White Matter Maturation Research Articles

Associations of gestational age and birth anthropometric indicators with brain white matter maturation in full-term neonates.

Newborn assessments, including gestational age (GA) and anthropometric measurements (birth weight, crown-heel length, head circumference) are routinely performed in pediatric settings, being used as important indicators in assessing neonatal development. Close associations of these birth indicators with later cognitive abilities were also reported. However, specific associations of these indicators with white matter (WM) development during the neonatal period remain unclear, as well as the extent to which they influence WM maturation. To address this issue, 51 full-term neonates (GA range, 37-42 weeks) with no abnormalities on MRI were retrospectively recruited. Specific correlations between birth indicators and WM maturation, quantified by diffusion tensor imaging (DTI)-metrics (fractional anisotropy, mean diffusivity, axial diffusivity, radial diffusivity), were identified by using DTI tract-based spatial statistics and automated fiber-tract quantification. Our findings suggest that (a) higher GA, birth weight, and crown-heel length may indicate greater WM maturation in full-term neonates, while head circumference presented weak correlation with WM maturation during early newborn period; (b) among the four indicators examined, GA was the one most associated with WM maturation. We believe that this study advances our knowledge of specific correlations between birth indicators and neonatal brain development and provides a valuable reference for future neonatal studies.

The emergence of long-range language network structural covariance and language abilities

Language skills increase as the brain matures. Language processing, especially the comprehension of syntactically complex sentences, is supported by a brain network involving functional interactions between left inferior frontal and left temporal regions in the adult brain, with reduced functional interactions in children. Here, we examined the gray matter covariance of the cortical thickness network relevant for syntactic processing in relation to language abilities in preschool children (i.e., 5-year-olds) and analyzed the developmental changes of the cortical thickness covariance cross-sectionally by comparing preschool children, school age children, and adults. Further, to demonstrate the agreement of cortical thickness covariance and white matter connectivity, tractography analyses were performed. Covariance of language-relevant seeds in preschoolers was strongest in contralateral homologous regions. A more adult-like, significant cortical thickness covariance between left frontal and left temporal regions, however, was observed in preschoolers with advanced syntactic language abilities. By comparing the three age groups, we could show that the cortical thickness covariance pattern from the language-associated seeds develops progressively from restricted in preschoolers to widely-distributed brain regions in adults. In addition, our results suggest that the cortical thickness covariance difference of the left inferior frontal gyrus to superior temporal gyrus/sulcus between preschoolers and adults is accompanied by distinctions in the white matter tracts linking these two areas, with more mature white matter in the arcuate fasciculus in adults compared to preschoolers. These findings provide anatomical evidence for developmental changes in language both from the perspective of gray matter structure co-variation within the language network and white matter maturity as the anatomical substrate for the structural covariance.

Dysmature superficial white matter microstructure in developmental focal epilepsy.

Benign epilepsy with centrotemporal spikes is a common childhood epilepsy syndrome that predominantly affects boys, characterized by self-limited focal seizures arising from the perirolandic cortex and fine motor abnormalities. Concurrent with the age-specific presentation of this syndrome, the brain undergoes a developmentally choreographed sequence of white matter microstructural changes, including maturation of association u-fibres abutting the cortex. These short fibres mediate local cortico-cortical communication and provide an age-sensitive structural substrate that could support a focal disease process. To test this hypothesis, we evaluated the microstructural properties of superficial white matter in regions corresponding to u-fibres underlying the perirolandic seizure onset zone in children with this epilepsy syndrome compared with healthy controls. To verify the spatial specificity of these features, we characterized global superficial and deep white matter properties. We further evaluated the characteristics of the perirolandic white matter in relation to performance on a fine motor task, gender and abnormalities observed on EEG. Children with benign epilepsy with centrotemporal spikes (n = 20) and healthy controls (n = 14) underwent multimodal testing with high-resolution MRI including diffusion tensor imaging sequences, sleep EEG recordings and fine motor assessment. We compared white matter microstructural characteristics (axial, radial and mean diffusivity, and fractional anisotropy) between groups in each region. We found distinct abnormalities corresponding to the perirolandic u-fibre region, with increased axial, radial and mean diffusivity and fractional anisotropy values in children with epilepsy (P = 0.039, P = 0.035, P = 0.042 and P = 0.017, respectively). Increased fractional anisotropy in this region, consistent with decreased integrity of crossing sensorimotor u-fibres, correlated with inferior fine motor performance (P = 0.029). There were gender-specific differences in white matter microstructure in the perirolandic region; males and females with epilepsy and healthy males had higher diffusion and fractional anisotropy values than healthy females (P ≤ 0.035 for all measures), suggesting that typical patterns of white matter development disproportionately predispose boys to this developmental epilepsy syndrome. Perirolandic white matter microstructure showed no relationship to epilepsy duration, duration seizure free, or epileptiform burden. There were no group differences in diffusivity or fractional anisotropy in superficial white matter outside of the perirolandic region. Children with epilepsy had increased radial diffusivity (P = 0.022) and decreased fractional anisotropy (P = 0.027) in deep white matter, consistent with a global delay in white matter maturation. These data provide evidence that atypical maturation of white matter microstructure is a basic feature in benign epilepsy with centrotemporal spikes and may contribute to the epilepsy, male predisposition and clinical comorbidities observed in this disorder.

