of different patterns of brain injury in the preterm newborn and present a comparison of cranial ultrasound and MRI for predicting cerebral palsy in preterm infants affected by the commoner intracranial pathologies.
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Affiliation(s)
- Dawn Gano
- Department of Neurology, University of California, San Francisco, CA, United States
| | - Frances M Cowan
- Department of Paediatrics, Imperial College London, London, United Kingdom
| | - Linda S de Vries
- Department of Neonatology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands.
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17
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Parodi A, Govaert P, Horsch S, Bravo MC, Ramenghi LA. Cranial ultrasound findings in preterm germinal matrix haemorrhage, sequelae and outcome. Pediatr Res 2020; 87:13-24. [PMID: 32218535 PMCID: PMC7098890 DOI: 10.1038/s41390-020-0780-2] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Germinal matrix-intraventricular haemorrhage (GMH-IVH), periventricular haemorrhagic infarction (PHI) and its complication, post-haemorrhagic ventricular dilatation (PHVD), are still common neonatal morbidities in preterm infants that are highly associated with adverse neurodevelopmental outcome. Typical cranial ultrasound (CUS) findings of GMH-IVH, PHI and PHVD, their anatomical substrates and underlying mechanisms are discussed in this paper. Furthermore, we propose a detailed descriptive classification of GMH-IVH and PHI that may improve quality of CUS reporting and prediction of outcome in infants suffering from GMH-IVH/PHI.
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Affiliation(s)
- Alessandro Parodi
- IRCCS, Istituto Giannina Gaslini, DINOGMI Department University of Genoa, Via Gaslini 5, 16148, Genoa, Italy
| | - Paul Govaert
- Department of Neonatology, Erasmus Medical Center University, Sophia Children's Hospital, Rotterdam, The Netherlands
- Department of Neonatology, ZNA Middelheim, Antwerp, Belgium
- Department of Rehabilitation and Physical Therapy, Gent University Hospital, Gent, Belgium
| | - Sandra Horsch
- Department of Neonatology, Helios Klinikum Berlin Buch, Berlin, Germany
| | | | - Luca A Ramenghi
- IRCCS, Istituto Giannina Gaslini, DINOGMI Department University of Genoa, Via Gaslini 5, 16148, Genoa, Italy.
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18
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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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19
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Breu M, Reisinger D, Tao L, Wu D, Zhang Y, Budde MD, Fatemi A, Pathak AP, Zhang J. In vivo high-resolution diffusion tensor imaging of the developing neonatal rat cortex and its relationship to glial and dendritic maturation. Brain Struct Funct 2019; 224:1815-1829. [PMID: 31011813 DOI: 10.1007/s00429-019-01878-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 04/11/2019] [Indexed: 12/25/2022]
Abstract
Diffusion tensor imaging (DTI) is increasingly utilized as a sensitive tool for studying brain maturation and injuries during the neonatal period. In this study, we acquired high resolution in vivo DTI data from neonatal rat brains from postnatal day 2 (P2) to P10 and correlated temporal changes in DTI derived markers with microstructural organization of glia, axons, and dendrites during this critical period of brain development. Group average images showed dramatic temporal changes in brain morphology, fractional anisotropy (FA) and mean diffusivity (MD). Most cortical regions showed a monotonous decline in FA and an initial increase in MD from P2 to P8 that declined slightly by P10. Qualitative histology revealed rapid maturation of the glial and dendritic networks in the developing cortex. In the cingulate and motor cortex, the decreases in FA over time significantly correlated with structural anisotropy values computed from histological sections stained with glial and dendritic markers. However, in the sensory and visual cortex, other factors probably contributed to the observed decreases in FA. We did not observe any significant correlations between FA and structural anisotropy computed from the axonal histological marker.
