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Early predictors of neurodevelopment after perinatal arterial ischemic stroke: a systematic review and meta-analysis. Pediatr Res 2022:10.1038/s41390-022-02433-w. [PMID: 36575364 DOI: 10.1038/s41390-022-02433-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 12/01/2022] [Accepted: 12/05/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND AIMS Perinatal arterial ischemic stroke (PAIS) often has lifelong neurodevelopmental consequences. We aimed to review early predictors (<4 months of age) of long-term outcome. METHODS We carried out a systematic literature search (PubMed and Embase), and included articles describing term-born infants with PAIS that underwent a diagnostic procedure within four months of age, and had any reported outcome parameter ≥12 months of age. Two independent reviewers included studies and performed risk of bias analysis. RESULTS We included 41 articles reporting on 1395 infants, whereof 1255 (90%) infants underwent follow-up at a median of 4 years. A meta-analysis was performed for the development of cerebral palsy (n = 23 studies); the best predictor was the qualitative or quantitative assessment of the corticospinal tracts on MRI, followed by standardized motor assessments. For long-term cognitive functioning, bedside techniques including (a)EEG and NIRS might be valuable. Injury to the optic radiation on DTI correctly predicted visual field defects. No predictors could be identified for behavior, language, and post-neonatal epilepsy. CONCLUSION Corticospinal tract assessment on MRI and standardized motor assessments are best to predict cerebral palsy after PAIS. Future research should be focused on improving outcome prediction for non-motor outcomes. IMPACT We present a systematic review of early predictors for various long-term outcome categories after perinatal arterial ischemic stroke (PAIS), including a meta-analysis for the outcome unilateral spastic cerebral palsy. Corticospinal tract assessment on MRI and standardized motor assessments are best to predict cerebral palsy after PAIS, while bedside techniques such as (a)EEG and NIRS might improve cognitive outcome prediction. Future research should be focused on improving outcome prediction for non-motor outcomes.
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2
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He Y, Ying J, Tang J, Zhou R, Qu H, Qu Y, Mu D. Neonatal Arterial Ischaemic Stroke: Advances in Pathologic Neural Death, Diagnosis, Treatment, and Prognosis. Curr Neuropharmacol 2022; 20:2248-2266. [PMID: 35193484 PMCID: PMC9890291 DOI: 10.2174/1570159x20666220222144744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/04/2022] [Accepted: 02/18/2022] [Indexed: 12/29/2022] Open
Abstract
Neonatal arterial ischaemic stroke (NAIS) is caused by focal arterial occlusion and often leads to severe neurological sequelae. Neural deaths after NAIS mainly include necrosis, apoptosis, necroptosis, autophagy, ferroptosis, and pyroptosis. These neural deaths are mainly caused by upstream stimulations, including excitotoxicity, oxidative stress, inflammation, and death receptor pathways. The current clinical approaches to managing NAIS mainly focus on supportive treatments, including seizure control and anticoagulation. In recent years, research on the pathology, early diagnosis, and potential therapeutic targets of NAIS has progressed. In this review, we summarise the latest progress of research on the pathology, diagnosis, treatment, and prognosis of NAIS and highlight newly potential diagnostic and treatment approaches.
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Affiliation(s)
- Yang He
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Junjie Ying
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Jun Tang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Ruixi Zhou
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Haibo Qu
- Department of Radiology, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Yi Qu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Dezhi Mu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
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3
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Saiote C, Sutter E, Xenopoulos-Oddsson A, Rao R, Georgieff M, Rudser K, Peyton C, Dean D, McAdams RM, Gillick B. Study Protocol: Multimodal Longitudinal Assessment of Infant Brain Organization and Recovery in Perinatal Brain Injury. Pediatr Phys Ther 2022; 34:268-276. [PMID: 35385465 PMCID: PMC9200232 DOI: 10.1097/pep.0000000000000886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Perinatal brain injury is a primary cause of cerebral palsy, a condition resulting in lifelong motor impairment. Infancy is an important period of motor system development, including development of the corticospinal tract (CST), the primary pathway for cortical movement control. The interaction between perinatal stroke recovery, CST organization, and resultant motor outcome in infants is not well understood. METHODS Here, we present a protocol for multimodal longitudinal assessment of brain development and motor function following perinatal brain injury using transcranial magnetic stimulation and magnetic resonance imaging to noninvasively measure CST functional and structural integrity across multiple time points in infants 3 to 24 months of age. We will further assess the association between cortical excitability, integrity, and motor function. DISCUSSION This protocol will identify bioindicators of motor outcome and neuroplasticity and subsequently inform early detection, diagnosis, and intervention strategies for infants with perinatal stroke, brain bleeds, and related diagnoses.
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Affiliation(s)
- Catarina Saiote
- Waisman Center (Drs Saiote, Sutter, Dean, and Gillick), Department of Pediatrics (Drs Dean, McAdams, and Gillick), and Department of Medical Physics (Dr Dean), University of Wisconsin-Madison, Madison, Wisconsin; Department of Rehabilitation Medicine (Dr Sutter and Ms Xenopoulos-Oddsson), Department of Pediatrics (Drs Rao and Georgieff), and Division of Biostatistics (Dr Rudser), University of Minnesota, Minneapolis, Minnesota; Department of Physical Therapy and Human Movement Sciences, Department of Pediatrics (Dr Peyton), Northwestern University, Chicago, Illinois
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4
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Larsen N, Craig BT, Hilderley AJ, Virani S, Murias K, Brooks BL, Kirton A, Carlson HL. Frontal interhemispheric structural connectivity, attention, and executive function in children with perinatal stroke. Brain Behav 2022; 12:e2433. [PMID: 34825521 PMCID: PMC8785614 DOI: 10.1002/brb3.2433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 10/18/2021] [Accepted: 10/25/2021] [Indexed: 11/23/2022] Open
Abstract
Perinatal stroke affects ∼1 in 1000 births and concomitant cognitive impairments are common but poorly understood. Rates of Attention Deficit/Hyperactivity Disorder (ADHD) are increased 5-10× and executive dysfunction can be disabling. We used diffusion imaging to investigate whether stroke-related differences in frontal white matter (WM) relate to cognitive impairments. Anterior forceps were isolated using tractography and sampled along the tract. Resulting metrics quantified frontal WM microstructure. Associations between WM metrics and parent ratings of ADHD symptoms (ADHD-5 rating scale) and executive functioning (Behavior Rating Inventory of Executive Function (BRIEF)) were explored. Eighty-three children were recruited (arterial ischemic stroke [AIS] n = 26; periventricular venous infarction [PVI] n = 26; controls n = 31). WM metrics were altered for stroke groups compared to controls. Along-tract analyses showed differences in WM metrics in areas approximating the lesion as well as more remote differences at midline and in the nonlesioned hemisphere. WM metrics correlated with parental ratings of ADHD and executive function such that higher diffusivity values were associated with poorer function. These findings suggest that underlying microstructure of frontal white matter quantified via tractography may provide a relevant biomarker associated with cognition and behavior in children with perinatal stroke.
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Affiliation(s)
- Nicole Larsen
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, Canada
| | - Brandon T Craig
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada.,Department of Pediatrics, University of Calgary, Calgary, Canada
| | - Alicia J Hilderley
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada.,Department of Pediatrics, University of Calgary, Calgary, Canada
| | - Shane Virani
- Department of Pediatrics, University of Calgary, Calgary, Canada
| | - Kara Murias
- Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada.,Department of Pediatrics, University of Calgary, Calgary, Canada.,Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
| | - Brian L Brooks
- Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada.,Department of Pediatrics, University of Calgary, Calgary, Canada.,Department of Clinical Neurosciences, University of Calgary, Calgary, Canada.,Department of Psychology, University of Calgary, Calgary, Canada
| | - Adam Kirton
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada.,Department of Pediatrics, University of Calgary, Calgary, Canada.,Department of Clinical Neurosciences, University of Calgary, Calgary, Canada.,Department of Radiology, University of Calgary, Calgary, Canada
| | - Helen L Carlson
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada.,Department of Pediatrics, University of Calgary, Calgary, Canada
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5
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Yin H, Wang X, Yang H, Zhu X, Wang J, Li Z. A pilot study of the General Movement Optimality Score detects early signs of motor disorder in neonates with arterial ischemic stroke. Early Hum Dev 2021; 163:105484. [PMID: 34655917 DOI: 10.1016/j.earlhumdev.2021.105484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 08/12/2021] [Accepted: 10/04/2021] [Indexed: 10/20/2022]
Abstract
AIM To explore whether the General Movement Optimality Score (GMOS) could help to identify asymmetric movement in infants with neonatal arterial ischemic stroke (NAIS) in the early stage. METHOD Twenty-seven infants with NAIS (16 males, 11 females) were enrolled. The general movement video was recorded approximately one month after birth. The GMOS focused separately on the neck and trunk and the upper and lower extremities. The differences between the ipsilesional and contralesional limbs were analyzed. RESULTS Eight infants who developed cerebral palsy (CP) had middle cerebral artery (MCA) infarction involving the main branch. By GMOS evaluation, the scores of the contralesional upper and/or lower limbs were lower than those of the ipsilesional side (p < 0.05). In the contralesional limbs, the CP group had a lower GMOS than the non-CP group. Distal rotatory components of the contralesional upper limbs and tremulous movement of the lower limbs showed significant differences. INTERPRETATION The GMOS could help to quantitatively find and assess the asymmetric movement of global and contralesional limbs. Distal rotatory movement of the upper limbs could be an early sign of abnormal motor function in infants with NAIS.
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Affiliation(s)
- Huanhuan Yin
- Department of Rehabilitation, Children's Hospital Fudan University, Shanghai, China
| | - Xinrui Wang
- Department of Neonatology, Children's Hospital of Fudan University, Key Laboratory of Neonatal Disease, National Health Commission, Shanghai 201102, China
| | - Hong Yang
- Department of Rehabilitation, Children's Hospital Fudan University, Shanghai, China
| | - Xiaoyun Zhu
- Department of Rehabilitation, Children's Hospital Fudan University, Shanghai, China
| | - Jun Wang
- Department of Rehabilitation, Children's Hospital Fudan University, Shanghai, China.
| | - Zhihua Li
- Department of Neonatology, Children's Hospital of Fudan University, Key Laboratory of Neonatal Disease, National Health Commission, Shanghai 201102, China.