Neonatal White Matter Maturation Is Associated With Infant Language Development

Neonatal White Matter Maturation Is Associated With Infant Language Development

Brain microstructural development in neonates with critical congenital heart disease: An atlas-based diffusion tensor imaging study.

BackgroundBrain microstructural maturation progresses rapidly in the third trimester of gestation and first weeks of life, but typical microstructural development may be influenced by the presence of critical congenital heart disease (CHD).ObjectiveThe aim of this study was to investigate the pattern of white matter (WM) microstructural development in neonates with different types of critical CHD. The secondary aim was to examine whether there is an association between WM microstructural maturity and neonatal ischemic brain injury.MethodsFor this prospective, longitudinal cohort study, 74 term born neonates underwent diffusion tensor imaging (DTI) before (N = 56) and after (N = 71) cardiac surgery performed <30 days of life for transposition of the great arteries (TGA), single ventricle physiology with aortic arch obstruction (SVP-AO), left- (LVOTO) or right ventricle outflow tract obstruction (RVOTO). Microstructural integrity was investigated by fractional anisotropy (FA) and by mean diffusivity (MD) in 16 white matter (WM) structures in three WM regions with correction for postmenstrual age. Ischemic brain injury was defined as moderate-severe white matter injury or stroke.ResultsBefore cardiac surgery, the posterior parts of the corona radiata and internal capsule showed significantly higher FA and lower MD compared to the anterior parts. Centrally-located WM structures demonstrated higher FA compared to peripherally-located structures. Neonates with TGA had higher FA in projection-, association- and commissural WM before surgery, when compared to other CHD groups. Neonates with LVOTO showed lower preoperative MD in these regions, and neonates with SVP-AO higher MD. Differences in FA/MD between CHD groups were most clear in centrally located WM structures. Between CHD groups, no differences in postoperative FA/MD or in change from pre- to postoperative FA/MD were seen. Neonatal ischemic brain injury was not associated with pre- or postoperative FA/MD.ConclusionsCollectively, these findings revealed brain microstructural WM development to follow the same organized pattern in critical CHD as reported in healthy and preterm neonates, from posterior-to-anterior and central-to-peripheral. Neonates with TGA and LVOTO showed the most mature WM microstructure before surgery and SVP-AO the least mature. Degree of WM microstructural immaturity was not associated with ischemic brain injury.

Disruptions in White Matter Maturation and Mediation of Cognitive Development in Youths on the Psychosis Spectrum

BackgroundPsychosis onset typically occurs in adolescence, and subclinical psychotic experiences peak in adolescence. Adolescence is also a time of critical neural and cognitive maturation. Using cross-sectional data from the Philadelphia Neurodevelopmental Cohort, we examined whether regional white matter (WM) development is disrupted in youths with psychosis spectrum (PS) features and whether WM maturation mediates the relationship between age and cognition in typically developing (TD) youths and youths with PS features. MethodsWe examined WM microstructure, as assessed via diffusion tensor imaging, in 670 individuals (age 10–22 years; 499 TD group, 171 PS group) by using tract-based spatial statistics. Multiple regressions were used to evaluate age × group interactions on regional WM indices. Mediation analyses were conducted on four cognitive domains—executive control, complex cognition, episodic memory, and social cognition—using a bootstrapping approach. ResultsThere were age × group interactions on fractional anisotropy (FA) in the superior longitudinal fasciculus (SLF) and retrolenticular internal capsule. Follow-up analyses revealed these effects were significant in both hemispheres. Bilateral SLF FA mediated the relationship between age and complex cognition in the TD group, but not the PS group. Regional FA did not mediate the age-associated increase in any of the other cognitive domains. ConclusionsOur results showed aberrant age-related effects in SLF and retrolenticular internal capsule FA in youths with PS features. SLF development supports emergence of specific higher-order cognitive functions in TD youths, but not in youths with PS features. Future mechanistic explanations for these relationships could facilitate development of earlier and refined targets for therapeutic interventions.