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Affiliation(s)
- Markus Breu
- Division of Neurogenetics, Kennedy Krieger Institute, Baltimore, MD, USA.,Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Dominik Reisinger
- Division of Neurogenetics, Kennedy Krieger Institute, Baltimore, MD, USA.,Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Liangcheng Tao
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dan Wu
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Yajing Zhang
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Matthew D Budde
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Ali Fatemi
- Division of Neurogenetics, Kennedy Krieger Institute, Baltimore, MD, USA.,Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Arvind P Pathak
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jiangyang Zhang
- Department of Radiology, New York University School of Medicine, 660 First Avenue, Room 207, New York, NY, 10016, USA.
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20
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Leijser LM, de Vries LS. Preterm brain injury: Germinal matrix-intraventricular hemorrhage and post-hemorrhagic ventricular dilatation. HANDBOOK OF CLINICAL NEUROLOGY 2019; 162:173-199. [PMID: 31324310 DOI: 10.1016/b978-0-444-64029-1.00008-4] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Germinal matrix hemorrhage and intraventricular hemorrhages (GMH-IVH) remain a common and clinically significant problem in preterm infants, particularly extremely preterm infants. A large GMH-IVH is often complicated by posthemorrhagic ventricular dilation (PHVD) or parenchymal hemorrhagic infarction and is associated with an increased risk of adverse neurologic sequelae. The widespread use of cranial ultrasonography since the early 1980s has shown a gradual decrease in the incidence of GMH-IVH and has helped with the identification of antenatal and perinatal risk factors and timing of the lesion. The increased use of magnetic resonance imaging (MRI) has contributed to more detailed visualization of the site and extent of the GMH-IVH. In addition, MRI has contributed to the awareness of associated white matter changes as well as associated cerebellar hemorrhages. Although GMH-IVH and PHVD still cannot be prevented, cerebrospinal fluid drainage initiated in the early stage of PHVD development seems to be associated with a better neurodevelopmental outcome. Further studies are underway to improve treatment strategies for PHVD and to potentially prevent and repair GMH-IVH and PHVD and associated brain injury. This chapter discusses the pathogenesis, incidence, risk factors, and management, including preventive measures, of GHM-IVH and PHVD.
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Affiliation(s)
- Lara M Leijser
- Department of Pediatrics, Section of Neonatology, University of Calgary, Cumming School of Medicine, Calgary, Canada
| | - Linda S de Vries
- Department of Neonatology, University Medical Center Utrecht, Utrecht, The Netherlands.
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21
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Counsell SJ, Arichi T, Arulkumaran S, Rutherford MA. Fetal and neonatal neuroimaging. HANDBOOK OF CLINICAL NEUROLOGY 2019; 162:67-103. [PMID: 31324329 DOI: 10.1016/b978-0-444-64029-1.00004-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Magnetic resonance imaging (MRI) can provide detail of the soft tissues of the fetal and neonatal brain that cannot be obtained by any other imaging modality. Conventional T1 and T2 weighted sequences provide anatomic detail of the normally developing brain and can demonstrate lesions, including those associated with preterm birth, hypoxic ischemic encephalopathy, perinatal arterial stroke, infections, and congenital malformations. Specialized imaging techniques can be used to assess cerebral vasculature (magnetic resonance angiography and venography), cerebral metabolism (magnetic resonance spectroscopy), cerebral perfusion (arterial spin labeling), and function (functional MRI). A wealth of quantitative tools, most of which were originally developed for the adult brain, can be applied to study the developing brain in utero and postnatally including measures of tissue microstructure obtained from diffusion MRI, morphometric studies to measure whole brain and regional tissue volumes, and automated approaches to study cortical folding. In this chapter, we aim to describe different imaging approaches for the fetal and neonatal brain, and to discuss their use in a range of clinical applications.