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6
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Perinatal stroke: mapping and modulating developmental plasticity. Nat Rev Neurol 2021; 17:415-432. [PMID: 34127850 DOI: 10.1038/s41582-021-00503-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2021] [Indexed: 02/04/2023]
Abstract
Most cases of hemiparetic cerebral palsy are caused by perinatal stroke, resulting in lifelong disability for millions of people. However, our understanding of how the motor system develops following such early unilateral brain injury is increasing. Tools such as neuroimaging and brain stimulation are generating informed maps of the unique motor networks that emerge following perinatal stroke. As a focal injury of defined timing in an otherwise healthy brain, perinatal stroke represents an ideal human model of developmental plasticity. Here, we provide an introduction to perinatal stroke epidemiology and outcomes, before reviewing models of developmental plasticity after perinatal stroke. We then examine existing therapeutic approaches, including constraint, bimanual and other occupational therapies, and their potential synergy with non-invasive neurostimulation. We end by discussing the promise of exciting new therapies, including novel neurostimulation, brain-computer interfaces and robotics, all focused on improving outcomes after perinatal stroke.
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7
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Biswas A, Mankad K, Shroff M, Hanagandi P, Krishnan P. Neuroimaging Perspectives of Perinatal Arterial Ischemic Stroke. Pediatr Neurol 2020; 113:56-65. [PMID: 33038575 DOI: 10.1016/j.pediatrneurol.2020.08.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 07/24/2020] [Accepted: 08/18/2020] [Indexed: 11/26/2022]
Abstract
Perinatal stroke ranks second only to that of adult stroke in the overall stroke incidence. It is a major contributor to long-term neurological morbidity, which includes cognitive dysfunction, cerebral palsy and seizures. Risk factors for stroke in the perinatal period differ from those in children and tend to be multifactorial. Differences in territorial predilection, response to injury, and stroke evolution exist when compared with childhood and adult stroke, and also among differing gestation age groups in the perinatal period (i.e., extreme preterm versus preterm versus term). The role of imaging is to diagnose stroke, exclude stroke mimics, establish the nature of stroke (arterial versus venous), and aid in prognostication. Magnetic resonance imaging is the mainstay of neuroimaging in perinatal stroke. Advanced imaging techniques such as diffusion tensor imaging and perfusion-weighted imaging are emerging as useful supplements to conventional imaging sequences. Here we describe the neuroimaging of perinatal arterial ischemic stroke with emphasis on imaging techniques, imaging phenotypes, stroke evolution, role of advanced imaging, and differences between stroke in preterm and term neonates. We also briefly describe the emerging role of fetal magnetic resonance imaging in the diagnosis of in utero stroke.
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Affiliation(s)
- Asthik Biswas
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Canada.
| | - Kshitij Mankad
- Department of Radiology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Manohar Shroff
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Prasad Hanagandi
- Department of Medical Imaging, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Pradeep Krishnan
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Canada
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8
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Wagenaar N, Verhage CH, de Vries LS, van Gasselt BPL, Koopman C, Leemans A, Groenendaal F, Benders MJNL, van der Aa NE. Early prediction of unilateral cerebral palsy in infants at risk: MRI versus the hand assessment for infants. Pediatr Res 2020; 87:932-939. [PMID: 31722367 DOI: 10.1038/s41390-019-0664-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 09/16/2019] [Accepted: 10/01/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND Neonates with unilateral perinatal brain injury (UPBI) are at risk for developing unilateral spastic cerebral palsy (USCP). This study compares several predictors for USCP later in life. METHODS Twenty-one preterm and 24 term born infants with UPBI were included, with an MRI scan including diffusion tensor imaging (DTI) performed at term equivalent age or around 3 months after birth, respectively. T2-weighted images and DTI-based tractography were used to measure the surface area, diameter, and fractional anisotropy (FA) of both corticospinal tracts (CSTs). The hand assessment for infants (HAI) was performed before 5, between 5 and 8 and between 8 and 12 months of (corrected) age. Asymmetry indices were derived from all techniques and related to USCP at ≥2 years of age. RESULTS MRI measures and HAI scores were significantly lower for the affected compared to the unaffected side. Before 5 months of age, FA asymmetry on DTI yielded the highest area under the curve compared to conventional MRI and HAI. CONCLUSIONS Prediction of USCP after UPBI is reliable using asymmetry of the CST on MRI, as well as clinical hand assessment. Before 5 months of age, DTI tractography provides strongest predictive information, while HAI specifically aids to prognosis of USCP at later age points.
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Affiliation(s)
- Nienke Wagenaar
- Department of Neonatology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Cornelia H Verhage
- Child Development and Exercise Centre, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Linda S de Vries
- Department of Neonatology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Bram P L van Gasselt
- Department of Neonatology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Corine Koopman
- Department of Neonatology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Alexander Leemans
- Image Sciences Institute, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Floris Groenendaal
- Department of Neonatology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Manon J N L Benders
- Department of Neonatology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Niek E van der Aa
- Department of Neonatology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands. .,UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
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9
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Mackay MT, Slavova N, Pastore-Wapp M, Grunt S, Stojanovski B, Donath S, Steinlin M. Pediatric ASPECTS predicts outcomes following acute symptomatic neonatal arterial stroke. Neurology 2020; 94:e1259-e1270. [DOI: 10.1212/wnl.0000000000009136] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 11/05/2019] [Indexed: 11/15/2022] Open
Abstract
ObjectiveTo test the hypothesis that the Alberta Stroke Program Early Computed Tomography Score (ASPECTS) is useful in determining outcomes after neonatal arterial ischemic stroke (NAIS), we assessed accuracy of the modified pediatric ASPECTS (pedASPECTS) to predict cerebral palsy (CP), neurologic impairment, and epilepsy.MethodsCross-sectional study included newborns with acute NAIS whose outcomes were assessed at ≥18 months after stroke. PedASPECTS accuracy to predict outcomes was determined by sensitivity, specificity, and receiver operator characteristic (ROC) curves, and correlation between pedASPECTS and infarct volume was determined by the Spearman correlation coefficient.ResultsNinety-six children met the inclusion criteria. Median percentage infarct to supratentorial brain volume was 6.8% (interquartile range [IQR] 3.0%–14.3%). Median pedASPECTS was 7 (IQR 4–10). At a median age of 2.1 years, 35% developed CP, 43% had neurologic impairment, and 7% had epilepsy. Median pedASPECTS predicted outcomes of interest: CP (10, IQR 8–12) vs no CP (5, IQR 4–8) (p < 0.0001), poor (9, IQR 7–12) vs good (6, IQR 4–8) neurologic outcomes (p < 0.0001), and epilepsy (10, IQR 8–12) vs no epilepsy (7, IQR 4–10) (p = 0.033). PedASPECTS accuracy was good for CP (ROC 0.811) and fair for neurologic impairment (ROC 0.760) and epilepsy (ROC 0.761). A pedASPECTS ≥8 had ≥69% sensitivity and ≥54% specificity for clinical outcomes. PedASPECTS correlated with infarct volume (Spearman rank 0.701, p < 0.0001).ConclusionsThis study provides Class II evidence that pedASPECTS has fair to good accuracy for predicting CP, neurologic impairment, and epilepsy after NAIS and correlates with infarct volume. PedASPECTS may assist with early identification of babies requiring close developmental surveillance.
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10
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Abstract
Perinatal strokes are a diverse but specific group of focal cerebrovascular injuries that occur early in brain development and affect an estimated 5 million people worldwide. The objective of this review is to describe the epidemiology, clinical presentations, pathophysiology, outcomes, and management for the 6 subtypes of perinatal stroke. Some perinatal strokes are symptomatic in the first days of life, typically with seizures, including neonatal arterial ischemic stroke, neonatal hemorrhagic stroke, and cerebral sinovenous thrombosis. The remaining subtypes present in the first year of life or later, usually with motor asymmetry and include arterial presumed perinatal ischemic stroke, presumed perinatal hemorrhagic stroke, and in utero periventricular venous infarction. The consequences of these injuries include cerebral palsy, epilepsy, and cognitive and behavioral challenges, in addition to the psychosocial impact on families. While there have been significant advances in understanding mechanisms of both injury and recovery, there is still a great deal to learn regarding causation and the optimization of outcomes.
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Affiliation(s)
- Mary Dunbar
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada; Calgary Pediatric Stroke Program, University of Calgary, Calgary, AB, Canada
| | - Adam Kirton
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada; Department of Clinical Neuroscience, University of Calgary, Calgary, AB, Canada; Department of Radiology, Faculty of Medicine, University of Calgary, Calgary, AB, Canada; Alberta Children's Hospital Research Institute, Calgary, AB, Canada; Hotchkiss Brain Institute, Calgary, AB, Canada; Calgary Pediatric Stroke Program, University of Calgary, Calgary, AB, Canada.
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11
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Srivastava R, Rajapakse T, Carlson HL, Keess J, Wei XC, Kirton A. Diffusion Imaging of Cerebral Diaschisis in Neonatal Arterial Ischemic Stroke. Pediatr Neurol 2019; 100:49-54. [PMID: 31147227 DOI: 10.1016/j.pediatrneurol.2019.04.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 04/19/2019] [Accepted: 04/20/2019] [Indexed: 01/28/2023]
Abstract
BACKGROUND Neonatal arterial ischemic stroke is a leading cause of cerebral palsy and lifelong disability. Diffusion-weighted imaging has revolutionized diagnosis and facilitated outcome prognostication in acute neonatal arterial ischemic stroke. Diaschisis refers to changes in brain areas functionally connected but structurally remote from primary injury. We hypothesized that acute diffusion-weighted imaging can quantify cerebral diaschisis and is associated with outcome from neonatal arterial ischemic stroke. METHODS Subjects were identified from a prospective, population-based research cohort (Alberta Perinatal Stroke Project). Inclusion criteria were unilateral middle cerebral artery neonatal arterial ischemic stroke, diffusion-weighted magnetic resonance imaging within 10 days of birth, and more than 12-months follow-up (pediatric stroke outcome measure). Diaschisis was characterized and quantified using a validated software method (ImageJ). Volumetric analysis assessed atrophy of affected structures. Diaschisis scores were corrected for infarct size and compared with outcomes (Mann-Whitney). RESULTS From 20 eligible neonatal arterial ischemic strokes, two were excluded for poor image quality. Of 18 remaining (61% male, median age 3.2 days), 16 (89%) demonstrated diaschisis. Thalamus (88%) was the most common location in addition to corpus callosum (50%). Age at imaging was not associated with diaschisis. Affected structures demonstrated atrophy on imaging. Long-term outcomes available in 81% (median age 7.5 years) were not associated with diaschisis scores. CONCLUSIONS Cerebral diaschisis occurs in neonatal arterial ischemic stroke and can be quantified with diffusion-weighted imaging. Occurrence is common and should not be mistaken for additional infarction. Determining clinical significance will require larger samples with well-characterized long-term outcomes.
