ISMRM 24th Annual Meeting & Exhibition • 07-13 May 2016 • Singapore

Scientific Session: Imaging of Pediatric Neuropathology

Wednesday, May 11, 2016
Room 300-302
16:00 - 18:00
Moderators: Petra Huppi Petra, Duan Xu

Complex congenital heart defects in infants produce lasting decreases in functional network segregation
Vincent Jerome Schmithorst1, Jodie Votava-Smith2, Vince Lee1, Vidya Rajagopalan2, Shaheda Suleiman1, Lisa Paquette2, and Ashok Panigrahy1
1Radiology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, United States, 2Children's Hospital of Los Angeles, Los Angeles, CA, United States
We used functional connectivity MRI and graph analysis to investigate the impact of congenital heart disease (CHD) on functional network topology in neonates.  Cost-dependent and cost-independent analyses both showed decreases in global segregation (transitivity).  The cost-dependent analysis showed a decrease in clustering coefficient (reflective of nodal changes) while the cost-independent analysis showed a decrease in modularity and an increase in participation coefficient (reflective of changed community structure).  Minimal differences were seen for CHD patients scanned post-operatively compared to those scanned pre-operatively.  Results indicate complex CHD results in lasting changes to functional network topology not ameliorated by the effects of surgery. 

Altered Cortical and Subcortical Structures and Structural Connectivity in Perinatally HIV-infected Children
Santosh Kumar Yadav1, Rakesh Kumar Gupta2, Ravindra Kumar Garg3, Vimala Venkatesh4, Ena Wang1, Francesco M Marincola1, and Mohammad Haris1
1Division of Translational Medicine, Sidra Medical and Research Center, Doha, Qatar, 2Department of Radiology, Fortis Memorial Research Institute, Gurgaon, India, 3Department of Neurology, King George Medical University, Lucknow, India, 4Department of Microbiology, King George Medical University, Lucknow, India
Cortical thickness, subcortical volumes and structural brain connectivity changes in HIV-seropositive children were evaluated in comparison to HIV-seronegative children. HIV-seropositive children showed altered cortical thicknesses, subcortical volumes and structural connectivity compared to those of HIV-seronegative children. In addition, changes in cortical and subcortical structures were significantly correlated with CD4+ counts and neuropsychological scores in HIV-seropositive children. We suggest that neuronal injury due to HIV-infection and inflammation might be possible reasons for the altered cortical thickness, subcortical volumes and connectivity in these patients.

Mapping longitudinal white matter changes in extremely preterm born infants
Eliza Orasanu1, Andrew Melbourne1, Marc Modat1, Marco Lorenzi1, Herve Lombaert2, Zach Eaton-Rosen1, Nicola Robertson3, Giles Kendall4, Neil Marlow5, and Sebastien Ourselin1
1Translational Imaging Group, Centre for Medical Image Computing, University College London, London, United Kingdom, 2INRIA, Palaiseau, France, 3Academic Neonatology, Institute for Women's Health, University College London, London, United Kingdom, 4Academic Neonatology, Institute for Women's Health, University College Hospital, London, United Kingdom, 5Institute for Women's Health, University College London, London, United Kingdom
During the preterm period, the brain undergoes changes in volume, structure and cortical folding, which can be connected with cognitive abilities in preterm born infants. Diffusion MRI allows us to investigate microstructural changes during this period. In this study we registered the longitudinal diffusion tensor images of six extremely preterm born infants and looked at white matter changes. The corpus callosum and internal capsule exhibits the most microstructural changes during this crucial period and we hypothesis that this can affect the neurodevelopment in these infants.