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Affiliation(s)
- Serena J Counsell
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.
| | - Tomoki Arichi
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Sophie Arulkumaran
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Mary A Rutherford
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
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22
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Basu AP, Pearse J, Watson R, Dulson P, Baggaley J, Wright B, Howel D, Vale L, Mitra D, Embleton N, Rapley T. Feasibility trial of an early therapy in perinatal stroke (eTIPS). BMC Neurol 2018; 18:102. [PMID: 30037324 PMCID: PMC6055336 DOI: 10.1186/s12883-018-1106-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 07/20/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Perinatal stroke (PS) affects up to 1/2300 infants and frequently leads to unilateral cerebral palsy (UCP). Preterm-born infants affected by unilateral haemorrhagic parenchymal infarction (HPI) are also at risk of UCP. To date no standardised early therapy approach exists, yet early intervention could be highly effective, by positively influencing processes of activity-dependent plasticity within the developing nervous system including the corticospinal tract. Our aim was to test feasibility and acceptability of an "early Therapy In Perinatal Stroke" (eTIPS) intervention, aiming ultimately to improve motor outcome. METHODS Design: Feasibility trial, North-East England, August 2015-September 2017. Participants were infants with PS or HPI, their carers and therapists. The intervention consisted of a parent-delivered lateralised therapy approach starting from term equivalent age and continuing until 6 months corrected age. The outcome measures were feasibility (recruitment and retention rates) and acceptability of the intervention (parental questionnaires including the Warwick-Edinburgh Mental Wellbeing Scale (WEBWMS), qualitative observations and in-depth interviews with parents and therapists). We also reviewed clinical imaging data and undertook assessments of motor function, including the Hand Assessment for Infants (HAI). Assessments were also piloted in typically developing (TD) infants, to provide further information on their ease of use and acceptability. RESULTS Over a period of 18 months we screened 20 infants referred as PS/HPI: 14 met the inclusion criteria and 13 took part. At 6 months, 11 (85%) of those enrolled had completed the final assessment. Parents valued the intervention and found it acceptable and workable. There were no adverse events related to the intervention. We recruited 14 TD infants, one of whom died prior to undertaking any assessments and one of whom was subsequently found to have a condition affecting neurodevelopmental progress: thus, data for 12 TD infants was analysed to 6 months. The HAI was well tolerated by infants and highly valued by parents. Completion rates for the WEBWMS were high and did not suggest any adverse effect of engagement in eTIPS on parental mental wellbeing. CONCLUSION The eTIPS intervention was feasible to deliver and acceptable to families. We plan to investigate efficacy in a multicentre randomised controlled trial. TRIAL REGISTRATION ISRCTN12547427 (registration request submitted 28/05/2015; retrospectively registered, 30/09/2015).
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Affiliation(s)
- Anna Purna Basu
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, NE1 7RU UK
- Department of Paediatric Neurology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE7 7DN UK
| | - Janice Pearse
- Therapy Services, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE7 7DN UK
| | - Rose Watson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, NE2 4AX UK
| | - Pat Dulson
- Newcastle Neonatal Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Jessica Baggaley
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, NE1 7RU UK
| | - Blythe Wright
- Human Biosciences, Northumbria University, Newcastle upon Tyne, NE1 8ST UK
| | - Denise Howel
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, NE2 4AX UK
| | - Luke Vale
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, NE2 4AX UK
| | - Dipayan Mitra
- Department of Neuroradiology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE7 7DN UK
| | - Nick Embleton
- Newcastle Neonatal Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Tim Rapley
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Coach Lane Campus West, Newcastle upon Tyne, NE7 7XA UK
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23
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Oishi K, Chang L, Huang H. Baby brain atlases. Neuroimage 2018; 185:865-880. [PMID: 29625234 DOI: 10.1016/j.neuroimage.2018.04.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Revised: 02/27/2018] [Accepted: 04/02/2018] [Indexed: 01/23/2023] Open
Abstract
The baby brain is constantly changing due to its active neurodevelopment, and research into the baby brain is one of the frontiers in neuroscience. To help guide neuroscientists and clinicians in their investigation of this frontier, maps of the baby brain, which contain a priori knowledge about neurodevelopment and anatomy, are essential. "Brain atlas" in this review refers to a 3D-brain image with a set of reference labels, such as a parcellation map, as the anatomical reference that guides the mapping of the brain. Recent advancements in scanners, sequences, and motion control methodologies enable the creation of various types of high-resolution baby brain atlases. What is becoming clear is that one atlas is not sufficient to characterize the existing knowledge about the anatomical variations, disease-related anatomical alterations, and the variations in time-dependent changes. In this review, the types and roles of the human baby brain MRI atlases that are currently available are described and discussed, and future directions in the field of developmental neuroscience and its clinical applications are proposed. The potential use of disease-based atlases to characterize clinically relevant information, such as clinical labels, in addition to conventional anatomical labels, is also discussed.
