Joint Annual Meeting ISMRM-ESMRMB 2014 10-16 May 2014 Milan, Italy

Fetal/Neonatal/Pediatric MRI

Monday 12 May 2014
Red 1 & 2  14:15 - 16:15 Moderators: P. Ellen Grant, M.D., Joseph V. Hajnal, Ph.D.

14:15 0127.   
Rui Vasco Simoes1, Magdalena Sanz-Cortes1, Nuria Bargallo2, Francesc Figueras1, and Eduard Gratacos1
1Dept of Maternal-Fetal Medicine, Hospital Clinic, Barcelona, Barcelona, Spain, 2Dept of Radiology, Hospital Clinic, Barcelona, Barcelona, Spain

Intrauterine growth restriction (IUGR) is associated with impaired neurodevelopment. Late-onset IUGR cases are particularly difficult to diagnose in the clinic and the metabolic changes underlying their long-term brain dysfunctions remain poorly understood. We show that the NAA/Cho ratio (LCModel) is significantly lower in late-onset IUGR fetuses than in age-matched controls, independent of clinical risk factors. Our preliminary MRS pattern classification results (SpectraClassifier) suggest the existence of metabolic signatures for each group: control, IUGR without risk factors, and IUGR with risk factors. Further work will validate these results with a follow-up study in a larger population cohort.

14:27 0128.   Blood Oxygenation of Human Fetal Brain in the Second and Third Trimester
Pavan Kumar Jella1, Uday Krishnamurthy1,2, Jaladhar Neelavalli1,2, Swati Mody1, Lami Yeo3,4, E. Hernandez-Andrade3,4, E. Ehterami1, M.D. Cabrera1, S.J. Korzeniewski3, E.M. Haacke1,2, Sonia Hassan3, and Roberto Romero3
1Department of Radiology, Wayne State University, Detroit, MI, United States, 2Biomedical Engineering, Wayne State University, Detroit, MI, United States, 3NICHD, NIH, DHHS, Perinatology Research Branch, Detroit, MI, United States, 4Obstetrics and Gynecology, Wayne State University, Detroit, MI, United States

A major issue in studying fetal hypoxic ischemic injury (HII); utero in humans and its identification is limited and often the diagnosis is postponed till the post neonatal period when the injury becomes evident in neuroimaging. Hence, non-invasive imaging methods for assessing hypoxic-ischemic brain injury in-utero are of high clinical interest. Magnetic resonance (MR) susceptibility weighted imaging (SWI), was used to measure fetal blood oxygenation that helps in assessing difference in fetal oxygen utilization between second and third trimester.

14:39 0129.   
Exploring the diffusivity changes of diffuse excessive high signal intensity (DEHSI) in preterm neonates by using two-compartment white matter model based on DKI
Jie Gao1, Xianjun Li1,2, Yumiao Zhang1, Yanyan Li1, Qinli Sun1, Xue Luo1,2, Bolang Yu1, and Jian Yang1,2
1Department of radiology, the first affiliated hospital of medical college, Xi'an Jiaotong University, Xi'an, Shannxi, China, 2Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, Shannxi, China

Diffuse excessive high signal intensity (DEHSI) is extremely common in preterm infants. It¡¯s still under debate about whether it represents a true white mater(WM) abnormality or just the relative immature in WM. Two-compartment WM model based on DKI can provides analytical expressions for the intra- and extra-axonal diffusion tensors and may be helpful in further exploring the diffusivity changes in DEHSI. So in this study, 8 preterm neonates with DEHSI and 8 matched controls who underwent MRI at term-equivalent age were enrolled. All diffusion parameters(FA=fractional anisotropy, MD=mean diffusivity, AD=axial diffusivity, RD=radial diffusivity, MK=mean kurtosis, AK=axial kurtosis, RK=radial kurtosis, AWF= axonal water fraction, Da=intra-axonal diffusivity, De¡Î=axial extra-axonal space diffusivity, De¡Í= radial extra-axonal space diffusivity, ¦Á=tortuosity) were compared between the two groups. The increased MD, AD, RD, De¡Î, De¡Í and no significantly changed MK, AK, RK, Da, AWF indicated that the diffusion changes in DEHSI were mainly due to the increased water and/or enlarged space in extra-axonal space, rather than injuries to axons or the process of myelination.