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Affiliation(s)
- Ratika Srivastava
- Division of Pediatric Neurology, Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Stollery Children's Hospital, Edmonton, Alberta, Canada; Calgary Pediatric Stroke Program, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Calgary Pediatric Stroke Program, Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Thilinie Rajapakse
- Division of Pediatric Neurology, Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Stollery Children's Hospital, Edmonton, Alberta, Canada; Calgary Pediatric Stroke Program, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Calgary Pediatric Stroke Program, Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Helen L Carlson
- Calgary Pediatric Stroke Program, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Calgary Pediatric Stroke Program, Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jamie Keess
- Calgary Pediatric Stroke Program, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Calgary Pediatric Stroke Program, Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Xing-Chang Wei
- Department of Radiology, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Adam Kirton
- Calgary Pediatric Stroke Program, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Calgary Pediatric Stroke Program, Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
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12
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Nemanich ST, Chen CY, Chen M, Zorn E, Mueller B, Peyton C, Elison JT, Stinear J, Rao R, Georgieff M, Menk J, Rudser K, Gillick B. Safety and Feasibility of Transcranial Magnetic Stimulation as an Exploratory Assessment of Corticospinal Connectivity in Infants After Perinatal Brain Injury: An Observational Study. Phys Ther 2019; 99:689-700. [PMID: 30806664 PMCID: PMC6545276 DOI: 10.1093/ptj/pzz028] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 02/13/2019] [Indexed: 01/21/2023]
Abstract
BACKGROUND Perinatal brain injuries often impact the corticospinal system, leading to motor impairment and cerebral palsy. Although transcranial magnetic stimulation (TMS) has been widely used to study corticospinal connectivity in adults and older children, similar studies of young infants are limited. OBJECTIVES The objective was to establish the safety and feasibility of advanced TMS assessments of the corticospinal connectivity of young infants with perinatal brain injury. DESIGN This was a pilot, cross-sectional study of 3- to 12-month-old (corrected age) infants with perinatal stroke or intracranial hemorrhage. METHODS Six participants (2 term, 4 preterm) were assessed with stereotactic neuronavigation-guided TMS. Single-pulse TMS was applied to each hemisphere and responses were recorded simultaneously from both upper limbs. During data collection, vital signs and stress responses were measured to assess safety. Developmental motor outcomes were evaluated using the General Movements Assessment and Bayley Scales of Infant and Toddler Development (3rd edition). A clinical diagnosis of cerebral palsy was recorded, if available. RESULTS No adverse events occurred during TMS testing. All sessions were well tolerated. Contralateral motor evoked responses were detected in 4 of 6 participants. Both contralateral and ipsilateral responses were observed in 2 of 6 participants. LIMITATIONS TMS responses were not obtained in all participants. This could be related to the location of brain injury or developmental stage of the corticospinal system controlling the wrist flexor muscle group from which responses were recorded. CONCLUSIONS This study provides a summary of the framework for performing novel TMS assessments in infants with perinatal brain injury. Implementing this approach to measure corticospinal connectivity in hypothesis-driven studies in young infants appears to be justified. Such studies could inform the characterization of corticospinal development and the neural mechanisms driving recovery following early interventions.
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Affiliation(s)
- Samuel T Nemanich
- Department of Rehabilitation Medicine, University of Minnesota, MMC 388, 420 Delaware St SE, Minneapolis, MN 55455 (USA). Address all correspondence to Dr Nemanich at:
| | - Chao-Ying Chen
- Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Mo Chen
- Department of Psychiatry and Behavioral Sciences, University of Minnesota
| | | | - Bryon Mueller
- Department of Psychiatry and Behavioral Sciences, University of Minnesota
| | - Colleen Peyton
- Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Jed T Elison
- Department of Pediatrics; and Institute of Child Development, College of Education and Human Development, University of Minnesota
| | - James Stinear
- Department of Exercise Sciences, University of Auckland, Auckland, New Zealand
| | - Raghu Rao
- Department of Pediatrics, University of Minnesota
| | | | - Jeremiah Menk
- School of Public Health, Division of Biostatistics, University of Minnesota
| | - Kyle Rudser
- School of Public Health, Division of Biostatistics, University of Minnesota
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13
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Donahue MJ, Dlamini N, Bhatia A, Jordan LC. Neuroimaging Advances in Pediatric Stroke. Stroke 2019; 50:240-248. [PMID: 30661496 PMCID: PMC6450544 DOI: 10.1161/strokeaha.118.020478] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 06/29/2018] [Indexed: 12/18/2022]
Affiliation(s)
| | - Nomazulu Dlamini
- Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Aashim Bhatia
- Radiology, Vanderbilt Medical Center, Nashville, TN, USA
| | - Lori C. Jordan
- Pediatrics–Division of Pediatric Neurology, Vanderbilt Medical Center, Nashville, TN, USA
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Abstract
Perinatal arterial ischemic stroke is a relatively common and serious neurologic disorder that can affect the fetus, the preterm, and the term-born infant. It carries significant long-term disabilities. Herein we describe the current understanding of its etiology, pathophysiology and classification, different presentations, and optimal early management. We discuss the role of different brain imaging modalities in defining the extent of lesions and the impact this has on the prediction of outcomes. In recent years there has been progress in treatments, making early diagnosis and the understanding of likely morbidities imperative. An overview is given of the range of possible outcomes and optimal approaches to follow-up and support for the child and their family in the light of present knowledge.
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15
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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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16
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Guyader JM, Huizinga W, Poot DHJ, van Kranenburg M, Uitterdijk A, Niessen WJ, Klein S. Groupwise image registration based on a total correlation dissimilarity measure for quantitative MRI and dynamic imaging data. Sci Rep 2018; 8:13112. [PMID: 30166626 PMCID: PMC6117310 DOI: 10.1038/s41598-018-31474-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 08/20/2018] [Indexed: 02/07/2023] Open
Abstract
The most widespread technique used to register sets of medical images consists of selecting one image as fixed reference, to which all remaining images are successively registered. This pairwise scheme requires one optimization procedure per pair of images to register. Pairwise mutual information is a common dissimilarity measure applied to a large variety of datasets. Alternative methods, called groupwise registrations, have been presented to register two or more images in a single optimization procedure, without the need of a reference image. Given the success of mutual information in pairwise registration, we adapt one of its multivariate versions, called total correlation, in a groupwise context. We justify the choice of total correlation among other multivariate versions of mutual information, and provide full implementation details. The resulting total correlation measure is remarkably close to measures previously proposed by Huizinga et al. based on principal component analysis. Our experiments, performed on five quantitative imaging datasets and on a dynamic CT imaging dataset, show that total correlation yields registration results that are comparable to Huizinga's methods. Total correlation has the advantage of being theoretically justified, while the measures of Huizinga et al. were designed empirically. Additionally, total correlation offers an alternative to pairwise mutual information on quantitative imaging datasets.
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Affiliation(s)
- Jean-Marie Guyader
- Biomedical Imaging Group Rotterdam, Departments of Radiology and Medical Informatics, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, The Netherlands.
| | - Wyke Huizinga
- Biomedical Imaging Group Rotterdam, Departments of Radiology and Medical Informatics, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Dirk H J Poot
- Biomedical Imaging Group Rotterdam, Departments of Radiology and Medical Informatics, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, The Netherlands
- Imaging Science and Technology, Faculty of Applied Sciences, Delft University of Technology, Delft, The Netherlands
| | - Matthijs van Kranenburg
- Departments of Radiology, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, The Netherlands
- Department of Cardiology, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - André Uitterdijk
- Department of Cardiology, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Wiro J Niessen
- Biomedical Imaging Group Rotterdam, Departments of Radiology and Medical Informatics, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, The Netherlands
- Imaging Science and Technology, Faculty of Applied Sciences, Delft University of Technology, Delft, The Netherlands
| | - Stefan Klein
- Biomedical Imaging Group Rotterdam, Departments of Radiology and Medical Informatics, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, The Netherlands
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17
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Yu S, Carlson HL, Mineyko A, Brooks BL, Kuczynski A, Hodge J, Dukelow S, Kirton A. Bihemispheric alterations in myelination in children following unilateral perinatal stroke. NEUROIMAGE-CLINICAL 2018; 20:7-15. [PMID: 29988959 PMCID: PMC6034585 DOI: 10.1016/j.nicl.2018.06.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 06/04/2018] [Accepted: 06/06/2018] [Indexed: 01/16/2023]
Abstract
Background Stroke is a leading cause of perinatal brain injury with variable outcomes including cerebral palsy and epilepsy. The biological processes that underlie these heterogeneous outcomes are poorly understood. Alterations in developmental myelination are recognized as a major determinant of outcome in preterm brain injury but have not been explored in perinatal stroke. We aimed to characterize myelination in hemiparetic children after arterial perinatal stroke, hypothesizing that ipsilesional myelination would be impaired, the degree of which would correlate with poor outcome. Methods Retrospective, controlled cohort study. Participants were identified through the Alberta Perinatal Stroke Project (APSP), a population-based research cohort (n > 400). Inclusion criteria were: 1) MRI-confirmed, unilateral arterial perinatal stroke, 2) T1-weighted MRI after 6 months of age, 3) absence of other neurological disorders, 4) neurological outcome that included at least one of the following tests - Pediatric Stroke Outcome Measure (PSOM), Assisting Hand Assessment (AHA), Melbourne Assessment (MA), neuropsychological evaluation (NPE), and robotic sensorimotor measurements. FreeSurfer software measured hemispheric asymmetry in myelination intensity (primary outcome). A second method using ImageJ software validated the detection of myelination asymmetry. A repeated measures ANOVA was used to compare perilesional, ipsilesional remote, and contralesional homologous region myelination between stroke cases and typically developing controls. Myelination metrics were compared to clinical outcome measures (t-test, Pearson's correlation). Results Twenty youth with arterial stroke (mean age: 13.4 ± 4.2yo) and 27 typically developing controls (mean age: 12.5 ± 3.7yo) were studied in FreeSurfer. Participants with stroke demonstrated lower myelination in the ipsilesional hemisphere (p < 0.0001). Myelination in perilesional regions had lower intensity compared to ipsilesional remote areas (p < .00001) and contralesional homologous areas (p < 0.00001). Ipsilesional remote regions had decreased myelination compared to homologous regions on the contralesional hemisphere (p = 0.016). Contralesional myelination was decreased compared to controls (p < 0.00001). Myelination metrics were not strongly associated with clinical motor, robotic sensorimotor, or neuropsychological outcomes though some complex tests requiring speeded responses had moderate effect sizes. Conclusion Myelination of apparently uninjured brain in both the ipsilesional and contralesional hemispheres is decreased after perinatal stroke. Differences appear to radiate outward from the lesion. Further study is needed to determine clinical significance. Myelination is altered in the lesioned hemisphere after perinatal stroke. The uninjured, contralesional hemisphere also demonstrates differences in myelination. Simple software can estimate MRI myelination abnormalities in children with perinatal brain injury.