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Affiliation(s)
- Kenichi Oishi
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Linda Chang
- Departments of Diagnostic Radiology and Nuclear Medicine, and Neurology, University of Maryland School of Medicine, Baltimore, MD, USA; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Medicine, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI, USA
| | - Hao Huang
- Department of Radiology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA; Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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24
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George JM, Pannek K, Rose SE, Ware RS, Colditz PB, Boyd RN. Diagnostic accuracy of early magnetic resonance imaging to determine motor outcomes in infants born preterm: a systematic review and meta-analysis. Dev Med Child Neurol 2018; 60:134-146. [PMID: 29193032 DOI: 10.1111/dmcn.13611] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/15/2017] [Indexed: 01/18/2023]
Abstract
AIM To examine the diagnostic ability of early magnetic resonance imaging (MRI; <36wks postmenstrual age) to detect later adverse motor outcomes or cerebral palsy (CP) in infants born preterm. METHOD Studies of infants born preterm with MRI earlier than 36 weeks postmenstrual age and quantitative motor data or a diagnosis of CP at or beyond 1 year corrected age were identified. Study details were extracted and meta-analyses performed where possible. Quality of included studies was evaluated with the QUADAS-2 (a revised tool for the quality assessment of diagnostic accuracy studies). RESULTS Thirty-one articles met the inclusion criteria, five of which reported diagnostic accuracy and five reported data sufficient for calculation of diagnostic accuracy. Early structural MRI global scores detected a later diagnosis of CP with a pooled sensitivity of 100% (95% confidence interval [CI] 86-100) and a specificity of 93% (95% CI 59-100). Global structural MRI scores determined adverse motor outcomes with a pooled sensitivity of 89% (95% CI 44-100) and a specificity of 98% (95% CI 90-100). White matter scores determined adverse motor outcomes with a pooled sensitivity of 33% (95% CI 20-48) and a specificity of 83% (95% CI 78-88). INTERPRETATION Early structural MRI has reasonable sensitivity and specificity to determine adverse motor outcomes and CP in infants born preterm. Greater reporting of diagnostic accuracy in studies examining relationships with motor outcomes and CP is required to facilitate clinical utility of early MRI. WHAT THIS PAPER ADDS Early magnetic resonance imaging (MRI) has reasonable sensitivity and specificity to determine later adverse motor outcomes and cerebral palsy (CP). Detection of infants who progressed to CP was stronger than motor outcomes. Global MRI scores determined adverse motor outcomes more accurately than white matter scores. Few studies report diagnostic accuracy of early MRI findings. Diagnostic accuracy is required to draw clinically meaningful conclusions from early MRI studies.
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Affiliation(s)
- Joanne M George
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Centre for Children's Health Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Kerstin Pannek
- The Australian e-Health Research Centre, Health and Biosecurity, CSIRO, Brisbane, Australia
| | - Stephen E Rose
- The Australian e-Health Research Centre, Health and Biosecurity, CSIRO, Brisbane, Australia
| | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia.,Queensland Centre for Intellectual and Developmental Disability, The University of Queensland, Brisbane, Australia
| | - Paul B Colditz
- Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Perinatal Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Roslyn N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Centre for Children's Health Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
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25
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Hodge J, Goodyear B, Carlson H, Wei XC, Kirton A. Segmental Diffusion Properties of the Corticospinal Tract and Motor Outcome in Hemiparetic Children With Perinatal Stroke. J Child Neurol 2017; 32:550-559. [PMID: 28424004 DOI: 10.1177/0883073817696815] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Perinatal stroke injures developing motor systems, resulting in hemiparetic cerebral palsy. Diffusion tensor imaging can explore structural connectivity. We used diffusion tensor imaging to assess corticospinal tract diffusion in hemiparetic children with perinatal stroke. Twenty-eight children (6-18 years) with unilateral stroke underwent diffusion tensor imaging. Four corticospinal tract assessments included full tract, partial tract, minitract and region of interest. Diffusion characteristics (fractional anisotropy, mean, axial, and radial diffusivity) were calculated. Ratios (lesioned/nonlesioned) were compared across segments and to validated long-term motor outcomes (Pediatric Stroke Outcome Measure, Assisting Hand Assessment, Melbourne Assessment). Fractional anisotropy and radial diffusivity ratios decreased as tract size decreased, while mean diffusivity showed consistent symmetry. Poor motor outcomes were associated with lower fractional anisotropy in all segments and radial diffusivity correlated with both Assisting Hand Assessment and Melbourne Assessment. Diffusion imaging of segmented corticospinal tracts is feasible in hemiparetic children with perinatal stroke. Correlations with disability support clinical relevance and utility in model development for personalized rehabilitation.
