Magnetic resonance imaging (MRI) evaluation of developmental delay in pediatric patients

Diagnostic findings and yield of investigations for children with developmental regression

Childhood conditions that feature developmental regression are poorly understood. Phenotype-genotype characterization and diagnostic yield data are needed to inform clinical decision-making. The aim of this study was to report the conditions featuring developmental regression and assess diagnostic yields of investigations. A retrospective chart review of children presenting with developmental regression to a tertiary pediatric genetic clinic between 2018 and 2021 was performed. Of 99 children, 30% (n = 30) had intellectual disability (ID), 21% (n = 21) were autistic, 39% (n = 39) were autistic with ID, and 9% (n = 9) did not have ID or autism. Thirty-two percent (n = 32) of children received a new diagnosis, including eight molecular findings not previously reported to feature developmental regression. Of the children investigated, exome sequencing (ES) provided the highest diagnostic yield (51.1%, n = 24/47), highest (63.6%, n = 14/22) for children with ID, 50% for autistic children with ID (n = 6/12) and children without autism or ID (n = 3/6), and 14.3% (n = 1/7) for autistic children without ID. We highlight the conditions that feature developmental regression and report on novel phenotypic expansions. The high diagnostic yield of ES, regardless of autism or ID diagnosis, indicates the presence of developmental regression as an opportunity to identify the cause, including for genetic differences not previously reported to include regression.

Reduced Cortical Complexity in Children with Developmental Delay in Saudi Arabia

INTRODUCTION

Developmental delay (DD) is a neurodevelopmental disorder characterized by delays in multiple domains. The investigation of brain structure in DD has been enhanced by advanced neuroimaging techniques that can identify regional surface deformities. Neuroimaging studies have identified structural brain abnormalities in individuals with DD, but research specific to the Saudi Arabian population is limited. In this study, we examine the neuroanatomical abnormalities in the cortical and subcortical regions of Saudi Arabian children with DD.

METHOD

A T1-weighted, 1-mm-thick MRI was used to acquire structural brain images of 29 children with DD and age-matched healthy controls.

RESULTS

Analysis of the MRI data revealed significant differences in several cortical and subcortical structures of gray matter (GM) and white matter (WM) in several brain regions of the DD group. Specifically, significant deformities were observed in the caudate nucleus, globus pallidus, frontal gyrus, pars opercularis, pars orbitalis, cingulate gyrus, and subcallosal gyrus. These findings suggest disrupted neurodevelopment in these regions, which may contribute to the cognitive, motor, and behavioral impairments commonly observed in individuals with DD.

CONCLUSIONS

The present study provides valuable insights into the neuroanatomical differences in Saudi Arabian children with DD. Our results provide evidence for cortical and subcortical abnormalities in DD. Deformities in the observed regions may contribute to cognitive impairment, emotional dysregulation, mood disorders, and language deficits commonly observed in DD. The structural analysis may enable the identification of neuroanatomical biomarkers to facilitate the early diagnosis or progression of DD. These results suggest that lower cortical complexity in DD children due to alterations in networks may play a critical role in early brain development.

Brain Magnetic Resonance Imaging Findings in Patients with Developmental Delay in Addis Ababa, Ethiopia

Background

Developmental delay is a major health problem throughout the world causing significant individual disability. Even though physical examination and patient history are the most important and basic evaluations of patients with developmental delay, additional investigations are usually required in supporting or reaching a diagnosis among which is neuroimaging. This study aims to assess brain Magnetic resonance imaging (MRI) patterns in patients presented with developmental delay.

Method

A retrospective analysis of 164 patients who had undergone brain Magnetic Resonance Imaging (MRI) evaluation for the developmental delay was done. The study was conducted between March to November 2021 G.C at Tikur Anbessa Specialized Hospital (TASH). The patients' clinical history and magnetic resonance imaging reports were reviewed from their medical records. All patients with developmental delay who had brain MRI evaluation at TASH and at one private diagnostic center in Addis Ababa were included in the study.

Results

A total of 164 patients were included in this study of which 95(57.9%) were male and 69(42.1%) female patients were seen. A total of 120 patients (73.2%) showed abnormal brain MRI studies. Previous neurovascular insults were the most common abnormalities seen in 75(45.7%) patients followed by imaging findings of congenital and developmental abnormalities seen in 20(12.2%) patients.