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Affiliation(s)
- Sabrina Yu
- Calgary Pediatric Stroke Program, University of Calgary, Calgary, AB, Canada
| | - Helen L Carlson
- Calgary Pediatric Stroke Program, University of Calgary, Calgary, AB, Canada; Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Aleksandra Mineyko
- Calgary Pediatric Stroke Program, University of Calgary, Calgary, AB, Canada; Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Brian L Brooks
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Andrea Kuczynski
- Calgary Pediatric Stroke Program, University of Calgary, Calgary, AB, Canada
| | - Jacquie Hodge
- Calgary Pediatric Stroke Program, University of Calgary, Calgary, AB, Canada
| | - Sean Dukelow
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Adam Kirton
- Calgary Pediatric Stroke Program, University of Calgary, Calgary, AB, Canada; Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.
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18
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Cooper AN, Anderson V, Hearps S, Greenham M, Ditchfield M, Coleman L, Hunt RW, Mackay MT, Monagle P, Gordon AL. Trajectories of Motor Recovery in the First Year After Pediatric Arterial Ischemic Stroke. Pediatrics 2017; 140:peds.2016-3870. [PMID: 28710246 DOI: 10.1542/peds.2016-3870] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/28/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Neuromotor impairments are common after pediatric stroke, but little is known about functional motor outcomes. We evaluated motor function and how it changed over the first 12 months after diagnosis. We also examined differences in outcome according to age at diagnosis and whether fine motor (FM) or gross motor (GM) function at 12 months was associated with adaptive behavior. METHODS This prospective, longitudinal study recruited children (N = 64) from The Royal Children's Hospital, Melbourne who were diagnosed with acute arterial ischemic stroke (AIS) between December 2007 and November 2013. Motor assessments were completed at 3 time points after the diagnosis of AIS (1, 6, and 12 months). Children were grouped as follows: neonates (n = 27), preschool-aged (n = 19), and school-aged (n = 18). RESULTS A larger lesion size was associated with poorer GM outcomes at 12 months (P = .016). Neonatal AIS was associated with better FM and GM function initially but with a reduction in z scores over time. For the preschool- and school-aged groups, FM remained relatively stable over time. For GM outcomes, the preschool- and the school-aged age groups displayed similar profiles, with gradual recovery over time. Overall, poor FM and GM outcomes at 12 months were associated with poorer adaptive behavior scores. CONCLUSIONS Motor outcomes and the trajectory of recovery post-AIS differed according to a child's age at stroke onset. These findings indicate that an individualized approach to surveillance and intervention may be needed that is informed in part by age at diagnosis.
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Affiliation(s)
- Anna N Cooper
- Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia
| | - Vicki Anderson
- Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia.,The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Stephen Hearps
- Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia
| | - Mardee Greenham
- Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia
| | - Michael Ditchfield
- Monash Medical Centre, Southern Health, Melbourne, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia
| | - Lee Coleman
- Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Rod W Hunt
- Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia.,The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Mark T Mackay
- Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia.,The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Paul Monagle
- Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia.,The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Anne L Gordon
- Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; and .,Kings College London, London, United Kingdom
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19
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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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20
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Understanding Brain Reorganization in Infants With Perinatal Stroke Through Neuroexcitability and Neuroimaging. Pediatr Phys Ther 2017; 29:173-178. [PMID: 28350777 PMCID: PMC5560124 DOI: 10.1097/pep.0000000000000365] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE The primary aim of this proposed study is to evaluate brain reorganization patterns in infants with perinatal stroke between 3 and 5 months of age using transcranial magnetic stimulation and magnetic resonance imaging, with the addition of the General Movements Assessment. A secondary aim is to demonstrate feasibility and safety of infant-appropriate brain assessment protocols. METHODS Ten infants with perinatal stroke will be enrolled. In this exploratory study, infants will first receive magnetic resonance imaging scanning during natural sleep to examine their corticospinal tract integrity. Infants will then receive transcranial magnetic stimulation to assess their corticomotor excitability. A General Movements Assessment video of at least 5 minutes will also be recorded. DISCUSSION Study results will enhance our understanding of brain reorganization in infants with perinatal stroke. We expect these results will also guide the development of early interventions designed to mitigate maladaptive neuroplastic changes and improve long-term motor outcomes.
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21
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Koenraads Y, Porro GL, Braun KPJ, Groenendaal F, de Vries LS, van der Aa NE. Prediction of visual field defects in newborn infants with perinatal arterial ischemic stroke using early MRI and DTI-based tractography of the optic radiation. Eur J Paediatr Neurol 2016; 20:309-318. [PMID: 26708504 DOI: 10.1016/j.ejpn.2015.11.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 10/08/2015] [Accepted: 11/23/2015] [Indexed: 01/16/2023]
Abstract
PURPOSE Visual field (VF) defects are common sequelae of perinatal arterial ischemic stroke (PAIS). The aim of this study was to investigate the predictive value of magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI) for VF defects following PAIS. METHODS Nineteen infants with unilateral PAIS, who underwent conventional MRI (T1/T2) and DTI at three months of age and a VF examination later in life (median age 3.2 yrs) were included. Conventional T1-weighted MRI was used to assess asymmetry of the optic radiation (OR). DTI-based tractography of the bilateral OR was performed, and the average fractional anisotropy (FA), axial (λ1), radial (λ23) and mean diffusivity (MD) were extracted. Asymmetry of the OR on MRI and DTI was used as a predictor of VF defects using receiver operating characteristic (ROC) analysis. RESULTS Of the 19 infants, nine had a normal VF, eight had a VF defect (six hemianopia and two quadrantanopia), and two had an inconclusive VF test. The presence or absence of a VF defect could be correctly predicted using conventional MRI assessment in the majority of the infants, with an area under the curve (AUC) of 0.90 (95% CI 0.66-0.99). Prediction based on DTI parameter asymmetry indices showed an AUC of 0.96 (95% CI 0.74-1.00), 0.78 (95% CI 0.52-0.94), 0.93 (95% CI 0.70-1.00) and 0.90 (95% CI 0.66-0.99) for FA, λ1, λ23 and MD, respectively. CONCLUSIONS VF defects following PAIS can be reliably predicted by assessment of asymmetry of the OR at three months on conventional MRI and DTI-based tractography with comparable predictive values. Conventional T1-weighted MRI can be used in clinical practice.
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Affiliation(s)
- Yvonne Koenraads
- Department of Ophthalmology, University Medical Center Utrecht, The Netherlands.
| | - Giorgio L Porro
- Department of Ophthalmology, University Medical Center Utrecht, The Netherlands.
| | - Kees P J Braun
- Department of Pediatric Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands.
| | - Floris Groenendaal
- Department of Neonatology, Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands.
| | - Linda S de Vries
- Department of Neonatology, Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands.
| | - Niek E van der Aa
- Department of Neonatology, Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands.
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22
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Huizinga W, Poot DHJ, Guyader JM, Klaassen R, Coolen BF, van Kranenburg M, van Geuns RJM, Uitterdijk A, Polfliet M, Vandemeulebroucke J, Leemans A, Niessen WJ, Klein S. PCA-based groupwise image registration for quantitative MRI. Med Image Anal 2015; 29:65-78. [PMID: 26802910 DOI: 10.1016/j.media.2015.12.004] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 12/10/2015] [Accepted: 12/10/2015] [Indexed: 11/17/2022]
Abstract
Quantitative magnetic resonance imaging (qMRI) is a technique for estimating quantitative tissue properties, such as the T1 and T2 relaxation times, apparent diffusion coefficient (ADC), and various perfusion measures. This estimation is achieved by acquiring multiple images with different acquisition parameters (or at multiple time points after injection of a contrast agent) and by fitting a qMRI signal model to the image intensities. Image registration is often necessary to compensate for misalignments due to subject motion and/or geometric distortions caused by the acquisition. However, large differences in image appearance make accurate image registration challenging. In this work, we propose a groupwise image registration method for compensating misalignment in qMRI. The groupwise formulation of the method eliminates the requirement of choosing a reference image, thus avoiding a registration bias. The method minimizes a cost function that is based on principal component analysis (PCA), exploiting the fact that intensity changes in qMRI can be described by a low-dimensional signal model, but not requiring knowledge on the specific acquisition model. The method was evaluated on 4D CT data of the lungs, and both real and synthetic images of five different qMRI applications: T1 mapping in a porcine heart, combined T1 and T2 mapping in carotid arteries, ADC mapping in the abdomen, diffusion tensor mapping in the brain, and dynamic contrast-enhanced mapping in the abdomen. Each application is based on a different acquisition model. The method is compared to a mutual information-based pairwise registration method and four other state-of-the-art groupwise registration methods. Registration accuracy is evaluated in terms of the precision of the estimated qMRI parameters, overlap of segmented structures, distance between corresponding landmarks, and smoothness of the deformation. In all qMRI applications the proposed method performed better than or equally well as competing methods, while avoiding the need to choose a reference image. It is also shown that the results of the conventional pairwise approach do depend on the choice of this reference image. We therefore conclude that our groupwise registration method with a similarity measure based on PCA is the preferred technique for compensating misalignments in qMRI.