Brain structure and neurological and behavioural functioning in infants born preterm.

To examine: (1) relationships between brain structure, and concurrently assessed neurological and behavioural functioning, in infants born preterm at term-equivalent age (TEA; approximately 38-44wks); and (2) whether brain structure-function relationships differ between infants born very (24-29wks) and moderate-late (32-36wks) preterm. A total of 257 infants (91 very preterm, 166 moderate-late preterm; 120 males, 137 females) had structural magnetic resonance imaging (MRI) and neurological and behavioural assessments (Prechtl's general movements assessment, Neonatal Intensive Care Unit Network Neurobehavioral Scale [NNNS] and Hammersmith Neonatal Neurological Examination [HNNE]). Two hundred and sixty-three infants (90 very preterm, 173 moderate-late preterm; 131 males, 132 females) had diffusion MRI and assessments. Associations were investigated between assessment scores and global brain volumes using linear regressions, regional brain volumes using Voxel-Based Morphometry, and white matter microstructure using Tract-Based Spatial Statistics. Suboptimal scores on some assessments were associated with lower fractional anisotropy and/or higher axial, radial, and mean diffusivities in some tracts: NNNS attention and reflexes, and HNNE total score and tone, were associated with the corpus callosum and optic radiation; NNNS quality of movement with the corona radiata; HNNE abnormal signs with several major tracts. Brain structure-function associations generally did not differ between the very and moderate-late preterm groups. White matter microstructural alterations may be associated with suboptimal neurological and behavioural performance in some domains at TEA in infants born preterm. Brain structure-function relationships are similar for infants born very preterm and moderate-late preterm. Brain volume is not related to neurological/behavioural function in infants born preterm at term. White matter microstructure is related to some neurological/behavioural domains at term. Brain-behaviour relationships are generally similar for infants born very preterm and moderate-late preterm.

A framework for multi-component analysis of diffusion MRI data over the neonatal period

We describe a framework for creating a time-resolved group average template of the developing brain using advanced multi-shell high angular resolution diffusion imaging data, for use in group voxel or fixel-wise analysis, atlas-building, and related applications. This relies on the recently proposed multi-shell multi-tissue constrained spherical deconvolution (MSMT-CSD) technique. We decompose the signal into one isotropic component and two anisotropic components, with response functions estimated from cerebrospinal fluid and white matter in the youngest and oldest participant groups, respectively. We build an orientationally-resolved template of those tissue components from data acquired from 113 babies between 33 and 44 weeks postmenstrual age, imaged as part of the Developing Human Connectome Project. These data were split into weekly groups, and registered to the corresponding group average templates using a previously-proposed non-linear diffeomorphic registration framework, designed to align orientation density functions (ODF). This framework was extended to allow the use of the multiple contrasts provided by the multi-tissue decomposition, and shown to provide superior alignment. Finally, the weekly templates were registered to the same common template to facilitate investigations into the evolution of the different components as a function of age. The resulting multi-tissue atlas provides insights into brain development and accompanying changes in microstructure, and forms the basis for future longitudinal investigations into healthy and pathological white matter maturation.

White matter microstructural development and cognitive ability in the first 2 years of life.

White matter (WM) integrity has been related to cognitive ability in adults and children, but it remains largely unknown how WM maturation in early life supports emergent cognition. The associations between tract-based measures of fractional anisotropy (FA) and axial and radial diffusivity (AD, RD) shortly after birth, at age 1, and at age 2 and cognitive measures at 1 and 2 years were investigated in 447 healthy infants. We found that generally higher FA and lower AD and RD across many WM tracts in the first year of life were associated with better performance on measures of general cognitive ability, motor, language, and visual reception skills at ages 1 and 2, suggesting an important role for the overall organization, myelination, and microstructural properties of fiber pathways in emergent cognition. RD in particular was consistently related to ability, and protracted development of RD from ages 1 to 2 years in several tracts was associated with higher cognitive scores and better language performance, suggesting prolonged plasticity may confer cognitive benefits during the second year of life. However, we also found that cognition at age 2 was weakly associated with WM properties across infancy in comparison to child and demographic factors including gestational age and maternal education. Our findings suggest that early postnatal WM integrity across the brain is important for infant cognition, though its role in cognitive development should be considered alongside child and demographic factors.