Conclusion

Brain MRI is an important input in the evaluation of patients with developmental delay. It can give evidence for the cause of developmental delay, especially in the diagnosis of perinatal/hypoxic-ischemic insults, and congenital and developmental malformations.

Brain Magnetic Resonance Imaging-Based Evaluation of Pediatric Patients With Developmental Delay: A Cross-Sectional Study

Background

Developmental delay refers to the insufficient acquisition of age-appropriate developmental milestones. According to World Health Organization, approximately 5% of all children under the age of 14 years display some developmental disability.

Aim and objective

Our objective was to investigate the prevalence of abnormal magnetic resonance imaging (MRI) brain findings in pediatric patients with non-syndromic developmental delay and to establish the utility of MRI for the same.

Material and Method

This cross-sectional study prospectively enrolled 60 pediatric patients (three months to 12 years) and data were analyzed using SPSS software.

Result

Abnormalities on MRI were seen in 80% of cases, with findings indicating perinatal hypoxic insult (36.67%) being the most common, followed by structural abnormalities of the brain (20%). There was no significant difference in the prevalence of abnormal findings when classified by gender or age, or between global developmental delay (GDD) alone and GDD with epilepsy. However, perinatal hypoxic insult was significantly associated with GDD with epilepsy rather than GDD alone (p < 0.01).

Conclusion

In this study, brain MRI provides a high yield of abnormal findings and helps calculate the relative prevalence of various common etiologies in non-syndromic developmental delay. This study supports several international guidelines that include MRI as the first-line investigation for non-syndromic developmental delay.

A Very Rare Case of Megalencephalic Leukoencephalopathy With Subcortical Cysts in a Child Born of Non-Consanguineous Marriage in a Non-Predisposed Community

Megalencephalic leukoencephalopathy (MLC) with subcortical cysts is a very rare white matter disorder characterized predominantly by motor developmental delay and seizures in a child with macrocephaly. Extrapyramidal symptoms, ataxia and mental retardation may also occur. Only a few cases of the disease have been reported worldwide with most of them showing an autosomal recessive pattern of inheritance. In India, most cases have been reported in Agrawal community. Here, we present an interesting case of MLC in a child born in non-Agrawal community to a non-consanguineous marriage. By reporting this case we intend to increase the research horizon and increase the published literature for atypical cases of MLC.

Genetic Approach to Diagnosis of Intellectual Disability

Intellectual disability is a non-specific phenotype present in a genetically heterogeneous group of disorders. It is characterized by deficits in intellectual and adaptive functioning, presenting before 18 y of age. Identifying the cause of ID is important to provide treatment where available, genetic counseling, recurrence risks and reproductive options for subsequent pregnancies. Advances in technology, especially next generation sequencing and microarrays, have greatly increased the diagnostic yield of evaluation in cases of ID. This paper describes the points in history taking and examination in the evaluation of a proband, and discusses the proper use of newer diagnostic technologies.

Does diffusion restriction changes in magnetic resonance imaging predict neurological outcome in neonatal seizures?

BACKGROUND

Neonatal seizures are a common manifestation of brain dysfunction. Neonatal magnetic resonance imaging (MRI) has rapidly become the study of choice for the evaluation of central nervous systems disorders in newborns. According to a study conducted in Wilhelmina Children's Hospital, University Medical Center Utrecht, diffusion Restriction (DR) changes in the MRI is a good indicator of cell dysfunction (reversible or irreversible) within one week of insult.

OBJECTIVES

The main aim of this study was to find the association of DR changes in MRI of brain for neonatal seizures with long term neurodevelopment outcome.

METHODS

This is a retrospective observational study conducted in Sri Ramachandra University. Retrospective data was collected for the time period of January 2010 to December 2011 from medical records department (MRD) for patient data, neonatal intensive care unit and reports from PACS for MRI images and the Karthikeyan child development unit for their developmental follow up reports.

RESULTS

Comparison of composite score for various domains with DR changes was done with a t-test and comparison of babies with developmental delay and DR changes with Chi-square test. MRI DR changes with developmental outcome in different domains namely cognition, language-receptive/expressive, fine and gross motor was studied. There is no statistical significance among those who have DR changes and with those who do not have DR changes.

CONCLUSION

Though diffusion restriction changes in MRI may not predict adverse long term neuro developmental outcome, they can be of use with regards to individual etiological profile as in stroke. Larger group study and long term follow up is required to substantiate these findings.