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Affiliation(s)
- W Huizinga
- Biomedical Imaging Group Rotterdam, Departments of Radiology & Medical Informatics, Erasmus MC, Rotterdam, The Netherlands.
| | - D H J Poot
- Biomedical Imaging Group Rotterdam, Departments of Radiology & Medical Informatics, Erasmus MC, Rotterdam, The Netherlands; Quantitative Imaging Group, Department of Imaging Physics, Faculty of Applied Sciences, Delft University of Technology, Delft, The Netherlands
| | - J-M Guyader
- Biomedical Imaging Group Rotterdam, Departments of Radiology & Medical Informatics, Erasmus MC, Rotterdam, The Netherlands
| | - R Klaassen
- Department of Medical Oncology, Academic Medical Center, Amsterdam, The Netherlands
| | - B F Coolen
- Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands
| | - M van Kranenburg
- Department of Radiology, Erasmus MC, Rotterdam, The Netherlands; Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - R J M van Geuns
- Department of Radiology, Erasmus MC, Rotterdam, The Netherlands; Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - A Uitterdijk
- Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - M Polfliet
- Vrije Universiteit Brussel, Department of Electronics and Informatics (ETRO), Brussels, Belgium; iMinds, Department of Medical IT, Ghent, Belgium
| | - J Vandemeulebroucke
- Vrije Universiteit Brussel, Department of Electronics and Informatics (ETRO), Brussels, Belgium; iMinds, Department of Medical IT, Ghent, Belgium
| | - A Leemans
- Image Sciences Institute, University Medical Center Utrecht, The Netherlands
| | - W J Niessen
- Biomedical Imaging Group Rotterdam, Departments of Radiology & Medical Informatics, Erasmus MC, Rotterdam, The Netherlands; Quantitative Imaging Group, Department of Imaging Physics, Faculty of Applied Sciences, Delft University of Technology, Delft, The Netherlands
| | - S Klein
- Biomedical Imaging Group Rotterdam, Departments of Radiology & Medical Informatics, Erasmus MC, Rotterdam, The Netherlands
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Dinomais M, Hertz-Pannier L, Groeschel S, Chabrier S, Delion M, Husson B, Kossorotoff M, Renaud C, Nguyen The Tich S. Long term motor function after neonatal stroke: Lesion localization above all. Hum Brain Mapp 2015; 36:4793-807. [PMID: 26512551 DOI: 10.1002/hbm.22950] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 08/07/2015] [Accepted: 08/11/2015] [Indexed: 12/21/2022] Open
Abstract
Motor outcome is variable following neonatal arterial ischemic stroke (NAIS). We analyzed the relationship between lesion characteristics on brain MRI and motor function in children who had suffered from NAIS. Thirty eight full term born children with unilateral NAIS were investigated at the age of seven. 3D T1- and 3D FLAIR-weighted MR images were acquired on a 3T MRI scanner. Lesion characteristics were compared between patients with and without cerebral palsy (CP) using the following approaches: lesion localization either using a category-based analysis, lesion mapping as well as voxel-based lesion-symptom mapping (VLSM). Using diffusion-weighted imaging the microstructure of the cortico-spinal tract (CST) was related to the status of CP by measuring DTI parameters. Whereas children with lesions sparing the primary motor system did not develop CP, CP was always present when extensive lesions damaged at least two brain structures involving the motor system. The VLSM approach provided a statistical map that confirmed the cortical lesions in the primary motor system and revealed that CP was highly correlated with lesions in close proximity to the CST. In children with CP, diffusion parameters indicated microstructural changes in the CST at the level of internal capsule and the centrum semiovale. White matter damage of the CST in centrum semiovale was a highly reproducible marker of CP. This is the first description of the implication of this latter region in motor impairment after NAIS. In conclusion, CP in childhood was closely linked to the location of the infarct in the motor system.
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Affiliation(s)
- Mickael Dinomais
- LUNAM, Université d'Angers, Laboratoire Angevin de Recherche en Ingénierie des Systèmes (LARIS) - EA7315, F-49000, Angers, France.,LUNAM, CHU Angers, Université d'Angers, Département de Médecine Physique et de Réadaptation, F- 49933, Angers, France
| | - Lucie Hertz-Pannier
- UNIACT, Neurospin, I2BM, DSV, CEA-Saclay, and INSERM U1129 Paris, Université Paris Descartes, Sorbonne Paris Cité, CEA, F-91191, Gif sur Yvette, France
| | - Samuel Groeschel
- Experimental Pediatric Neuroimaging, Department of Pediatric Neurology & Developmental Medicine, University Children's Hospital Tübingen, Germany
| | - Stéphane Chabrier
- CHU Saint-Étienne, Centre national de référence de l'AVC de l'enfant and Inserm CIC1408, F-42055, Saint-Étienne, France.,Université de Saint-x000C9;tienne, Groupe de recherche sur la thrombose - EA3065, F-42023, Saint-Étienne, France
| | - Matthieu Delion
- LUNAM, CHU Angers, Université d'Angers, Département de Neurochirurgie, F-49933, Angers, France.,LUNAM, Université d'Angers, Laboratoire d'Anatomie, Faculté de Médecine F-49045, Angers, France
| | - Béatrice Husson
- Assistance Publique-Hôpitaux de Paris, CHU Bicêtre, Service d'Imagerie Pédiatrique and Centre national de référence de l'AVC de l'enfant, Paris, France
| | - Manoelle Kossorotoff
- Pediatric Neurology Department and French Center for Pediatric Stroke, University Hospital Necker-Enfants Malades, AP-HP Assistance Publique-Hôpitaux de Paris, F-75743, Paris, France
| | - Cyrille Renaud
- CHU Saint-Étienne, Centre national de référence de l'AVC de l'enfant and Inserm CIC1408, F-42055, Saint-Étienne, France
| | - Sylvie Nguyen The Tich
- LUNAM, Université d'Angers, Laboratoire Angevin de Recherche en Ingénierie des Systèmes (LARIS) - EA7315, F-49000, Angers, France.,LUNAM, CHU Angers, Université d'Angers, Département de Neuropédiatrie, F-49933, Angers, France
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Neonatal DTI early after birth predicts motor outcome in preterm infants with periventricular hemorrhagic infarction. Pediatr Res 2015; 78:298-303. [PMID: 25978802 DOI: 10.1038/pr.2015.94] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Accepted: 02/05/2015] [Indexed: 12/23/2022]
Abstract
BACKGROUND To determine the association between early neonatal diffusion tensor imaging (DTI) and the development of unilateral spastic cerebral palsy (USCP) in preterm infants with periventricular hemorrhagic infarction (PVHI). METHODS Preterm infants with PVHI were assessed with early (≤4 wk after birth) and term-equivalent age MRI-DTI. Involvement of corticospinal tracts was assessed by visual assessment of the posterior limb of the internal capsule (PLIC) on DTI (classified asymmetrical, equivocal, or symmetrical) and by an atlas-based approach calculating fractional anisotropy asymmetry index in the PLIC. Motor outcome was assessed at ≥15 mo corrected age. RESULTS Seven out of 23 infants with PVHI developed USCP. Their PLIC was visually scored as asymmetrical in 6 and equivocal in 1 on the early DTI. Thirteen out of 16 infants with a symmetrical motor development had a symmetrical PLIC on early DTI, the remaining 3 were equivocal. All infants with USCP had a fractional anisotropy asymmetry index of >0.05 (optimal cut-off value) on early DTI. In infants with a symmetrical motor development (n = 16), 14 had an asymmetry index ≤0.05 while 2 had an index >0.05. CONCLUSION DTI in preterm infants with PVHI within a few weeks after birth is associated with later motor development.
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Perrone D, Aelterman J, Pižurica A, Jeurissen B, Philips W, Leemans A. The effect of Gibbs ringing artifacts on measures derived from diffusion MRI. Neuroimage 2015; 120:441-55. [PMID: 26142273 DOI: 10.1016/j.neuroimage.2015.06.068] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 05/22/2015] [Accepted: 06/24/2015] [Indexed: 12/13/2022] Open
Abstract
Diffusion-weighted (DW) magnetic resonance imaging (MRI) is a unique method to investigate microstructural tissue properties noninvasively and is one of the most popular methods for studying the brain white matter in vivo. To obtain reliable statistical inferences with diffusion MRI, however, there are still many challenges, such as acquiring high-quality DW-MRI data (e.g., high SNR and high resolution), careful data preprocessing (e.g., correcting for subject motion and eddy current induced geometric distortions), choosing the appropriate diffusion approach (e.g., diffusion tensor imaging (DTI), diffusion kurtosis imaging (DKI), or diffusion spectrum MRI), and applying a robust analysis strategy (e.g., tractography based or voxel based analysis). Notwithstanding the numerous efforts to optimize many steps in this complex and lengthy diffusion analysis pipeline, to date, a well-known artifact in MRI--i.e., Gibbs ringing (GR)--has largely gone unnoticed or deemed insignificant as a potential confound in quantitative DW-MRI analysis. Considering the recent explosion of diffusion MRI applications in biomedical and clinical applications, a systematic and comprehensive investigation is necessary to understand the influence of GR on the estimation of diffusion measures. In this work, we demonstrate with simulations and experimental DW-MRI data that diffusion estimates are significantly affected by GR artifacts and we show that an off-the-shelf GR correction procedure based on total variation already can alleviate this issue substantially.
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Affiliation(s)
- Daniele Perrone
- iMinds - Image Processing and Interpretation, Ghent University, Ghent, Belgium.
| | - Jan Aelterman
- iMinds - Image Processing and Interpretation, Ghent University, Ghent, Belgium
| | - Aleksandra Pižurica
- iMinds - Image Processing and Interpretation, Ghent University, Ghent, Belgium
| | - Ben Jeurissen
- iMinds - Vision Lab, Department of Physics, University of Antwerp, Belgium
| | - Wilfried Philips
- iMinds - Image Processing and Interpretation, Ghent University, Ghent, Belgium
| | - Alexander Leemans
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands
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26
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Chen CY, Tafone S, Lo W, Heathcock JC. Perinatal stroke causes abnormal trajectory and laterality in reaching during early infancy. RESEARCH IN DEVELOPMENTAL DISABILITIES 2015; 38:301-308. [PMID: 25577180 DOI: 10.1016/j.ridd.2014.11.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 11/18/2014] [Accepted: 11/20/2014] [Indexed: 06/04/2023]
Abstract
The developmental progression of reaching and early signs of upper extremity neglect is common concern for infants at risk for hemiparesis and cerebral palsy. We investigated the emergence of reaching and laterality in infants at risk for hemiplegic cerebral palsy. Eight infants with perinatal stroke (PS) and thirteen infants with typical development (TD) were assessed bimonthly from 2 to 7 months of age for 10 visits per infant. Reaching number and hand-toy contact duration were measured. Infants with PS demonstrated a linear trajectory of reaching behaviors with asymmetrical upper extremity performance. Infants with TD demonstrated a linear and quadratic trajectory of reaching behaviors and symmetrical upper extremity performance over the same age range. These results suggest that infants with PS have delay reaching and early signs of neglect not currently accounted for in clinical practice.
