Advanced Imaging of Prenatal/Neonatal Brain Injury
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Tuesday 8 May 2012
Room 201  13:30 - 15:30 Moderators: Linda Chang, Pratik Mukherjee

13:30 0245.   Graph theory to analyse developmental plasticity in connectivity of preterm children
Elda Fischi-Gomez1,2, Alessandra Griffa1, Alessandro Daducci1, François Lazeyras3,4, Jean-Philippe Thiran1,5, and Petra S. Hüppi2
1Ecole Polytechnique Federale de Lausanne (EPFL). Signal Processing Laboratory (LTS5), Lausanne, Switzerland, 2Division of Development and Growth. Department of Pediatrics. University of Geneva, Geneva, Switzerland, 3Center for Biomedical Imaging (CIBM),Lausanne and Geneva, Switzerland,4Department of Radiology, University of Geneva and University Hospital of Geneva, Geneva, Switzerland, 5Department of Radiology of the University Hospital Center (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland

We used DTI and network analysis to determine the impact of prematurity and prenatal growth restriction in neurostructural outcome of preterm born children at age 6 years-old. We construct individual brain network graphs derived from structural connectivity matrices, composed by an efficacy component (weighted by the mean FA value of the bundle connecting two cortical regions) and the density component (assumed to be constant within a group). Both groups, when compared to controls, show smaller efficiency (with an average path length's increase) and transitivity that may contribute to learning disabilities and behavior disorders linked to preterm infants at school age.

13:42 0246.   Testing the sensitivity of Tract-Based Spatial Statistics to simulated treatment effects in preterm neonates
Gareth Ball1, Serena J Counsell1, Tomoki Arichi1,2, Nazakat Merchant1,2, Daniel Rueckert3, A David Edwards1,2, and James P Boardman1,4
1Centre for the Developing Brain, Imaging Sciences Department, MRC Clinical Sciences Centre, Hammersmith Hospital, Imperial College London, London, United Kingdom, 2Division of Neonatology, Imperial College London Healthcare NHS Trust, London, United Kingdom, 3Biomedical Image Analysis Group, Department of Computing, Imperial College London, London, United Kingdom, 4Simpson Centre for Reproductive Health, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom

Preterm birth is associated with poor neurodevelopmental outcome. Microstructural alterations in the developing white matter are thought to represent key components of preterm brain injury. Developing early imaging biomarkers that are sensitive to these alterations, such as TBSS, would be beneficial to the evaluation of early neuroprotective strategies in preterm infants. Here, the sensitivity of TBSS to detect changes in white matter microstructure in neonates is tested by simulating global treatment ‘effects’, represented by increased fractional anisotropy, in groups of different sizes. Simulations were found to predict well a real biological effect, represented by increasing age at scan.

13:54 0247.   Microstructural Brain Abnormalities in Neonates with Prenatal Stimulant Exposure
Linda Chang1, Kenichi Oishi2, Jon Skranes3, Steve Buchthal1, Caroline Jiang1, Dan Alicata4, Antonette Hernandez1, Heather Johansen1, Christine Cloak1, Tricia Wright5, Lillian Fujimoto6, Susumu Mori2, and Thomas Ernst1
1Dept of Medicine, University of Hawaii, Honolulu, Hawaii, United States, 2Dept of Radiology, Johns Hopkins University, Baltimore, Maryland, United States, 3Dept of Laboratory Medicine, Children’s & Women’s Health, Norwegian University of Science and Technology, Tronheim, Oslo, Norway, 4Dept of Psychiatry, University of Hawaii, Honolulu, Hawaii, United States, 5Dept of Obstetric & Gynecology, University of Hawaii, Honolulu, Hawaii, United States,6Straub Mililani Clinic, Mililani, Hawaii, United States

Prenatal stimulant-exposure, with nicotine and/or methamphetamine may be associated with abnormal brain development, although data in humans are limited. This study aims to evaluate whether the major white matter tracts and deep gray matter are abnormal in neonates with stimulant exposure (n=18) compared to unexposed healthy neonates (n=45). An automated atlas with LDDMM was used to assess diffusion tensor imaging (DTI) measures. Stimulant-exposed neonates showed lower FA in fornix and slower age-related decline in diffusion (axonal and radial) in the superior longitudinal fasciculus than unexposed infants. These findings suggest delayed brain myelination despite similar subject characteristics at time of scans.

