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Merhav G, Ravid S, Shapira Rootman M. Exploring the thalamus L-sign: initial findings and associations with white matter injury in premature infants. Pediatr Radiol 2024:10.1007/s00247-024-05976-8. [PMID: 38970707 DOI: 10.1007/s00247-024-05976-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 06/12/2024] [Accepted: 06/17/2024] [Indexed: 07/08/2024]
Abstract
BACKGROUND The thalamus L-sign, characterized by damage to the lateral and posterior parts of the thalamus, has recently been identified as a potential marker of partial prolonged hypoxic-ischemic injury (HII). Although prematurity-related thalamic injury is well documented, its association with the thalamus L-sign is infrequently described. OBJECTIVE The primary objective of this study was to further investigate the thalamus L-sign in premature birth and white matter injury. MATERIALS AND METHODS A retrospective analysis of 246 brain magnetic resonance imaging (MRI) scans from preterm infants born before 37 weeks of gestation was conducted to explore the occurrence, characteristics, and associations of the thalamus L-sign with white matter injury. RESULTS The L-sign was detected in 12.6% of patients with periventricular leukomalacia (PVL), primarily in severe cases (57.9% of severe PVL). All cases were associated with posterior parieto-occipital PVL. Four patients exhibited unilateral or asymmetric L-signs, which were linked to high-grade intraventricular hemorrhage (IVH) or periventricular hemorrhagic infarction on the ipsilateral side, with the most severe white matter injury occurring on that side. No significant differences were observed regarding gestational age at birth, duration of neonatal intensive care unit hospitalization, percentage of IVH, hypoglycemia, or jaundice between patients with moderate-to-severe PVL with and without the thalamus L-sign. CONCLUSION The thalamus L-sign may serve as a marker for severe parieto-occipital PVL and may be exacerbated and appear asymmetric in cases of ipsilateral IVH or periventricular hemorrhagic infarction.
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Affiliation(s)
- Goni Merhav
- Medical Imaging Division, Rambam Health Care Campus, HaAliya HaShniya 8, PO Box 9602, 3109601, Haifa, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Sarit Ravid
- Pediatric Neurology Unit, Rambam Health Care Campus, Haifa, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Mika Shapira Rootman
- Medical Imaging Division, Rambam Health Care Campus, HaAliya HaShniya 8, PO Box 9602, 3109601, Haifa, Israel.
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.
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Govaert P, Arena R, Dudink J, Steggerda S, Agut T, Marissens G, Hoebeek F. Developmental anatomy of the thalamus, perinatal lesions, and neurological development. Dev Med Child Neurol 2024. [PMID: 38875159 DOI: 10.1111/dmcn.15992] [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: 11/21/2023] [Revised: 05/04/2024] [Accepted: 05/08/2024] [Indexed: 06/16/2024]
Abstract
The thalamic nuclei develop before a viable preterm age. GABAergic neuronal migration is especially active in the third trimester. Thalamic axons meet cortical axons during subplate activation and create the definitive cortical plate in the second and third trimesters. Default higher-order cortical driver connections to the thalamus are then replaced by the maturing sensory networks, in a process that is driven by first-order thalamic neurons. Surface electroencephalographic activity, generated first in the subplate and later in the cortical plate, gradually show oscillations based on the interaction of the cortex with thalamus, which is controlled by the thalamic reticular nucleus. In viable newborn infants, in addition to sensorimotor networks, the thalamus already contributes to visual, auditory, and pain processing, and to arousal and sleep. Isolated thalamic lesions may present as clinical seizures. In addition to asphyxia and stroke, infection and network injury are also common. Cranial ultrasound can be used to classify neonatal thalamic injuries based on functional parcelling of the mature thalamus. We provide ample illustration and a detailed description of the impact of neonatal focal thalamic injury on neurological development, and discuss the potential for neuroprotection based on thalamocortical plasticity.
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Affiliation(s)
- Paul Govaert
- Department of Neonatology, UZBrussel, Brussels, Belgium
| | - Roberta Arena
- Department of Neonatology, UZBrussel, Brussels, Belgium
| | - Jeroen Dudink
- Department of Neonatology, UZBrussel, Brussels, Belgium
| | | | - Thais Agut
- Department of Neonatology, UZBrussel, Brussels, Belgium
| | | | - Freek Hoebeek
- Department for Developmental Origins of Disease/Brain Centre, Division Woman and Baby, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
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Misser SK, Archary M. Mimickers of hypoxic-ischaemic brain injury in term neonates: What the radiologist should know. SA J Radiol 2024; 28:2810. [PMID: 38628264 PMCID: PMC11019187 DOI: 10.4102/sajr.v28i1.2810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 12/12/2023] [Indexed: 04/19/2024] Open
Abstract
Patterns of neonatal hypoxic-ischaemic brain injury (HIBI) are fairly well known. There are, however, other diagnoses with imaging patterns that may mimic HIBI. A review of MRI studies was conducted for children with suspected cerebral palsy, correlated with prior imaging, clinical details and laboratory tests where available. In the 63 identified cases, imaging features were, in many cases, very similar to the known patterns of HIBI. The alternative diagnoses can be classified as developmental, vascular, chromosomal, infections, metabolic disorders, and congenital syndromes. These findings are described in this pictorial essay. The potential mimickers of HIBI described in this essay can demonstrate similar imaging appearances to HIBI. Contribution There are multiple possible causes of neonatal encephalopathy other than hypoxic-ischaemic encephalopathy. Many conditions may mimic HIBI, each of which can be associated with significant morbidity. It is prudent for the reporting radiologist to be aware of these alternate clinico-radiological diagnoses.