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Affiliation(s)
- Chao-Ying Chen
- The Ohio State University, School of Health and Rehabilitation Sciences, Division of Physical Therapy, United States
| | - Sara Tafone
- The Ohio State University, School of Health and Rehabilitation Sciences, Division of Physical Therapy, United States
| | - Warren Lo
- Nationwide Children's Hospital, Department of Neurology, United States
| | - Jill C Heathcock
- The Ohio State University, School of Health and Rehabilitation Sciences, Division of Physical Therapy, United States; Nationwide Children's Hospital, Center for Perinatal Research, United States.
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Allievi AG, Arichi T, Gordon AL, Burdet E. Technology-aided assessment of sensorimotor function in early infancy. Front Neurol 2014; 5:197. [PMID: 25324827 PMCID: PMC4181230 DOI: 10.3389/fneur.2014.00197] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 09/17/2014] [Indexed: 01/31/2023] Open
Abstract
There is a pressing need for new techniques capable of providing accurate information about sensorimotor function during the first 2 years of childhood. Here, we review current clinical methods and challenges for assessing motor function in early infancy, and discuss the potential benefits of applying technology-assisted methods. We also describe how the use of these tools with neuroimaging, and in particular functional magnetic resonance imaging (fMRI), can shed new light on the intra-cerebral processes underlying neurodevelopmental impairment. This knowledge is of particular relevance in the early infant brain, which has an increased capacity for compensatory neural plasticity. Such tools could bring a wealth of knowledge about the underlying pathophysiological processes of diseases such as cerebral palsy; act as biomarkers to monitor the effects of possible therapeutic interventions; and provide clinicians with much needed early diagnostic information.
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Affiliation(s)
- Alessandro G Allievi
- Human Robotics Group, Department of Bioengineering, Imperial College London , London , UK
| | - Tomoki Arichi
- Human Robotics Group, Department of Bioengineering, Imperial College London , London , UK ; Department of Perinatal Imaging and Health, King's College London , London , UK
| | - Anne L Gordon
- Paediatric Neurosciences, Evelina London Children's Hospital, Guy's and St Thomas' NHS Trust , London , UK ; Institute of Psychiatry, Psychology and Neuroscience, Kings College London , London , UK
| | - Etienne Burdet
- Human Robotics Group, Department of Bioengineering, Imperial College London , London , UK
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Allievi AG, Arichi T, Gordon AL, Burdet E. Technology-aided assessment of sensorimotor function in early infancy. Front Neurol 2014; 5:197. [PMID: 25324827 DOI: 10.3389/fneur.2014.00197/abstract] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 09/17/2014] [Indexed: 05/23/2023] Open
Abstract
There is a pressing need for new techniques capable of providing accurate information about sensorimotor function during the first 2 years of childhood. Here, we review current clinical methods and challenges for assessing motor function in early infancy, and discuss the potential benefits of applying technology-assisted methods. We also describe how the use of these tools with neuroimaging, and in particular functional magnetic resonance imaging (fMRI), can shed new light on the intra-cerebral processes underlying neurodevelopmental impairment. This knowledge is of particular relevance in the early infant brain, which has an increased capacity for compensatory neural plasticity. Such tools could bring a wealth of knowledge about the underlying pathophysiological processes of diseases such as cerebral palsy; act as biomarkers to monitor the effects of possible therapeutic interventions; and provide clinicians with much needed early diagnostic information.
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Affiliation(s)
- Alessandro G Allievi
- Human Robotics Group, Department of Bioengineering, Imperial College London , London , UK
| | - Tomoki Arichi
- Human Robotics Group, Department of Bioengineering, Imperial College London , London , UK ; Department of Perinatal Imaging and Health, King's College London , London , UK
| | - Anne L Gordon
- Paediatric Neurosciences, Evelina London Children's Hospital, Guy's and St Thomas' NHS Trust , London , UK ; Institute of Psychiatry, Psychology and Neuroscience, Kings College London , London , UK
| | - Etienne Burdet
- Human Robotics Group, Department of Bioengineering, Imperial College London , London , UK
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30
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Diffusion tensor MRI of chemotherapy-induced cognitive impairment in non-CNS cancer patients: a review. Brain Imaging Behav 2014; 7:409-35. [PMID: 23329357 DOI: 10.1007/s11682-012-9220-1] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Patients with non-central nervous system cancers often experience subtle cognitive deficits after treatment with cytotoxic agents. Therapy-induced structural changes to the brain could be one of the possible causes underlying these reported cognitive deficits. In this review, we evaluate the use of diffusion tensor imaging (DTI) for assessing possible therapy-induced changes in the microstructure of the cerebral white matter (WM) and provide a critical overview of the published DTI research on therapy-induced cognitive impairment. Both cross-sectional and longitudinal DTI studies have demonstrated abnormal microstructural properties in WM regions involved in cognition. These findings correlated with cognitive performance, suggesting that there is a link between reduced "WM integrity" and chemotherapy-induced impaired cognition. In this paper, we will also introduce the basics of diffusion tensor imaging and how it can be applied to evaluate effects of therapy on structural changes in cerebral WM. The review concludes with considerations and discussion regarding DTI data interpretation and possible future directions for investigating therapy-induced WM changes in cancer patients. This review article is part of a Special Issue entitled: Neuroimaging Studies of Cancer and Cancer Treatment.
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31
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Tuor UI, Morgunov M, Sule M, Qiao M, Clark D, Rushforth D, Foniok T, Kirton A. Cellular correlates of longitudinal diffusion tensor imaging of axonal degeneration following hypoxic-ischemic cerebral infarction in neonatal rats. NEUROIMAGE-CLINICAL 2014; 6:32-42. [PMID: 25379414 PMCID: PMC4215526 DOI: 10.1016/j.nicl.2014.08.003] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Revised: 07/14/2014] [Accepted: 08/04/2014] [Indexed: 02/07/2023]
Abstract
Ischemically damaged brain can be accompanied by secondary degeneration of associated axonal connections e.g. Wallerian degeneration. Diffusion tensor imaging (DTI) is widely used to investigate axonal injury but the cellular correlates of many of the degenerative changes remain speculative. We investigated the relationship of DTI of directly damaged cerebral cortex and secondary axonal degeneration in the cerebral peduncle with cellular alterations in pan-axonal neurofilament staining, myelination, reactive astrocytes, activation of microglia/macrophages and neuronal cell death. DTI measures (axial, radial and mean diffusivity, and fractional anisotropy (FA)) were acquired at hyperacute (3 h), acute (1 and 2 d) and chronic (1 and 4 week) times after transient cerebral hypoxia with unilateral ischemia in neonatal rats. The tissue pathology underlying ischemic and degenerative responses had a complex relationship with DTI parameters. DTI changes at hyperacute and subacute times were smaller in magnitude and tended to be transient and/or delayed in cerebral peduncle compared to cerebral cortex. In cerebral peduncle by 1 d post-insult, there were reductions in neurofilament staining corresponding with decreases in parallel diffusivity which were more sensitive than mean diffusivity in detecting axonal changes. Ipsilesional reductions in FA within cerebral peduncle were robust in detecting both early and chronic degenerative responses. At one or four weeks post-insult, radial diffusivity was increased ipsilaterally in the cerebral peduncle corresponding to pathological evidence of a lack of ontogenic myelination in this region. The detailed differences in progression and magnitude of DTI and histological changes reported provide a reference for identifying the potential contribution of various cellular responses to FA, and, parallel, radial, and mean diffusivity. Diffusion tensor imaging (DTI) widely used; cellular correlates often speculative Studied longitudinal DTI and histological changes following hypoxia–ischemia Compared neonatal cortex changes to those in degenerating cerebral peduncle DTI and cellular changes were often transient or delayed in cerebral peduncle. This provides a reference for potential cellular contributions to DTI changes.
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Affiliation(s)
- Ursula I Tuor
- Hotchkiss Brain Institute, Faculty of Medicine, University of Calgary, Calgary, T2N 4N1, Canada ; Experimental Imaging Centre, Faculty of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada ; Departments of Physiology and Pharmacology, Faculty of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada ; Department of Clinical Neurosciences, Faculty of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Melissa Morgunov
- Experimental Imaging Centre, Faculty of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada ; Departments of Physiology and Pharmacology, Faculty of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Manasi Sule
- Experimental Imaging Centre, Faculty of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada ; Departments of Physiology and Pharmacology, Faculty of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Min Qiao
- Experimental Imaging Centre, Faculty of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada ; Departments of Physiology and Pharmacology, Faculty of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Darren Clark
- Hotchkiss Brain Institute, Faculty of Medicine, University of Calgary, Calgary, T2N 4N1, Canada ; Department of Clinical Neurosciences, Faculty of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada ; Department of Medical Physics and Informatics, School of Medicine, University of Szeged, Szeged, Hungary
| | - David Rushforth
- Experimental Imaging Centre, Faculty of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Tadeusz Foniok
- Experimental Imaging Centre, Faculty of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Adam Kirton
- Hotchkiss Brain Institute, Faculty of Medicine, University of Calgary, Calgary, T2N 4N1, Canada ; Department of Clinical Neurosciences, Faculty of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada ; Department of Pediatrics, Alberta Children's Hospital Research Institute, Faculty of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
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Basu AP. Early intervention after perinatal stroke: opportunities and challenges. Dev Med Child Neurol 2014; 56:516-21. [PMID: 24528276 PMCID: PMC4020312 DOI: 10.1111/dmcn.12407] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/05/2014] [Indexed: 12/16/2022]
Abstract
Perinatal stroke is the most common cause of hemiplegic cerebral palsy. No standardized early intervention exists despite evidence for a critical time window for activity-dependent plasticity to mould corticospinal tract development in the first few years of life. Intervention during this unique period of plasticity could mitigate the consequences of perinatal stroke to an extent not possible with later intervention, by preserving the normal pattern of development of descending motor pathways. This article outlines the broad range of approaches currently under investigation. Despite significant progress in this area, improved early detection and outcome prediction remain important goals.