Combining lesion burden with cortical malformation morphology strongly predicts motor outcomes in children with cerebral palsy
Alex Pagnozzi1, Nicholas Dowson1, James Doecke1, Simona Fiori2, Andrea Guzzetta3, Roslyn N Boyd4, and Stephen Rose1
1The Australian e-Health Research Centre, CSIRO Health & Biosecurity, Brisbane, Australia, 2Stella Maris Institute, Pisa, Italy, 3Stella Maris institute, Pisa, Italy, 4The University of Queensland, Queensland Cerebral Palsy and Rehabilitation Research Centre, Brisbane, Australia
Magnetic Resonance Imaging (MRI) is the clinical standard for assessing developmental brain injury in children with Cerebral Palsy (CP). We propose an automated process that segments the spectrum of white and grey matter injury, including tissue lesions and malformations of the cortex, and correlates biomarkers of injury with the Assisting Hand Assessment (AHA), a clinical score quantifying hand function. The proposed method is shown to perform accurate tissue and injury segmentation using T1 and T2 MRI compared to the manual classification of injury, and was significantly correlated with AHA (p<0.001).

Quantitative Spectroscopic Imaging in Metachromatic Leukodystrophy: value in prognosis and treatment monitoring.
Diane van Rappard1, Antoine Klauser2, Marjan Steenweg1, Marjo van der Knaap1, Nicole Wolf1, and Petra Pouwels3
1Child Neurology, VU University Medical Center, Amsterdam, Netherlands, 2Centre d'Imagerie BioMédicale, Geneva University, Geneva, Switzerland, 3Physics & Medical Technology, VU University Medical Center, Amsterdam, Netherlands
Currently, hematopoietic stem cell transplantation (HSCT) is the only treatment option for patients with metachromatic leukodystrophy (MLD). This study in MLD patients and controls investigated the possible additional prognostic value of quantitative MRSI. In WM (consisting of lesions and NAWM), ratios of Cho/NAA and Ins/NAA were significantly higher in patients who were considered non-eligible for HSCT than in eligible patients. Follow-up of successfully treated patients showed partial normalization of concentrations and ratios. This study suggests that quantitative MRS can support the decision whom to treat, especially when neurological and cognitive examinations are ambiguous.

Optimizing unanesthetized cerebral oxygen consumption measures: comparison of MRI and near-infrared spectroscopy (NIRS) approaches in neonates with congenital heart disease
Jeffrey N Stout1, Silvina Ferradal2, Borjan Gagoski2, Lilla Zollei3, Divya S Bolar3,4, Alex Lin5, Henry H Cheng6, Elfar Adalsteinsson1,7,8, and Patricia Ellen Grant2
1Harvard-MIT Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, United States, 2Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children’s Hospital, Boston, MA, United States, 3Martinos Center for Biomedical Imaging, MGH/Harvard Medical School, Boston, MA, United States, 4Department of Radiology, Massachusetts General Hospital, Boston, MA, United States, 5Department of Radiology, Brigham and Women's Hospital, Boston, MA, United States, 6Department of Cardiology, Boston Children’s Hospital, Boston, MA, United States, 7Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA, United States, 8Institute for Medical Engineering and Science, Cambridge, MA, United States
Concern for cerebral perfusion in neonates with congenital heart disease (CHD) has driven investigations into cerebral hemodynamics. MRI in combination with bedside NIRS has the potential to provide complementary measures of hemodynamics to guide surgical timing and assess response to surgery. We compare MRI and NIRS measures of cerebral hemodynamics. Modality results compare well to literature studies, but intermodality correlation is limited. Before combining modalities additional studies are needed to better understand why cerebral blood flow and CMRO2 measures in MRI and NIRS differ.