14:06 0248.   
Longitudinal Structural Brain Changes in Children and Adolescents with Prenatal Alcohol Exposure
Catherine Lebel1, Eric Kan2, Sarah Mattson3, Edward Riley3, Kenneth Jones4, Colleen Adnams5, Philip May6, Mary O'Connor7, Katherine Narr1, and Elizabeth Sowell1,2
1Neurology, University of California, Los Angeles, CA, United States, 2Children's Hospital Los Angeles, CA, United States, 3Psychology, San Diego State University, CA, United States, 4Pediatrics, University of California, San Diego, CA, United States, 5Psychiatry and Mental Health, University of Cape Town, South Africa, 6Nutrition, University of North Carolina, Chapel Hill, NC, United States, 7Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, United States

Children and youth prenatally exposed to alcohol demonstrate structural brain abnormalities compared to controls, but it is not clear whether these abnormalities change over time. In the first longitudinal study of cortical development, we demonstrate several brain regions with different developmental trajectories between alcohol-exposed subjects and controls, mainly in the parietal lobe. In general, subjects with prenatal alcohol exposure demonstrated less overall volume change, suggesting decreased cortical plasticity compared to controls. These results are important to consider in studies of group differences, which may change over time, and also are relevant for treatment and interventions in this population.

14:18 0249.   Predicting neurological outcome in neonatal encephalopathy: A machine learning and network analysis approach
Etay Ziv1, Olga Tymofiyeva1, Sonia L Bonifacio2, Patrick S McQuillen2, Donna M Ferriero2, A James Barkovich1, Duan Xu1, and Christopher P Hess1
1Department of Radiology & Biomedical Imaging, UCSF, San Francisco, CA, United States, 2Department of Pediatrics, UCSF, San Francisco, CA, United States

Neonatal encephalopathy represents a heterogeneous group of conditions associated with life-long developmental disabilities. The ability to predict outcome early on in the perinatal period could potentially have a significant impact on subsequent treatment. Structural connectivity networks of the brain can be constructed using diffusion MRI. We hypothesize that networks derived from patients who have poor outcome may have different structure than those who have good outcome. Here we present an unbiased approach to enumerate a large set of network properties and using a combination of unsupervised and supervised learning, we demonstrate surprisingly good discrimination between good and poor neurological outcome.

14:30 0250.   DTI of the Inter-hemispheric Connectivities in Neonates with Transposition of the Great Arteries Undergoing Cardiopulmonary Bypass Surgery.
Malek I Makki1, Rabia Liamlahi2, Hitendu Dave3, Bea Latal4, Vera Bernet5, Ianina Scheer6, Klaudija Batinic2, Cornelia Hagmann7, and Walter Knirsch2
1MRI Research, University Children Hospital Zurich, Zurich, Switzerland, 2Cardiology, University Children Hospital Zurich, 3Congenital Cardiovascular Surgery, University Children Hospital Zurich, 4Child Development, University Children Hospital Zurich, 5Pediatrics Intensive Care, University Children Hospital Zurich, 6Diagnostic Imaging, University Children Hospital Zurich, 7University Hospital Zurich

Fifteen neonates with d-transposition of the great artery underwent DTI before and after cardiopulmonary bypas surgery. The genu and splenium od the corpus callosum were investigated with DTI and compared to ten age amtched healthy neonates. Abnormal white matter growth was reported in the genu but not in the splenium.

14:42 0251.   The Variation of White Matter Tract in Neonates with Mild Hypoxic-Ischemic Injury:A Diffusion Tensor Image Analysis by Tract-Based Spatial Statistics (TBSS)
Gao Jie1, Li Xianjun2, Hou Xin1, Sun Qinli1, Yu Bolang1, Ed X Wu3, Wan Mingxi2, and Yang Jian1
1Department of radiology, the first affiliated hospital of medical college, Xi’an Jiaotong University, Xi'an, Shannxi, China,2Department of Biomedical Engineering, School of Life Science and Technology, Xi' an Jiaotong University, Xi'an, Shannxi, China,3Laboratory of Biomedical Imaging and Signal Processing, The University of Hong Kong, Hong Kong SAR, China

TThe aim of this study is to use tract-based spatial statistics (TBSS) to test the voxel-wise differences in fractional anisotropy (FA),lower case Greek lambda1,lower case Greek lambda2,lower case Greek lambda3 between normal and mild hypoxic-ischemic (HI) neonatal brains. 41 full term neonates (17 neonates with mild HI injury, 24 neonates as normal control,) and 31 preterm neonates (11 neonates with mild HI injury, 20 neonates as normal control) underwent T1 weighted images (T1WIs), T2 weighted images (T2WIs) and diffusion tensor image (DTI) within 28 days after birth. The results of TBSS mainly showed significantly decreased FA and increased lower case Greek lambda2, lower case Greek lambda3 in multiple white matter tracts (p<0.05). These differences of DTI indexes between the mild HI and normal neonates were mainly located in cerebral peduncle (CP), posterior limb of internal capsule (PLIC) and corona radiata (CR) both in full term and preterm groups. Moreover, the additional regions with above changes of DTI indexes in full term neonates were exhibited in external capsule (EC) and splenium of the corpus callosum (SCC) mainly. This is the first study to explore white matter injury in both preterm and term neonatal brains with mild HI injury by using TBSS for DTI data analyzing. TBSS, as an objective and sensitive method, can reveal multiple white matter microstructural abnormalities in mild HI neonatal brains.

