Sensory and motor deficits in children with cerebral palsy born preterm correlate with diffusion tensor imaging abnormalities in thalamocortical pathways

Abstract

Aim Cerebral palsy (CP) is frequently linked to white matter injury in children born preterm. Diffusion tensor imaging (DTI) is a powerful technique providing precise identification of white matter microstructure. We investigated the relationship between DTI‐observed thalamocortical (posterior thalamic radiation) injury, motor (corticospinal tract) injury, and sensorimotor function. Method Twenty‐eight children born preterm (16 males, 12 females; mean age 5y 10mo, SD 2y 6mo, range 16mo–13y; mean gestational age at birth 28wks, SD 2.7wks, range 23–34wks) were included in this case–control study. Twenty‐one children had spastic diplegia, four had spastic quadriplegia, two had hemiplegia, and one had ataxic/hypotonic CP; 15 of the participants walked independently. Normative comparison data were obtained from 35 healthy age‐matched children born at term (19 males, 16 females; mean age 5y 9mo, SD 4y 4mo, range 15mo–15y). Two‐dimensional DTI color maps were created to evaluate 26 central white matter tracts, which were graded by a neuroradiologist masked to clinical status. Quantitative measures of touch, proprioception, strength (dynamometer), and spasticity (modified Ashworth scale) were obtained from a subset of participants. Results All 28 participants with CP had periventricular white‐matter injury on magnetic resonance imaging. Using DTI color maps, there was more severe injury in the posterior thalamic radiation pathways than in the descending corticospinal tracts. Posterior thalamic radiation injury correlated with reduced contralateral touch threshold, proprioception, and motor severity, whereas corticospinal tract injury did not correlate with motor or sensory outcome measures. Interpretation These findings extend previous research demonstrating that CP in preterm children reflects disruption of thalamocortical connections as well as descending corticospinal pathways.

Anatomical characterization of athetotic and spastic cerebral palsy using an atlas‐based analysis

“…DTI carries unique anatomical information that cannot be obtained by relaxation-based contrasts and prior studies have demonstrated the usefulness of evaluating the correlation between white matter damage and clinical function in preterm infants and spastic CP patients (11)(12)(13)(14)(15)(16)(17). Previously, manual-ROI based analyses of DTI data, including ours, have been reported for CP patients (11)(12)(13)(14)(15)(16)(17), which have indicated more diffuse and severe involvement of the deep gray matter and white matter structures in athetotic CP patients compared to the spastic type. These analyses, however, measured only a small portion of the brains, leaving many brain structures unmeasured.…”

White Matter Abnormalities Are Related to Microstructural Changes in Preterm Neonates at Term-Equivalent Age: A Diffusion Tensor Imaging and Probabilistic Tractography Study

“…Only a few studies have used DTI and tractography for the assessment of white matter injury in neonates, 16,17 and most tractography studies were performed on children older than 2 years of age and usually in a small cohort. [18][19][20] Little is known about the microstructural changes in specific fiber tracts in the preterm brain at term-equivalent age, and to our knowledge, no study has yet shown the association between microstructural changes by fiber tracking and WMA graded according to Woodward et al 11 In this study by using DTI and probabilistic tractography, we investigated DTI parameters (tract volume, FA, MD, // , and Ќ ) in the CST, SLF, TRs, and corpus callosum. The aim of the study was to investigate whether WMA on conventional brain MR imaging are related to diffusion changes in specific fiber tracts.…”

Advanced Fiber Tracking in Early Acquired Brain Injury Causing Cerebral Palsy

“…[14][15][16] In addition, correlations have been shown between diffusion measures in motor and sensory tracts and specific measures of sensory and/or motor functions. [5][6][7][17][18][19][20] Some studies suggest that sensory and motor functions correlate more strongly with changes in the sensory pathways (superior and posterior thalamic radiation) than changes in the motor pathways (CST). 6,19 These findings indicate that preservation of sensory pathways is important for motor function.…”

“…[5][6][7][17][18][19][20] Some studies suggest that sensory and motor functions correlate more strongly with changes in the sensory pathways (superior and posterior thalamic radiation) than changes in the motor pathways (CST). 6,19 These findings indicate that preservation of sensory pathways is important for motor function. However, most tractography studies in CP have used deterministic diffusion tensor tractography, which is a limitation because the algorithm cannot progress in areas where the tensor model shows a high uncertainty in the estimated fiber directions due to complex fiber architecture or pathologic changes.…”