Quantitating polyunsaturated fatty acids in neonates with hypoxic-ischemic brain injury
Jessica Lee Wisnowski1,2, Aaron J Reitman3,4, Tai-Wei Lee Wu3, Eugenia Ho5, Claire McLean6, Douglas Lee Vanderbilt6, Marvin D Nelson1, Ashok Panigrahy7, Philippe Lee Friedlich3,8, and Stefan Lee Bluml1
1Radiology, Children's Hospital Los Angeles, Los Angeles, CA, United States, 2Rudi Schulte Research Institute, Santa Barbara, CA, United States, 3Center for Fetal and Neonatal Medicine, Children's Hospital Los Angeles, Los Angeles, CA, United States, 4Division of Neonatal Medicine, LAC + USC Medical Center, Los Angeles, CA, United States, 5Division of Child Neurology, Children's Hospital Los Angeles, Los Angeles, CA, United States, 6Children's Hospital Los Angeles, Los Angeles, CA, United States, 7Radiology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, United States, 8Division of Neonatal Medicine, University of Southern California, Los Angeles, CA, United States
Polyunsaturated fatty acids (PUFA) are endogenous components of cellular membranes and a potential biomarker for apoptosis following hypoxic-ischemic (HI) brain injury. Prior studies have applied 1H-MRS techniques for quantifying PUFA in human carcinomas. Here, using a retrospective dataset of 1,046 neonatal 1H-MRS spectra, we demonstrate that PUFA can be routinely characterized in newborns using a modified LCModel (Provencher, Inc) pipeline.


Tract-specific analysis of white matter fasciculi in a large cohort of preterm infants
Diliana Pecheva1, Hui Zhang2, Gareth Ball1, Mary Rutherford1, Nigel Kennea 3, Joseph V. Hajnal1, Daniel Alexander2, A. David Edwards1, and Serena J. Counsell1
1Centre for the Developing Brain, King's College London, London, United Kingdom, 2Department of Computer Science & Centre for Medical Image Computing, University College London, London, United Kingdom,3Neonatal Unit, St Georges Hospital NHS Trust, London, United Kingdom
Preterm birth adversely affects brain development and diffuse white matter (WM) injury is often observed in preterm infants. Diffusion tensor imaging (DTI) allows us to study these effects in vivo. In this study tract-specific analysis, a novel method for large infant cohort analyses, was used to study the effects of age at scan and prematurity at birth on major WM tracts in 384 preterm infants. Our results show that age at scan is associated with widespread changes in DTI metrics across WM tracts, while the impact of prematurity at birth is more localized. 

Brain Reorganization in  Young Children with Epilepsy Surgery: Longitudinal Tractography-Based Connectome Study - Permission Withheld
Jeong-Won Jeong1,2, Eishi Asano1, Csaba Juhasz1,2, and Harry T. Chugani1,2
1Pediatrics and Neurology, Wayne State University, Detroit, MI, United States, 2Translational Imaging Laboratory, Children's Hospital of Michigan, Detroit, MI, United States
Both ictal and interictal epileptic activities  can lead to progressive deterioration of affected brain structure and function with an additional indirect impairment of functional reorganization (or compensation) in no-epileptic areas. This study applies whole brain connectome analysis for children with intractable focal epilepsy in order to investigate the potential effect of epilepsy surgery and surgical outcome on the pattern of axonal plasticity in the contralateral hemisphere.  We found that post-operative seizures are associated with increased connectivity, most pronounced in the temporal pole region of the contralateral hemisphere. Such increased connectivity may be an imaging marker of recurrent epilepsy after focal cortical resection.

Disrupted Development and Integrity of Frontal White Matter in Patients Treated for Pediatric Posterior Fossa Tumors
John O Glass1, Robert J Ogg1, Jung W Hyun2, Julie H Harreld1, Yimei Li2, Amar Gajjar3, and Wilburn E Reddick1
1Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, TN, United States, 2Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, United States, 3Oncology, St. Jude Children's Research Hospital, Memphis, TN, United States
This study assessed the longitudinal white matter (WM) microstructure of 129 patients and 72 normal healthy age-similar controls. WM volume, fractional anisotropy (FA), and radial (RAD) and axial (AX) diffusivity trajectories were examined. After surgery but before any additional therapy, frontal WM volume in patients was similar to controls, while FA and AX were reduced in patients, suggestive of acute, indirect microstructural/axonal injury caused by disease and/or surgical excision. Over the next three years, AX, RAD, and WM volume decreased in patients, which would be consistent with possible resolution of axonal swelling combined with chronic demyelination.

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