14:54 0252.   Diffusion tractography in term neonates with hypoxic-ischemic encephalopathy: Projection Fiber System and corpus callosum involvement as predictors of neurodevelopmental outcome
Katyucia de Macedo Rodrigues1, Maria de Carmen Fons Stupina2,3, Ainsley MacLean4, Janet Soul2, Rudolph Pienaar5, Omar Khwaja2, and P. Ellen Grant5
1Radiology, Children's Hospital Boston, Boston, Massachusettes, United States, 2Neurology, Children's Hospital Boston, Boston, Massachusettes, United States, 3Pediatric Neurology, Sant Joan de Seu Hospital for Children, Barcelona, Spain, 4Neuroradiology, Brigham and Women's Hospital, Boston, Massachusettes, United States, 5Center for Fetal-Neonatal Neuroimaging & Developmental Science, Children's Hospital Boston, Boston, Massachusettes, United States

We performed a tractography-based DTI analysis of projection and comissural tracts in term/near term neonates who presented perinatal HIE and had a brain MRI performed within 7 postnatal days and neonates with normal MRI without HIE and studied its correlation with early motor outcome. Tractography-based analysis demonstrated selective vulnerability of corticospinal tract in HIE, with low mean tract ADC and FA correlating significantly with early neurological outcome. Treatment with hypothermia was associated with increase in mean ADC in the splenium of the corpus callosum and significantly higher mean tract FA suggesting less metabolic compromise and preservation of white matter microstructure.

15:06 0253.   Quantitative improvement in FA values in various fiber bundles is associated with improvement in Clinical Grade of children with Cerebral Palsy following therapy
Saurabh Chaturvedi1, Puneet Goyal2, Vimal K Paliwal3, Ankita Chourasia1, Yogita Rai1, Ravindra Kumar Garg4, Ram Kishore Singh Rathore5, and Rakesh Kumar Gupta1
1Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar pradesh, India, 2Anaesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India, 3Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, UP, India, 4Neurology, Chhatrapati Sahu ji Maharaj Medical University, Lucknow, Uttar Pradesh, India, 5Indian Institute of Technology, Kanpur

We examined 10 CP children twice (10 base line&10 follow up at 6month; 8 boys&2 girls) (mean age=6 years) who had spastic diplegia, GMFM score ranging from 50-60 and with grade II spasticity. There was a significant difference between FA values of baseline and follow-up in left motor, left sensory, CG, ATR, PTR bundles. A significant positive correlation was found between GMFM scores and FA values of left motor (r=0.723, p<0.001), left sensory (r=0.609, p=0.004), CG (r=0.787, p<0.001) and ATR (r=0.420, p=0.065).We conclude that improvement in white matter fibers is associated with physical improvement in these children.

15:18 0254.   Prognostic Significance of Combined Diffusion Weighted Imaging and Magnetic Resonance Spectroscopy in Neonates with Hypoxic Ischemic Injury
Eva-Maria Ratai1, Jason M Johnson2, Bindu Setty2, Joseph Chou3, Kalpathy Krishnamoorthy4, Paul Caruso2, and P Ellen Grant5
1Radiology, A. A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, United States, 2Radiology, Massachusetts General Hospital, United States, 3Pediatric Medical Services / Neonatal ICU, Massachusetts General Hospital, United States, 4Pediatric Neurology, Massachusetts General Hospital, United States, 5Radiology, Children’s Hospital Boston, United States

The goal of this study was to investigate the prognostic values of ADC and MRS in neonatal hypoxic ischemic injury within 5 days of life. Eight of 17 patients died before discharge from the hospital and nine had unfavorable outcome including severe developmental delay. Low concentrations of N-acetylaspartate, choline, creatine and low ADC values in the basal ganglia were predictive of poor outcome. High glutamate/glutamine levels were also associated with poor outcome. Spearman Rank analysis between ADC and spectroscopic markers revealed significant correlations between ADC and choline as well as ADC and N-Acetylaspartate. No correlation with lactate was found.