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Affiliation(s)
- Anna P Basu
- NIHR Clinical Trials Fellow, Newcastle upon Tyne Hospitals NHS Foundation Trust. Level 3, Sir James Spence Institute, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK
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van der Aa NE, Benders MJNL, Groenendaal F, de Vries LS. Neonatal stroke: a review of the current evidence on epidemiology, pathogenesis, diagnostics and therapeutic options. Acta Paediatr 2014; 103:356-64. [PMID: 24428836 DOI: 10.1111/apa.12555] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Revised: 01/02/2014] [Accepted: 01/10/2014] [Indexed: 12/26/2022]
Abstract
UNLABELLED Neonatal stroke, including perinatal arterial ischaemic stroke and cerebral sinovenous thrombosis, remains a serious problem in the neonate. This article reviews the current evidence on epidemiology, pathogenesis, diagnostics and therapeutic options. CONCLUSION Although our understanding of the underlying mechanisms and possible risk factors has improved, little progress has been made towards therapeutic options. Considering the high incidence of neurological sequelae, the need for therapeutic options is high and should be the focus of future research.
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Affiliation(s)
- NE van der Aa
- Department of Neonatology; Wilhelmina Children's Hospital; University Medical Center Utrecht; Utrecht The Netherlands
| | - MJNL Benders
- Department of Neonatology; Wilhelmina Children's Hospital; University Medical Center Utrecht; Utrecht The Netherlands
| | - F Groenendaal
- Department of Neonatology; Wilhelmina Children's Hospital; University Medical Center Utrecht; Utrecht The Netherlands
| | - LS de Vries
- Department of Neonatology; Wilhelmina Children's Hospital; University Medical Center Utrecht; Utrecht The Netherlands
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Aarnink SH, Vos SB, Leemans A, Jernigan TL, Madsen KS, Baaré WFC. Automated longitudinal intra-subject analysis (ALISA) for diffusion MRI tractography. Neuroimage 2014; 86:404-16. [PMID: 24157921 DOI: 10.1016/j.neuroimage.2013.10.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 10/10/2013] [Indexed: 12/13/2022] Open
Affiliation(s)
- Saskia H Aarnink
- Image Sciences Institute, University Medical Center Utrecht, the Netherlands; Elkerliek Hospital, Medical Physics, Helmond, The Netherlands
| | - Sjoerd B Vos
- Image Sciences Institute, University Medical Center Utrecht, the Netherlands.
| | - Alexander Leemans
- Image Sciences Institute, University Medical Center Utrecht, the Netherlands
| | - Terry L Jernigan
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Denmark; Center for Integrated Molecular Brain Imaging, Copenhagen, Denmark; Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark; Center for Human Development, University of California, San Diego, La Jolla, CA, USA
| | - Kathrine Skak Madsen
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Denmark; Center for Integrated Molecular Brain Imaging, Copenhagen, Denmark
| | - William F C Baaré
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Denmark
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35
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Plaisier A, Pieterman K, Lequin MH, Govaert P, Heemskerk AM, Reiss IKM, Krestin GP, Leemans A, Dudink J. Choice of diffusion tensor estimation approach affects fiber tractography of the fornix in preterm brain. AJNR Am J Neuroradiol 2014; 35:1219-25. [PMID: 24407271 DOI: 10.3174/ajnr.a3830] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Neonatal DTI enables quantitative assessment of microstructural brain properties. Although its use is increasing, it is not widely known that vast differences in tractography results can occur, depending on the diffusion tensor estimation methodology used. Current clinical work appears to be insufficiently focused on data quality and processing of neonatal DTI. To raise awareness about this important processing step, we investigated tractography reconstructions of the fornix with the use of several estimation techniques. We hypothesized that the method of tensor estimation significantly affects DTI tractography results. MATERIALS AND METHODS Twenty-eight DTI scans of infants born <29 weeks of gestation, acquired at 30-week postmenstrual age and without intracranial injury observed, were prospectively collected. Four diffusion tensor estimation methods were applied: 1) linear least squares; 2) weighted linear least squares; 3) nonlinear least squares, and 4) robust estimation of tensors by outlier rejection. Quality of DTI data and tractography results were evaluated for each method. RESULTS With nonlinear least squares and robust estimation of tensors by outlier rejection, significantly lower mean fractional anisotropy values were obtained than with linear least squares and weighted linear least squares. Visualized quality of tract reconstruction was significantly higher by use of robust estimation of tensors by outlier rejection and correlated with quality of DTI data. CONCLUSIONS Quality assessment and choice of processing methodology have considerable impact on neonatal DTI analysis. Dedicated acquisition, quality assessment, and advanced processing of neonatal DTI data must be ensured before performing clinical analyses, such as associating microstructural brain properties with patient outcome.
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Affiliation(s)
- A Plaisier
- From the Division of Neonatology, Department of Pediatrics (A.P., K.P., P.G., A.M.H., J.D.), Erasmus Medical Center-Sophia, Rotterdam, The NetherlandsDepartments of Radiology (A.P., M.H.L., A.M.H., G.P.K., J.D.)
| | - K Pieterman
- From the Division of Neonatology, Department of Pediatrics (A.P., K.P., P.G., A.M.H., J.D.), Erasmus Medical Center-Sophia, Rotterdam, The Netherlands
| | - M H Lequin
- Departments of Radiology (A.P., M.H.L., A.M.H., G.P.K., J.D.)
| | - P Govaert
- From the Division of Neonatology, Department of Pediatrics (A.P., K.P., P.G., A.M.H., J.D.), Erasmus Medical Center-Sophia, Rotterdam, The NetherlandsDepartment of Pediatrics (P.G.), Koningin Paola Children's Hospital, Antwerp, Belgium
| | - A M Heemskerk
- From the Division of Neonatology, Department of Pediatrics (A.P., K.P., P.G., A.M.H., J.D.), Erasmus Medical Center-Sophia, Rotterdam, The NetherlandsDepartments of Radiology (A.P., M.H.L., A.M.H., G.P.K., J.D.)
| | - I K M Reiss
- Neonatology (I.K.M.R.), Erasmus Medical Center, Rotterdam, The Netherlands
| | - G P Krestin
- Departments of Radiology (A.P., M.H.L., A.M.H., G.P.K., J.D.)
| | - A Leemans
- Image Sciences Institute (A.L.), University Medical Center Utrecht, Utrecht, The Netherlands
| | - J Dudink
- From the Division of Neonatology, Department of Pediatrics (A.P., K.P., P.G., A.M.H., J.D.), Erasmus Medical Center-Sophia, Rotterdam, The NetherlandsDepartments of Radiology (A.P., M.H.L., A.M.H., G.P.K., J.D.)
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Hancock C, Bernal B, Medina C, Medina S. Cost Analysis of Diffusion Tensor Imaging and MR Tractography of the Brain. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/ojrad.2014.43034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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37
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Affiliation(s)
- Adam Kirton
- From the Calgary Pediatric Stroke Program, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada (A.K.); and Children's Stroke Program, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada (G.d.V.)
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Russ JB, Verina T, Comer JD, Comi AM, Kaltschmidt JA. Corticospinal tract insult alters GABAergic circuitry in the mammalian spinal cord. Front Neural Circuits 2013; 7:150. [PMID: 24093008 PMCID: PMC3782692 DOI: 10.3389/fncir.2013.00150] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 09/06/2013] [Indexed: 11/17/2022] Open
Abstract
During perinatal development, corticospinal tract (CST) projections into the spinal cord help refine spinal circuitry. Although the normal developmental processes that are controlled by the arrival of corticospinal input are becoming clear, little is known about how perinatal cortical damage impacts specific aspects of spinal circuit development, particularly the inhibitory microcircuitry that regulates spinal reflex circuits. In this study, we sought to determine how ischemic cortical damage impacts the synaptic attributes of a well-characterized population of inhibitory, GABAergic interneurons, called GABApre neurons, which modulates the efficiency of proprioceptive sensory terminals in the sensorimotor reflex circuit. We found that putative GABApre interneurons receive CST input and, using an established mouse model of perinatal stroke, that cortical ischemic injury results in a reduction of CST density within the intermediate region of the spinal cord, where these interneurons reside. Importantly, CST alterations were restricted to the side contralateral to the injury. Within the synaptic terminals of the GABApre interneurons, we observed a dramatic upregulation of the 65-isoform of the GABA synthetic enzyme glutamic acid decarboxylase (GAD65). In accordance with the CST density reduction, GAD65 was elevated on the side of the spinal cord contralateral to cortical injury. This effect was not seen for other GABApre synaptic markers or in animals that received sham surgery. Our data reveal a novel effect of perinatal stroke that involves severe deficits in the architecture of a descending spinal pathway, which in turn appear to promote molecular alterations in a specific spinal GABAergic circuit.
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Affiliation(s)
- Jeffrey B Russ
- Weill Cornell/Rockefeller University/Sloan-Kettering Tri-Institutional MD-PhD Program New York, NY, USA ; Neuroscience Program, Weill Cornell Medical College New York, NY, USA ; Developmental Biology Program, Sloan-Kettering Institute New York, NY, USA
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Affiliation(s)
- Adam Kirton
- Section of Neurology, Department of Pediatrics and Clinical Neurosciences, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
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van der Aa NE, Verhage CH, Groenendaal F, Vermeulen RJ, de Bode S, van Nieuwenhuizen O, de Vries LS. Neonatal neuroimaging predicts recruitment of contralesional corticospinal tracts following perinatal brain injury. Dev Med Child Neurol 2013; 55:707-12. [PMID: 23646925 DOI: 10.1111/dmcn.12160] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/10/2013] [Indexed: 11/30/2022]
Abstract
AIM Unilateral perinatal brain injury may result in recruitment of ipsilateral projections originating in the unaffected hemisphere and development of unilateral spastic cerebral palsy (USCP). The aim of this study was to assess the predictive value of neonatal neuroimaging following perinatal brain injury for recruitment of ipsilateral corticospinal tracts. METHOD Neonatal magnetic resonance imaging (MRI) and cranial ultrasound scans of 37 children (20 males, 17 females; median [range] gestational age 36 wks(+4) [26(+6) -42wks(+5) ] and birthweight 2312 g ([770-5230g]) with unilateral perinatal arterial ischaemic stroke (n=23) or periventricular haemorrhagic infarction (n=14) were reviewed and scored for involvement of the corticospinal trajectory. Hand function was assessed using the Assisting Hand Assessment (AHA) and transcranial magnetic stimulation (TMS) was performed (age range 7y 4mo-18y and 7mo) to determine the type of cortical motor organization (normal, mixed or ipsilateral). Neuroimaging scores were used to predict TMS patterns. RESULTS Eighteen children developed USCP with ipsilateral corticospinal tract projections in 13 children (eight mixed, five ipsilateral). AHA scores decreased with increased ipsilateral projections. Asymmetry of the corticospinal tracts seen on neonatal MRI was predictive of development of USCP and recruitment of ipsilateral tracts (positive and negative predictive value of 73% and 91%). INTERPRETATION Neonatal neuroimaging can predict recruitment of ipsilateral corticospinal tracts. Early knowledge of the expected pattern of cortical motor organization will allow early identification of children eligible for early therapy.