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Affiliation(s)
- Shalendra K Misser
- Faculty of Radiology, Lake Smith and Partners Inc., Durban, South Africa
- Department of Radiology, Faculty of Health Sciences, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Moherndran Archary
- Department of Pediatrics, Faculty of Health Sciences, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
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Misser SK, Mchunu N, Lotz JW, Kjonigsen L, Ulug A, Archary M. Neuroquantification enhances the radiological evaluation of term neonatal hypoxic-ischaemic cerebral injuries. SA J Radiol 2023; 27:2728. [PMID: 38223530 PMCID: PMC10784209 DOI: 10.4102/sajr.v27i1.2728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 10/28/2023] [Indexed: 01/16/2024] Open
Abstract
Background Injury patterns in hypoxic-ischaemic brain injury (HIBI) are well recognised but there are few studies evaluating cerebral injury using neuroquantification models. Objectives Quantification of brain volumes in a group of patients with clinically determined cerebral palsy. Method In this retrospective study, 297 children with cerebral palsy were imaged for suspected HIBI with analysis of various cerebral substrates. Of these, 96 children over the age of 3 years with a clinical diagnosis of cerebral palsy and abnormal MRI findings underwent volumetric analyses using the NeuroQuant® software solution. The spectrum of volumetric changes and the differences between the various subtypes (and individual subgroups) of HIBI were compared. Results Compared with the available normative NeuroQuant® database, the average intracranial volume was reduced to the 1st percentile in all patient groups (p < 0.001). Statistically significant differences were observed among the types and subgroups of HIBI. Further substrate volume reductions were identified and described involving the thalami, brainstem, hippocampi, putamina and amygdala. The combined volumes of five regions of interest (frontal pole, putamen, hippocampus, brainstem and paracentral lobule) were consistently reduced in the Rolandic basal ganglia-thalamus (RBGT) subtype. Conclusion This study determined a quantifiable reduction of intracranial volume in all subtypes of HIBI and predictable selective cerebral substrate volume reduction in subtypes and subgroups. In the RBGT subtype, a key combination of five substrate injuries was consistently noted, and thalamic, occipital lobe and brainstem volume reduction was also significant when compared to the watershed subtype. Contribution This study demonstrates the value of integrating an artificial intelligence programme into the radiologists' armamentarium serving to quantify brain injuries more accurately in HIBI. Going forward this will be an inevitable evolution of daily radiology practice in many fields of medicine, and it would be beneficial for radiologists to embrace these technological innovations.
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Affiliation(s)
- Shalendra K Misser
- Department of Radiology, Lake Smit and Partners Inc., Durban, South Africa
- Department of Radiology, Faculty of Health Sciences, University of KwaZulu-Natal, Duban, South Africa
| | - Nobuhle Mchunu
- Biostatistics Research Unit, South African Medical Research Council, Durban, South Africa
- Department of Statistics, Faculty of Science, School of Mathematics, Statistics and Computer Sciences, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - Jan W Lotz
- Department of Radiodiagnosis, Faculty of Sciences, Stellenbosch University, Cape Town, South Africa
| | | | - Aziz Ulug
- Cortechs Labs, San Diego, United States of America
| | - Moherndran Archary
- Department of Pediatrics, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Tian Z, Zhu Q, Wang R, Xi Y, Tang W, Yang M. The advantages of the magnetic resonance image compilation (MAGiC) method for the prognosis of neonatal hypoglycemic encephalopathy. Front Neurosci 2023; 17:1179535. [PMID: 37397446 PMCID: PMC10309001 DOI: 10.3389/fnins.2023.1179535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 05/30/2023] [Indexed: 07/04/2023] Open
Abstract
Objectives To explore the prognostic value of magnetic resonance image compilation (MAGiC) in the quantitative assessment of neonatal hypoglycemic encephalopathy (HE). Methods A total of 75 neonatal HE patients who underwent synthetic MRI were included in this retrospective study. Perinatal clinical data were collected. T1, T2 and proton density (PD) values were measured in the white matter of the frontal lobe, parietal lobe, temporal lobe and occipital lobe, centrum semiovale, periventricular white matter, thalamus, lenticular nucleus, caudate nucleus, corpus callosum and cerebellum, which were generated by MAGiC. The patients were divided into two groups (group A: normal and mild developmental disability; group B: severe developmental disability) according to the score of Bayley Scales of Infant Development (Bayley III) at 9-12 months of age. Student's t test, Wilcoxon test, and Fisher's test were performed to compare data across the two groups. Multivariate logistic regression was used to identify the predictors of poor prognosis, and receiver operating characteristic (ROC) curves were created to evaluate the diagnostic accuracy. Results T1 and T2 values of the parietal lobe, occipital lobe, center semiovale, periventricular white matter, thalamus, and corpus callosum were higher in group B than in group A (p < 0.05). PD values of the occipital lobe, center semiovale, thalamus, and corpus callosum were higher in group B than in group A (p < 0.05). Multivariate logistic regression analysis showed that the duration of hypoglycemia, neonatal behavioral neurological assessment (NBNA) scores, T1 and T2 values of the occipital lobe, and T1 values of the corpus callosum and thalamus were independent predictors of severe HE (OR > 1, p < 0.05). The T2 values of the occipital lobe showed the best diagnostic performance, with an AUC value of 0.844, sensitivity of 83.02%, and specificity of 88.16%. Furthermore, the combination of MAGiC quantitative values and perinatal clinical features can improve the AUC (AUC = 0.923) compared with the use of MAGiC or perinatal clinical features alone. Conclusion The quantitative values of MAGiC can predict the prognosis of HE early, and the prediction efficiency is further optimized after being combined with clinical features.