14:51 0130.   Brain temperatures during therapeutic hypothermia of birth asphyxia are significantly different in patients with poor outcome versus patients with mild to moderate injury
Stefan Bluml1,2, Tai-Wei Wu3,4, Ashok Panigrahy1,5, John P Grimm1, Marvin D Nelson1, Thomas G Perkins6, Jonathan Chia6, and Jessica L Wisnowski1,5
1Children's Hospital Los Angeles/USC, Los Angeles, CA, United States, 2Rudi Schulte Research Institute, Santa Barbara, CA, United States, 3Neonatology, Children's Hospital Los Angeles/USC, CA, United States, 4Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, 5Children's Hospital of Pittsburgh, Pittsburgh, PA, United States, 6Philips Healthcare, Cleveland, OH, United States

Therapeutic hypothermia (TH) aims to lower brain temperature to prevent secondary energy failure in newborns with birth asphyxia. However, newborn brain temperature during TH is unknown as generally rectal temperatures are monitored. In this study we show, by direct brain temperature measurement using MR spectroscopy, that the brain temperatures during TH were higher in patients with poor outcome when compared with patients with mild to moderate injury. It may be necessary to measure brain temperature directly in individual patients to ascertain that the targeted level of cooling has been achieved.

15:03 0131.   
Arterial spin labeling perfusion MRI in neonates with hypoxic-ischemic encephalopathy.
Jill B. De Vis1, Jeroen Hendrikse1, Esben T. Petersen1, Linda S. de Vries2, Frank van Bel2, Thomas Alderliesten2, Floris Groenendaal2, and Manon J.N.L. Benders2
1Radiology, University Medical Center Utrecht, Utrecht, Utrecht, Netherlands, 2Neonatology, University Medical Center Utrecht, Utrecht, Utrecht, Netherlands

Hypoxic-ischemic injury in neonates can cause impaired autoregulation of the cerebral vasculature resulting in hyperperfusion of brain tissue and probably secondary injury. In this study we investigated whether hyperperfusion, evaluated with arterial spin labeling MR imaging is associated with an adverse outcome in neonates with hypoxic-ischemic encephalopathy. We found higher perfusion in the basal ganglia and thalami of neonates with adverse compared to favorable outcome (69 ± 27 versus 31 ± 10 ml/100g/min, p < 0.01). Hyperperfusion in the basal ganglia and thalami had a sensitivity of 86% and a specificity of 100% for the prediction of adverse outcome.

15:15 0132.   
Imaging the developing brain at the bedside: A comparison of diffuse optical tomography and functional MRI
Silvina L. Ferradal1, Steve M. Liao2, Adam T. Eggebrecht1, Joshua S. Shimony1, Terrie E. Inder3, Joseph P. Culver1, and Christopher D. Smyser2
1Radiology, Washington University in St. Louis, St. Louis, MO, United States, 2Pediatrics, Washington University in St. Louis, St. Louis, MO, United States,3Harvard Medical School, Boston, MA, United States

Adverse neurodevelopmental outcomes in preterm infants remain a clinical challenge. While functional connectivity (fc) using functional MRI opens a window to study brain function in neonates, frequent longitudinal monitoring is often restricted in the sickest infants. Diffuse optical tomography (DOT) provides a portable alternative modality for evaluating brain function at the bedside. Here we demonstrate that our DOT system generates resting-state maps exhibiting strong agreement with non-concurrent fcMRI maps in identical subjects. Our results suggest that fcDOT provides satisfactory spatial localization and resolution, and illustrates its potential as a viable imaging tool for bedside monitoring.