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Affiliation(s)
- Jacquie Hodge
- 1 Calgary Pediatric Stroke Program, University of Calgary, Calgary, AB, Canada
| | - Bradley Goodyear
- 2 Department of Radiology, University of Calgary, Calgary, AB, Canada.,3 Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Helen Carlson
- 1 Calgary Pediatric Stroke Program, University of Calgary, Calgary, AB, Canada.,4 Alberta Children's Hospital Research Institute, Alberta Children's Hospital, Calgary, AB, Canada
| | - Xing-Chang Wei
- 2 Department of Radiology, University of Calgary, Calgary, AB, Canada
| | - Adam Kirton
- 1 Calgary Pediatric Stroke Program, University of Calgary, Calgary, AB, Canada.,4 Alberta Children's Hospital Research Institute, Alberta Children's Hospital, Calgary, AB, Canada
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26
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Weak functional connectivity in the human fetal brain prior to preterm birth. Sci Rep 2017; 7:39286. [PMID: 28067865 PMCID: PMC5221666 DOI: 10.1038/srep39286] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 11/21/2016] [Indexed: 12/21/2022] Open
Abstract
It has been suggested that neurological problems more frequent in those born preterm are expressed prior to birth, but owing to technical limitations, this has been difficult to test in humans. We applied novel fetal resting-state functional MRI to measure brain function in 32 human fetuses in utero and found that systems-level neural functional connectivity was diminished in fetuses that would subsequently be born preterm. Neural connectivity was reduced in a left-hemisphere pre-language region, and the degree to which connectivity of this left language region extended to right-hemisphere homologs was positively associated with the time elapsed between fMRI assessment and delivery. These results provide the first evidence that altered functional connectivity in the preterm brain is identifiable before birth. They suggest that neurodevelopmental disorders associated with preterm birth may result from neurological insults that begin in utero.
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27
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Fifty years of brain imaging in neonatal encephalopathy following perinatal asphyxia. Pediatr Res 2017; 81:150-155. [PMID: 27673422 DOI: 10.1038/pr.2016.195] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 07/22/2016] [Indexed: 12/21/2022]
Abstract
In the past brain imaging of term infants with hypoxic-ischemic encephalopathy (HIE) was performed with cranial ultrasound (cUS) and computed tomography (CT). Both techniques have several disadvantages sensitivity and specificity is limited compared with magnetic resonance imaging (MRI) and CT makes use of radiation. At present MRI including diffusion weighted MRI during the first week of life, has become the method of choice for imaging infants with HIE. In addition to imaging, blood vessels and blood flow can be visualized using MR angiography, MR venography, and arterial spin labeling. Since the use of these techniques additional lesions in infants with HIE, such as arterial ischemic stroke, sinovenous thrombosis, and subdural hemorrhages can be diagnosed, and the incidence appears to be higher than shown previously. Phosphorus magnetic resonance spectroscopy (MRS) has led to the concept of secondary energy failure in infants with HIE, but has not been widely used. Proton MRS of the basal ganglia and thalamus is one of the best predictors of neurodevelopmental outcome. cUS should still be used for screening infants admitted to a NICU with neonatal encephalopathy. In the future magnetic resonance techniques will be increasingly used as early biomarkers of neurodevelopmental outcome in trials of neuroprotective strategies.