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Affiliation(s)
- Zhongfu Tian
- Department of Radiology, Women's Hospital of Nanjing Medical University (Nanjing Maternity and Child Health Care Hospital), Nanjing, China
| | - Qing Zhu
- Department of Radiology, Women's Hospital of Nanjing Medical University (Nanjing Maternity and Child Health Care Hospital), Nanjing, China
| | - Ruizhu Wang
- Department of Radiology, Children’s Hospital of Nanjing Medical University, Nanjing, China
| | - Yanli Xi
- Department of Radiology, Children’s Hospital of Nanjing Medical University, Nanjing, China
| | - Wenwei Tang
- Department of Radiology, Women's Hospital of Nanjing Medical University (Nanjing Maternity and Child Health Care Hospital), Nanjing, China
| | - Ming Yang
- Department of Radiology, Children’s Hospital of Nanjing Medical University, Nanjing, China
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Yuzkan S, Emecen Sanli M, Balci M, Cennetoglu P, Kafadar I, Kocak B. Use of Thalamus L-Sign to Differentiate Periventricular Leukomalacia From Neurometabolic Disorders. J Child Neurol 2023; 38:446-453. [PMID: 37128731 DOI: 10.1177/08830738231168973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
PURPOSE To assess the diagnostic value of the thalamus L-sign on magnetic resonance imaging (MRI) in distinguishing between periventricular leukomalacia and neurometabolic disorders in pediatric patients. METHODS In this retrospective study, clinical and imaging information was collected from 50 children with periventricular leukomalacia and 52 children with neurometabolic disorders. MRI was used to evaluate the L-sign of the thalamus (ie, injury to the posterolateral thalamus) and the lobar distribution of signal intensity changes. Age, sex, gestational age, and level of Gross Motor Function Classification System (only for periventricular leukomalacia) constituted the clinical parameters. Statistical evaluation of group differences for imaging and clinical variables were conducted using univariable statistical methods. The intra- and inter-observer agreement was evaluated using Cohen's kappa. Univariable or multivariable logistic regression was employed for selection of variables, determining independent predictors, and modeling. RESULTS The thalamus L-sign was observed in 70% (35/50) of patients in the periventricular leukomalacia group, but in none of the patients with neurometabolic disorder (P < .001). The gestational age between groups varied significantly (P < .001). Involvement of frontal, parietal, and occipital lobes differed significantly between groups (P < .001). In the logistic regression, the best model included negative thalamus L-sign and gestational age, yielding an area under the curve, accuracy, sensitivity, specificity, and precision values of 0.995, 96.1%, 96%, 96.2%, and 96%, respectively. Both the lack of thalamus L-sign and gestational age were independent predictors (P < .001). CONCLUSIONS The thalamus L-sign and gestational age may be useful in distinguishing between periventricular leukomalacia and neurometabolic disorders.
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Affiliation(s)
- Sabahattin Yuzkan
- Department of Radiology, University of Health Sciences, Basaksehir Cam and Sakura City Hospital, Basaksehir, Istanbul, Turkey
| | - Merve Emecen Sanli
- Department of Pediatric Inherited Metabolic Diseases, University of Health Sciences, Basaksehir Cam and Sakura City Hospital, Basaksehir, Istanbul, Turkey
| | - Merve Balci
- Department of Radiology, University of Health Sciences, Basaksehir Cam and Sakura City Hospital, Basaksehir, Istanbul, Turkey
| | - Pakize Cennetoglu
- Department of Pediatric Neurology, University of Health Sciences, Basaksehir Cam and Sakura City Hospital, Basaksehir, Istanbul, Turkey
| | - Ihsan Kafadar
- Department of Pediatric Neurology, University of Health Sciences, Basaksehir Cam and Sakura City Hospital, Basaksehir, Istanbul, Turkey
| | - Burak Kocak
- Department of Radiology, University of Health Sciences, Basaksehir Cam and Sakura City Hospital, Basaksehir, Istanbul, Turkey
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