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Feasibility of fast brain diffusion MRI to quantify white matter injury in pediatric hydrocephalus.
J Neurosurg Pediatr 2019; :1-8JN

Abstract

OBJECTIVE

Traditionally, diffusion MRI (dMRI) has been performed in parallel with high-resolution conventional MRI, which requires long scan times and may require sedation or general anesthesia in infants and young children. Conversely, fast brain MRI permits image acquisition without the need for sedation, although its short pulse sequences, susceptibility to motion artifact, and contrast resolution have limited its use to assessing ventricular size or major structural variations. Here, the authors demonstrate the feasibility of leveraging a 3-direction fast brain MRI protocol to obtain reliable dMRI measures.

METHODS

Fast brain MRI with 3-direction dMRI was performed in infants and children before and after hydrocephalus treatment. Regions of interest in the posterior limbs of the internal capsules (PLICs) and the genu of the corpus callosum (gCC) were drawn on diffusion-weighted images, and mean diffusivity (MD) data were extracted. Ventricular size was determined by the frontal occipital horn ratio (FOHR). Differences between and within groups pre- and posttreatment, and FOHR-MD correlations were assessed.

RESULTS

Of 40 patients who met inclusion criteria (median age 27.5 months), 15 (37.5%), 17 (42.5%), and 8 (20.0%) had posthemorrhagic hydrocephalus (PHH), congenital hydrocephalus (CH), or no intracranial abnormality (controls), respectively. A hydrocephalus group included both PHH and CH patients. Prior to treatment, the FOHR (p < 0.001) and PLIC MD (p = 0.027) were greater in the hydrocephalus group than in the controls. While the mean gCC MD in the hydrocephalus group (1.10 × 10-3 mm2/sec) was higher than that of the control group (0.98), the difference was not significant (p = 0.135). Following a median follow-up duration of 14 months, decreases in FOHR, PLIC MD, and gCC MD were observed in the hydrocephalus group and were similar to those in the control group (p = 0.107, p = 0.702, and p = 0.169, respectively). There were no correlations identified between FOHR and MDs at either time point.

CONCLUSIONS

The utility of fast brain MRI can be extended beyond anatomical assessments to obtain dMRI measures. A reduction in PLIC and gCC MD to levels similar to those of controls was observed within 14 months following shunt surgery for hydrocephalus in PHH and CH infants. Further studies are required to assess the role of fast brain dMRI for assessing clinical outcomes in pediatric hydrocephalus patients.

Authors+Show Affiliations

1Department of Neuroscience, Washington University School of Medicine, St. Louis, Missouri. 2Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada; and.Departments of3Radiology.4Neurosurgery.4Neurosurgery.4Neurosurgery.4Neurosurgery.5Neurology, and.4Neurosurgery.4Neurosurgery.6Surgery, Washington University School of Medicine, St. Louis, Missouri.4Neurosurgery.Departments of3Radiology.4Neurosurgery.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31323624