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28
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Kim DY, Park HK, Kim NS, Hwang SJ, Lee HJ. Neonatal diffusion tensor brain imaging predicts later motor outcome in preterm neonates with white matter abnormalities. Ital J Pediatr 2016; 42:104. [PMID: 27906083 PMCID: PMC5134238 DOI: 10.1186/s13052-016-0309-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 11/12/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND White matter (WM) abnormalities associated with prematurity are one of the most important causes of neurological disability that involves spastic motor deficits in preterm newborns. This study aimed to evaluate regional microstructural changes in diffusion tensor imaging (DTI) associated with WM abnormalities. METHODS We prospectively studied extremely low birth weight (ELBW; <1000 g) preterm infants who were admitted to the Neonatal Intensive Care Unit of Hanyang University Hospital between February 2011 and February 2014. WM abnormalities were assessed with conventional magnetic resonance (MR) imaging and DTI near term-equivalent age before discharge. Region-of-interests (ROIs) measurements were performed to examine the regional distribution of fractional anisotropy (FA) values. RESULTS Thirty-two out of 72 ELBW infants underwent conventional MR imaging and DTI at term-equivalent age. Ten of these infants developed WM abnormalities associated with prematurity. Five of ten of those with WM abnormalities developed cerebral palsy (CP). DTI in the WM abnormalities with CP showed a significant reduction of mean FA in the genu of the corpus callosum (p = 0.022), the ipsilateral posterior limb of the internal capsule (p = 0.019), and the ipsilateral centrum semiovale (p = 0.012) compared to normal WM and WM abnormalities without CP. In infants having WM abnormalities with CP, early FA values in neonatal DTI revealed abnormalities of the WM regions prior to the manifestation of hemiparesis. CONCLUSIONS DTI performed at term equivalent age shows different FA values in WM regions among infants with or without WM abnormalities associated with prematurity and/or CP. Low FA values of ROIs in DTI are related with later development of spastic CP in preterm infants with WM abnormalities.
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Affiliation(s)
- Do-Yeon Kim
- Department of Pediatrics, Hanyang University College of Medicine, Seoul, South Korea
| | - Hyun-Kyung Park
- Department of Pediatrics, Hanyang University College of Medicine, Seoul, South Korea
| | - Nam-Su Kim
- Department of Pediatrics, Hanyang University College of Medicine, Seoul, South Korea
| | - Se-Jin Hwang
- Division of Neuroanatomy, Department of Anatomy and Histology, Hanyang University College of Medicine, Seoul, South Korea
| | - Hyun Ju Lee
- Department of Pediatrics, Hanyang University College of Medicine, Seoul, South Korea.
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29
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Scheck SM, Fripp J, Reid L, Pannek K, Fiori S, Boyd RN, Rose SE. Extent of altered white matter in unilateral and bilateral periventricular white matter lesions in children with unilateral cerebral palsy. RESEARCH IN DEVELOPMENTAL DISABILITIES 2016; 55:368-376. [PMID: 27280312 DOI: 10.1016/j.ridd.2016.04.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 03/21/2016] [Accepted: 04/16/2016] [Indexed: 06/06/2023]
Abstract
AIMS To investigate the extent of white matter damage in children with unilateral cerebral palsy (UCP) caused by periventricular white matter lesions comparing between unilateral and bilateral lesions; and to investigate a relationship between white matter microstructure and hand function. METHODS AND PROCEDURES Diffusion MRI images from 46 children with UCP and 18 children with typical development (CTD) were included. Subjects were grouped by side of hemiparesis and unilateral or bilateral lesions. A voxel-wise white matter analysis was performed to identify regions where fractional anisotropy (FA) was significantly different between UCP groups and CTD; and where FA correlated with either dominant or impaired hand function (using Jebsen Taylor Hand Function Test). OUTCOMES AND RESULTS Children with unilateral lesions had reduced FA in the corticospinal tract of the affected hemisphere. Children with bilateral lesions had widespread reduced FA extending into all lobes. In children with left hemiparesis, impaired hand function correlated with FA in the contralateral corticospinal tract. Dominant hand function correlated with FA in the posterior thalamic radiations as well as multiple other regions in both left and right hemiparesis groups. CONCLUSIONS AND IMPLICATIONS Periventricular white matter lesions consist of focal and diffuse components. Focal lesions may cause direct motor fibre insult resulting in motor impairment. Diffuse white matter injury is heterogeneous, and may contribute to more global dysfunction.