15:27 0133.   
Hemiplegic cerebral palsy and constraint-induced movement therapy: Resting state functional magnetic resonance and diffusion tensor imaging predictors and neuroplastic changes
Kathryn Yvonne Manning1, Darcy Fehlings2, and Ravi S. Menon3
1Medical Biophysics, The University of Western Ontario, London, Ontario, Canada, 2Holland Bloorview Kids Rehabilitation Hospital, University of Toronto, Toronto, Ontario, Canada, 3Robarts Research Institute, The University of Western Ontario, London, Ontario, Canada

Hemiplegic cerebral palsy patients experience learned non-use where the hemiplegic arm is further inhibited from healthy development as most tasks are performed with the unaffected limb. Constraint-induced movement therapy (CIMT) has rendered significant functional improvement in many patients, though not all experience success and little is known about the possible neurological predictors. Resting state functional MRI and diffusion tensor imaging reveal altered global network organization and quantify white matter tract integrity. Potential predictors of clinical success are identified, and resting state network reorganization after CIMT provides evidence of neuroplasticity.

15:39 0134.   
Reduced GABA concentration in children with Tourette's Syndrome is linked to sensory impairments and tic severity
Nicolaas A Puts1,2, Stewart H Mostofsky3,4, Mark Tommerdahl5, and Richard A Edden1,2
1Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins University, Baltimore, Maryland, United States, 2FM Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland, United States, 3Department of Neurology, The Johns Hopkins University, Baltimore, Maryland, United States, 4Laboratory for Neurocognitive and Imaging Research, Kennedy Krieger Institute, Baltimore, Maryland, United States, 5Department of Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States

GABA concentration is reduced in children with TS and is linked to behavior and diagnostic measures

Emma Muñoz-Moreno1, Elda Fischi-Gomez2,3, Dafnis Batalle1, Lana Vasung3, Elisenda Eixarch1,4, Jean-Philippe Thiran2,5, Eduard Gratacos1,4, and Petra Susan Huppi3
1Fetal and Perinatal Medicine Research Group, IDIBAPS, Barcelona, Spain, 2Signal Processing Laboratory 5 (LTS5), Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland, 3Division of Development and Growth. Department of Pediatrics, University of Geneva, Geneva, Switzerland,4Maternal-Fetal Medicine Department, ICGON, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain, 5Department of Radiology, University Hospital Center (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland

Intrauterine Growth Restriction (IUGR) due to placental insufficiency is associated with short and long-term neurodevelopmental disorders. In this study, connectomic analysis based on diffusion magnetic resonance (dMRI) was performed in cohorts of 1-, 6- and 9-year-old children that were born preterm. Two groups were considered at each age, children with normal growth and children with IUGR. Tractography was used to infer the connections between brain regions, and estimate the connectome matrix of each subject, and graph measures were computed. Results showed that a pattern of alterations in graph measures describing brain organization in IUGR persists along childhood.

16:03 0136.   Tract-Based Spatial Statistics Analysis of Diffusion Tensor Data in Very Preterm 7 year-olds
Claire E Kelly1, Deanne K Thompson1,2, Alexander Leemans3, Chris Adamson1, Jian Chen1, Terrie E Inder4, Jeanie LY Cheong1,5, Lex W Doyle1,5, and Peter J Anderson1,6
1Murdoch Childrens Research Institute, Melbourne, VIC, Australia, 2Florey Institute of Neuroscience and Mental Health, Melbourne, VIC, Australia,3Image Sciences Institute, University Medical Center Utrecht, Utrecht, Netherlands, 4Brigham and Women's Hospital, Boston, MA, United States, 5Royal Women's Hospital, Melbourne, VIC, Australia, 6Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia

Very preterm birth (VPT, <32 weeks’ gestation) increases the risk of white matter injury. Tract-Based Spatial Statistics (TBSS) provides a method for studying whole brain white matter microstructure in VPT children. This study analysed diffusion tensor data from 150 VPT children and 35 term controls (born ≥37 weeks’ gestation) at 7 years of age. There were regions of higher diffusivity in the VPT children compared with controls. Increasing brain abnormality scored on neonatal MRI was associated with widespread lower fractional anisotropy and higher diffusivity in VPT children. TBSS provides a sensitive method for studying white matter microstructure in VPT children.