Jeong-Won Jeong1, Jessica Lee2, David O Kamson3, Harry T Chugani4, Csaba Juhász4. 1. Translational Imaging Laboratory, Children's Hospital of Michigan, Detroit, MI, USA; Carman and Ann Adams Department of Pediatrics, School of Medicine, Wayne State University, Detroit, MI, USA; Department of Neurology, School of Medicine, Wayne State University, Detroit, MI, USA. Electronic address: jeongwon@pet.wayne.edu. 2. School of Medicine, Wayne State University, Detroit, MI, USA. 3. Translational Imaging Laboratory, Children's Hospital of Michigan, Detroit, MI, USA. 4. Translational Imaging Laboratory, Children's Hospital of Michigan, Detroit, MI, USA; Carman and Ann Adams Department of Pediatrics, School of Medicine, Wayne State University, Detroit, MI, USA; Department of Neurology, School of Medicine, Wayne State University, Detroit, MI, USA.
Abstract
PURPOSE: To examine whether an objective segmenation of corticospinal tract (CST) associated with hand and leg movements can be used to detect central motor weakness in the corresponding extremities in a pediatric population. MATERIAL AND METHODS: This retrospective study included diffusion tensor imaging (DTI) of 25 children with central paresis affecting at least one limb (age: 9.0±4.2years, 15 boys, 5/13/7 children with left/right/both hemispheric lesions including ischemia, cyst, and gliosis), as well as 42 pediatric control subjects with no motor dysfunction (age: 9.0±5.5years, 21 boys, 31 healthy/11 non-lesional epilepsy children). Leg- and hand-related CST pathways were segmented using DTI-maximum a posteriori (DTI-MAP) classification. The resulting CST volumes were then divided by total supratentorial white matter volume, resulting in a marker called "normalized streamline volume ratio (NSVR)" to quantify the degree of axonal loss in separate CST pathways associated with leg and hand motor functions. A receiver operating characteristic curve was applied to measure the accuracy of this marker to identify extremities with motor weakness. RESULTS: NSVR values of hand/leg CST selectively achieved the following values of accuracy/sensitivity/specificity: 0.84/0.84/0.57, 0.82/0.81/0.55, 0.78/0.75/0.55, 0.79/0.81/0.54 at a cut-off of 0.03/0.03/0.03/0.02 for right hand CST, left hand CST, right leg CST, and left leg CST, respectively. Motor weakness of hand and leg was most likely present at the cut-off values of hand and leg NSVR (i.e., 0.029/0.028/0.025/0.020 for left-hand/right-hand/left-leg/right-leg). The control group showed a moderate age-related increase in absolute CST volumes and a biphasic age-related variation of the normalized CST volumes, which were lacking in the paretic children. CONCLUSIONS: This study demonstrates that DTI-MAP classification may provide a new imaging tool to quantify axonal loss in children with central motor dysfunction. Using this technique, we found that early-life brain lesions affect the maturational trajectory of the primary motor pathway which may be used as an effective marker to facilitate evidence-based treatment of paretic children.
PURPOSE: To examine whether an objective segmenation of corticospinal tract (CST) associated with hand and leg movements can be used to detect central motor weakness in the corresponding extremities in a pediatric population. MATERIAL AND METHODS: This retrospective study included diffusion tensor imaging (DTI) of 25 children with central paresis affecting at least one limb (age: 9.0±4.2years, 15 boys, 5/13/7 children with left/right/both hemispheric lesions including ischemia, cyst, and gliosis), as well as 42 pediatric control subjects with no motor dysfunction (age: 9.0±5.5years, 21 boys, 31 healthy/11 non-lesional epilepsychildren). Leg- and hand-related CST pathways were segmented using DTI-maximum a posteriori (DTI-MAP) classification. The resulting CST volumes were then divided by total supratentorial white matter volume, resulting in a marker called "normalized streamline volume ratio (NSVR)" to quantify the degree of axonal loss in separate CST pathways associated with leg and hand motor functions. A receiver operating characteristic curve was applied to measure the accuracy of this marker to identify extremities with motor weakness. RESULTS: NSVR values of hand/leg CST selectively achieved the following values of accuracy/sensitivity/specificity: 0.84/0.84/0.57, 0.82/0.81/0.55, 0.78/0.75/0.55, 0.79/0.81/0.54 at a cut-off of 0.03/0.03/0.03/0.02 for right hand CST, left hand CST, right leg CST, and left leg CST, respectively. Motor weakness of hand and leg was most likely present at the cut-off values of hand and leg NSVR (i.e., 0.029/0.028/0.025/0.020 for left-hand/right-hand/left-leg/right-leg). The control group showed a moderate age-related increase in absolute CST volumes and a biphasic age-related variation of the normalized CST volumes, which were lacking in the paretic children. CONCLUSIONS: This study demonstrates that DTI-MAP classification may provide a new imaging tool to quantify axonal loss in children with central motor dysfunction. Using this technique, we found that early-life brain lesions affect the maturational trajectory of the primary motor pathway which may be used as an effective marker to facilitate evidence-based treatment of paretic children.
Authors: Seung Ok Baek; Sung Ho Jang; Eusil Lee; Saeyoon Kim; Jeong Ok Hah; Yong Hoon Park; Jae Min Lee; Su Min Son Journal: Neurosci Lett Date: 2013-10-28 Impact factor: 3.046
Authors: David O Kamson; Csaba Juhász; Joseph Shin; Michael E Behen; William C Guy; Harry T Chugani; Jeong-Won Jeong Journal: Pediatr Neurol Date: 2013-12-18 Impact factor: 3.372
Authors: Yong Jae Jung; Sung Ho Jang; Sang Seok Yeo; Eunsil Lee; Saeyoon Kim; Dong Gyu Lee; Han Sun Kim; Su Min Son Journal: Eur Neurol Date: 2012-03-08 Impact factor: 1.710
Authors: Jeong-Won Jeong; Eishi Asano; Erik C Brown; Vijay N Tiwari; Diane C Chugani; Harry T Chugani Journal: Epilepsia Date: 2013-06-17 Impact factor: 5.864