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Affiliation(s)
- Niek E van der Aa
- Department of Neonatology, Wilhelmina Children's Hospital, Utrecht, the Netherlands.
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van der Aa NE, Northington FJ, Stone BS, Groenendaal F, Benders MJ, Porro G, Yoshida S, Mori S, de Vries LS, Zhang J. Quantification of white matter injury following neonatal stroke with serial DTI. Pediatr Res 2013; 73:756-62. [PMID: 23478641 PMCID: PMC6117163 DOI: 10.1038/pr.2013.45] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Diffusion tensor imaging (DTI) can be used to predict outcome following perinatal arterial ischemic stroke (PAIS), although little is known about white matter changes over time. METHODS Infants with PAIS were serially scanned in the neonatal period (n = 15), at 3 mo (n = 16), and at 24 mo (n = 8). Fractional anisotropy (FA) values in five regions of interest (anterior and posterior limb of the internal capsule, corpus callosum, optic radiation, and posterior thalamic radiation) were obtained and compared with FA values of healthy controls and neurodevelopmental outcome. RESULTS In the neonatal period, no differences in FA values were found. At 3 mo, the six infants who ultimately developed motor deficits showed lower FA values in all affected regions. Four infants developed a visual field defect and showed lower FA values in the affected optic radiation at 3 mo (0.22 vs. 0.29; P = 0.03). Finally, a correlation between FA values of the corpus callosum at 3 mo and the Griffiths developmental quotients was found (r = 0.66; P = 0.03). At 24 mo, a similar pattern was observed. CONCLUSION Neonatal FA measurements may underestimate the extent of injury following PAIS. FA measurements at 3 mo could be considered a more reliable predictor of neurodevelopmental outcome and correlate with DTI findings at 24 mo.
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Affiliation(s)
- Niek E van der Aa
- Department of Neonatology, Wilhelmina Children’s Hospital, University Medical Center, Utrecht, The Netherlands
| | - Frances J. Northington
- Department of Pediatrics, Eudowood Neonatal Pulmonary Division-NICN, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Brian S. Stone
- Department of Pediatrics, Eudowood Neonatal Pulmonary Division-NICN, Johns Hopkins University School of Medicine, Baltimore, MD, USA,Department of Neonatology, Children’s National Medical Center, Washington, DC, USA
| | - Floris Groenendaal
- Department of Neonatology, Wilhelmina Children’s Hospital, University Medical Center, Utrecht, The Netherlands
| | - Manon J.N.L. Benders
- Department of Neonatology, Wilhelmina Children’s Hospital, University Medical Center, Utrecht, The Netherlands
| | - Giorgio Porro
- Department of Ophthalmology, University Medical Center Utrecht, The Netherlands
| | - Shoko Yoshida
- Dept. of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA,F.M. Kirby Functional Imaging Center, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Susumu Mori
- Dept. of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA,F.M. Kirby Functional Imaging Center, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Linda S. de Vries
- Department of Neonatology, Wilhelmina Children’s Hospital, University Medical Center, Utrecht, The Netherlands
| | - Jiangyang Zhang
- Dept. of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Kirton A. Modeling developmental plasticity after perinatal stroke: defining central therapeutic targets in cerebral palsy. Pediatr Neurol 2013; 48:81-94. [PMID: 23337000 DOI: 10.1016/j.pediatrneurol.2012.08.001] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Accepted: 08/02/2012] [Indexed: 01/18/2023]
Abstract
Perinatal stroke is presented as the ideal human model of developmental neuroplasticity. The precise timing, mechanisms, and locations of specific perinatal stroke diseases provide common examples of well defined, focal, perinatal brain injuries. Motor disability (hemiparetic cerebral palsy) constitutes the primary adverse outcome and the focus of models explaining how motor systems develop in health and after early injury. Combining basic science animal work with human applied technology (functional magnetic resonance imaging, diffusion tensor imaging, and transcranial magnetic stimulation), a model of plastic motor development after perinatal stroke is presented. Potential central therapeutic targets are revealed. The means to measure and modulate these targets, including evidence-based rehabilitation therapies and noninvasive brain stimulation, are suggested. Implications for clinical trials and future directions are discussed.
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Affiliation(s)
- Adam Kirton
- Calgary Pediatric Stroke Program, Alberta Children's Hospital Research Institute, and Section of Neurology, Department of Pediatrics and Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.
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Kristo G, Leemans A, Raemaekers M, Rutten GJ, de Gelder B, Ramsey NF. Reliability of two clinically relevant fiber pathways reconstructed with constrained spherical deconvolution. Magn Reson Med 2013; 70:1544-56. [PMID: 23359402 DOI: 10.1002/mrm.24602] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Revised: 11/05/2012] [Accepted: 11/27/2012] [Indexed: 11/07/2022]
Abstract
The single diffusion tensor model is inadequate for the reconstruction of fiber pathways in brain regions with multiple fiber orientations. To overcome this limitation, constrained spherical deconvolution has been proposed. A high reliability of constrained spherical deconvolution is, however, a pre-requisite for its use in clinical applications. Reliability of reconstructed fiber pathways can be assessed in terms of architectural (addressing their spatial configuration) and microstructural (addressing diffusion-derived measures along the fibers) reproducibility. We assess the reliability for two clinically relevant fiber pathways: the corticospinal tract and arcuate fasciculus. The fiber pathways were reconstructed using constrained spherical deconvolution in 11 healthy subjects who were scanned on three occasions. Coefficients of variations of diffusion-derived measures were used to assess the microstructural reproducibility. Image correlation and fiber overlap were used to assess the architectural reproducibility. The mean correlation between sessions was 72% for both the corticospinal tract and arcuate fasciculus. The mean overlap between sessions was 63% for the corticospinal tract and 58% for the arcuate fasciculus. Coefficients of variations of diffusion-derived measures showed very low variation (all measures <3.1%). These results are comparable with reliability results based on the diffusion tensor model, which is commonly used in clinical settings. The reliability results found here are, therefore, promising to further investigate the use of constrained spherical deconvolution in clinical practice.
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Affiliation(s)
- Gert Kristo
- Department of Medical Psychology and Neuropsychology, University of Tilburg, Tilburg, The Netherlands; Department of Neurosurgery, St. Elisabeth Hospital, Tilburg, The Netherlands; Department of Neurology and Neurosurgery, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht, The Netherlands
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Xu D, Mukherjee P, Barkovich AJ. Pediatric brain injury: can DTI scalars predict functional outcome? Pediatr Radiol 2013; 43:55-9. [PMID: 23288477 PMCID: PMC3755904 DOI: 10.1007/s00247-012-2481-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Accepted: 07/18/2012] [Indexed: 12/30/2022]
Abstract
Diffusion imaging has made significant inroads into the clinical diagnosis of a variety of diseases by inferring changes in microstructure, namely cell membranes, myelin sheath and other structures that inhibit water diffusion. This review discusses recent progress in the use of diffusion parameters in predicting functional outcome. Studies in the literature using only scalar parameters from diffusion measurements, such as apparent diffusion coefficient (ADC) and fractional anisotropy (FA), are summarized. Other more complex mathematical models and post-processing uses are also discussed briefly.
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Affiliation(s)
- Duan Xu
- Department of Radiology and Biomedical Imaging, University of California-San Francisco, 1 Irving St, AC112, Box 2512, San Francisco, CA 94143, USA.
| | - Pratik Mukherjee
- Department of Radiology and Biomedical Imaging, University of California
– San Francisco
| | - A James Barkovich
- Department of Radiology and Biomedical Imaging, University of California
– San Francisco
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Investigating the need of triggering the acquisition for infant diffusion MRI: a quantitative study including bootstrap statistics. Neuroimage 2012; 69:198-205. [PMID: 23247188 PMCID: PMC3566546 DOI: 10.1016/j.neuroimage.2012.11.063] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Revised: 09/20/2012] [Accepted: 11/30/2012] [Indexed: 01/02/2023] Open
Abstract
Diffusion weighted magnetic resonance imaging is increasingly being used for neonatal and young pediatric subjects. Our purpose was to investigate a) whether cardiac triggering was needed to reduce variability of diffusion (tensor) imaging data, b) how pulsation artifacts affect the fitted diffusion tensor when triggering is not used and c) the feasibility of triggered data acquisition in neonates and young children. Data were collected from 11 infants and 7 adults. In seven infants and seven adults, diffusion encoding was applied solely along the z gradient direction with and without cardiac triggering. Non-parametric bootstrap statistical methods were applied to investigate the dependence of variance on triggering. One infant and all adults served as test–retest controls. From the remaining three infants diffusion tensor imaging data were acquired with and without triggering. Our findings that used the repeated measurements in a single diffusion-encoding direction indicated that without triggering the variability in the data was increased significantly both in infants and adults. When collecting diffusion tensor data in infants, this increased variability results in erroneous fractional anisotropy values and artifactual fiber direction estimates. Contrary to previous reports but supported by our findings involving adults, pulsation artifacts were present in a larger extent of the brain in the infant population. In conclusion, triggering is feasible in young subjects and is preferred when acquiring diffusion MRI data. In doing so, the amount of erroneous estimations due to image artifacts will be minimized, which in turn will lead to more specific and less ambiguous interpretations. Although fitting the pulse-monitoring device requires additional set-up time, the total imaging time is usually shorter than acquiring multiple data sets to compile a single, artifact-free set.
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Reliability of the corticospinal tract and arcuate fasciculus reconstructed with DTI-based tractography: implications for clinical practice. Eur Radiol 2012; 23:28-36. [DOI: 10.1007/s00330-012-2589-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Accepted: 06/29/2012] [Indexed: 10/28/2022]
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