Citation

Isaacs, Albert M., et al. "Feasibility of Fast Brain Diffusion MRI to Quantify White Matter Injury in Pediatric Hydrocephalus." Journal of Neurosurgery. Pediatrics, 2019, pp. 1-8.
Isaacs AM, Shimony JS, Morales DM, et al. Feasibility of fast brain diffusion MRI to quantify white matter injury in pediatric hydrocephalus. J Neurosurg Pediatr. 2019.
Isaacs, A. M., Shimony, J. S., Morales, D. M., Castaneyra-Ruiz, L., Hartman, A., Cook, M., ... Limbrick, D. D. (2019). Feasibility of fast brain diffusion MRI to quantify white matter injury in pediatric hydrocephalus. Journal of Neurosurgery. Pediatrics, pp. 1-8. doi:10.3171/2019.5.PEDS18596.
Isaacs AM, et al. Feasibility of Fast Brain Diffusion MRI to Quantify White Matter Injury in Pediatric Hydrocephalus. J Neurosurg Pediatr. 2019 Jul 19;1-8. PubMed PMID: 31323624.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Feasibility of fast brain diffusion MRI to quantify white matter injury in pediatric hydrocephalus. AU - Isaacs,Albert M, AU - Shimony,Joshua S, AU - Morales,Diego M, AU - Castaneyra-Ruiz,Leandro, AU - Hartman,Alexis, AU - Cook,Madison, AU - Smyser,Christopher D, AU - Strahle,Jennifer, AU - Smyth,Matthew D, AU - Yan,Yan, AU - McAllister,James P, AU - McKinstry,Robert C, AU - Limbrick,David D, Y1 - 2019/07/19/ PY - 2018/11/05/received PY - 2019/05/14/accepted PY - 2019/7/20/entrez PY - 2019/7/20/pubmed PY - 2019/7/20/medline KW - CH = congenital hydrocephalus KW - FOHR = frontal occipital horn ratio KW - MD = mean diffusivity KW - PHH = posthemorrhagic hydrocephalus KW - PLIC = posterior limb of the internal capsule KW - PVWM = periventricular white matter KW - ROI = region of interest KW - dMRI = diffusion MRI KW - diffusion MRI KW - diffusion tensor imaging KW - fast brain MRI KW - gCC = genu of the corpus callosum KW - hydrocephalus SP - 1 EP - 8 JF - Journal of neurosurgery. Pediatrics JO - J Neurosurg Pediatr N2 - OBJECTIVE: Traditionally, diffusion MRI (dMRI) has been performed in parallel with high-resolution conventional MRI, which requires long scan times and may require sedation or general anesthesia in infants and young children. Conversely, fast brain MRI permits image acquisition without the need for sedation, although its short pulse sequences, susceptibility to motion artifact, and contrast resolution have limited its use to assessing ventricular size or major structural variations. Here, the authors demonstrate the feasibility of leveraging a 3-direction fast brain MRI protocol to obtain reliable dMRI measures. METHODS: Fast brain MRI with 3-direction dMRI was performed in infants and children before and after hydrocephalus treatment. Regions of interest in the posterior limbs of the internal capsules (PLICs) and the genu of the corpus callosum (gCC) were drawn on diffusion-weighted images, and mean diffusivity (MD) data were extracted. Ventricular size was determined by the frontal occipital horn ratio (FOHR). Differences between and within groups pre- and posttreatment, and FOHR-MD correlations were assessed. RESULTS: Of 40 patients who met inclusion criteria (median age 27.5 months), 15 (37.5%), 17 (42.5%), and 8 (20.0%) had posthemorrhagic hydrocephalus (PHH), congenital hydrocephalus (CH), or no intracranial abnormality (controls), respectively. A hydrocephalus group included both PHH and CH patients. Prior to treatment, the FOHR (p < 0.001) and PLIC MD (p = 0.027) were greater in the hydrocephalus group than in the controls. While the mean gCC MD in the hydrocephalus group (1.10 × 10-3 mm2/sec) was higher than that of the control group (0.98), the difference was not significant (p = 0.135). Following a median follow-up duration of 14 months, decreases in FOHR, PLIC MD, and gCC MD were observed in the hydrocephalus group and were similar to those in the control group (p = 0.107, p = 0.702, and p = 0.169, respectively). There were no correlations identified between FOHR and MDs at either time point. CONCLUSIONS: The utility of fast brain MRI can be extended beyond anatomical assessments to obtain dMRI measures. A reduction in PLIC and gCC MD to levels similar to those of controls was observed within 14 months following shunt surgery for hydrocephalus in PHH and CH infants. Further studies are required to assess the role of fast brain dMRI for assessing clinical outcomes in pediatric hydrocephalus patients. SN - 1933-0715 UR - https://www.unboundmedicine.com/medline/citation/31323624/Feasibility_of_fast_brain_diffusion_MRI_to_quantify_white_matter_injury_in_pediatric_hydrocephalus L2 - https://thejns.org/doi/10.3171/2019.5.PEDS18596 DB - PRIME DP - Unbound Medicine ER -