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Affiliation(s)
- Simon M Scheck
- The University of Queensland, School of Medicine, Brisbane, Australia; The University of Queensland, Queensland Cerebral Palsy and Rehabilitation Research Centre, Brisbane, Australia; Wellington Regional Hospital, Department of Obstetrics and Gynaecology, Wellington, New Zealand
| | - Jurgen Fripp
- Australian e-Health Research Centre, CSIRO, Brisbane, Australia
| | - Lee Reid
- The University of Queensland, School of Medicine, Brisbane, Australia; Australian e-Health Research Centre, CSIRO, Brisbane, Australia
| | - Kerstin Pannek
- The University of Queensland, School of Medicine, Brisbane, Australia; Australian e-Health Research Centre, CSIRO, Brisbane, Australia
| | - Simona Fiori
- Department of Developmental Neuroscience, Stella Maris Scientific Institute, Pisa, Italy
| | - Roslyn N Boyd
- The University of Queensland, Queensland Cerebral Palsy and Rehabilitation Research Centre, Brisbane, Australia
| | - Stephen E Rose
- Australian e-Health Research Centre, CSIRO, Brisbane, Australia.
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30
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Pavaine J, Young JM, Morgan BR, Shroff M, Raybaud C, Taylor MJ. Diffusion tensor imaging-based assessment of white matter tracts and visual-motor outcomes in very preterm neonates. Neuroradiology 2015; 58:301-10. [PMID: 26687071 DOI: 10.1007/s00234-015-1625-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 11/09/2015] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The purpose of this study was to assess the impact of brain injury on white matter development and long-term outcomes in very preterm (VPT) neonates. METHODS Eighty-five VPT neonates (born <32/40 weeks gestational age (GA)) scanned within 2 weeks of birth were divided into three groups based on the presence of perinatal cerebral injury: (i) no injury, (ii) mild/moderate injury and (iii) severe injury. Diffusion tensor imaging (DTI) was acquired for each neonate and fractional anisotropy (FA), and diffusivity measures were calculated in the posterior limb of the internal capsule (PLIC) and optic radiation (OR). At 2 and 4 years of age, 41 and 44 children were assessed for motor and visual-motor abilities. Analyses determined the relation between GA and DTI measures, injury groups and DTI measures as well as developmental assessments. RESULTS GA was related to all DTI measures within the PLIC bilaterally, FA in the OR bilaterally and AD in the left OR. The severely injured group had significantly different DTI measures in the left PLIC compared to the other two groups, independent of lateralization of lesions. Group differences in the left OR were also found, due to higher incidence of the white matter injury in the left hemisphere. No differences were found between groups and outcome measures at 2 and 4 years, with the exception of destructive periventricular venous haemorrhagic infarction (PVHI). CONCLUSIONS DTI measures of the PLIC and OR were affected by injury in VPT neonates. These findings seen shortly after birth did not always translate into long-term motor and visual-motor impairments suggesting compensatory mechanisms.
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Affiliation(s)
- Julia Pavaine
- Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada. .,Department of Medical Imaging, University of Toronto, Toronto, ON, Canada.
| | - Julia M Young
- Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.,Department of Psychology, University of Toronto, Toronto, ON, Canada
| | - Benjamin R Morgan
- Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Manohar Shroff
- Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.,Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Charles Raybaud
- Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.,Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Margot J Taylor
- Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.,Department of Medical Imaging, University of Toronto, Toronto, ON, Canada.,Department of Psychology, University of Toronto, Toronto, ON, Canada
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