Longitudinal Effects of Everolimus on White Matter Diffusion in Tuberous Sclerosis Complex

ObjectiveWe studied the longitudinal effects of everolimus, an inhibitor of the mammalian target of rapamycin (mTOR), on callosal white matter diffusion tensor imaging (DTI) in patients with tuberous sclerosis complex (TSC). MethodsSerial imaging data spanning nine years were used from the open label, Phase I/II trial (NCT00411619) and open-ended extension phase of everolimus for the treatment of subependymal giant cell astrocytoma associated with TSC. From 28 patients treated with everolimus and 25 untreated control patients, 481 MRI scans were available. Rigorous quality control resulted in omission of all scans with diffusion weighted imaging data in less than 15 directions or more than eight artifacted volumes, and all postsurgical scans. We applied a linear mixed-effects model to the remaining 125 scans (17 treated, 24 controls) for longitudinal analysis of each DTI metric of manually drawn callosal regions of interest. ResultsOn a population level, mTOR inhibition was associated with a decrease in mean diffusivity. In addition, in treated patients only, a decrease of radial diffusivity was observed; in untreated patients only, an increase of axial diffusivity was seen. In patients below age 10, effect-sizes were consistently greater, and longer treatment was associated with greater rate of diffusion change. There was no correlation between DTI metrics and reduction of subependymal giant cell astrocytoma volume, or everolimus serum levels. ConclusionsEffects from mTOR overactivity on white matter microstructural integrity in TSC were modified through pharmacologic inhibition of mTOR. These changes sustained over time, were greater with longer treatment and in younger patients during a time of rapid white matter maturation.

Prenatal Bisphenol A Exposure and Brain Structure in Preschool-Aged Children

Background/Aim: In Canada, over 90% of the population has detectable levels of bisphenol A (BPA) due to dietary and non-dietary exposure. Human epidemiological studies have demonstrated behavioral effects of BPA exposure in children. Further, reported effects have been found to be sex-specific. Although behavioral outcomes have been examined, there is limited understanding of the effects of BPA exposure on children&amp;#8217;s brain structure. This study examined the effects of maternal BPA exposure on subsequent child white matter brain structure at 3 to 6 years of age.Method: Maternal total BPA concentrations in spot urine samples obtained during the second trimester of pregnancy were analyzed for 99 women. Their children participated in magnetic resonance imaging (MRI) between 3 to 6 years of age. Associations between prenatal BPA exposure and child fractional anisotropy and mean diffusivity within 10 isolated white matter tracts were investigated, controlling for sex and total maternal creatinine levels. Anisotropy and diffusivity provide measures of white matter structure and maturity.Results: Significant positive associations were observed between the level of prenatal BPA exposure and child white matter mean diffusivity within the splenium, and the right inferior frontal occipital, inferior longitudinal fasciculus, uncinated fasciculi, and pyramidal fibers. Significant sex differences were found, with more associations noted among females. No associations were observed between prenatal BPA exposure and child white matter anisotropy.Conclusions: Higher prenatal BPA exposure was related to higher mean diffusivity in white matter tracts at 3 to 6 years of age. Developmental studies show that with age, white matter anisotropy increases and diffusivity decreases in typically developing children. The current findings suggest that exposure to higher levels of BPA prenatally may be related to reduced white matter maturity in preschool aged children.

Corpus callosum microstructure is associated with motor function in preschool children

The preschool period is a time of significant physical and behavioral growth, including the improvement of gross and fine motor skills. Although motor development has been comprehensively mapped from infancy to adulthood, the neural correlates associated with motor advancements during early childhood remain unclear. The current study used diffusion tensor imaging (DTI) to delineate key motor pathways and characterize their relationships with motor performance in 80 typically developing preschool children, aged 3–6 years. The Movement Assessment Battery for Children-2nd edition (MABC-II) was used to assess motor functioning. Partial correlations between DTI parameters and motor performance, controlling for sex and age, revealed a positive correlation between motor performance and fractional anisotropy of corpus callosum motor fibers, as well as negative correlations of motor performance with mean and radial diffusivity. These results appear to be driven by females, as correlations were significant in girls but not boys when analyzed separately. Mean corticospinal tract (CST) diffusion parameters were not significantly related to motor performance, but relationships were observed at regionally specific locations along the bilateral CST. These findings suggest preschool-aged children with better motor performance show more mature white matter patterns within motor pathways, and that the structural variation in these pathways may partially account for the natural variability in motor performance.

Platform Session – NIBS: Developmental differences in motor cortex TMS-EEG responses associate with local white matter microstructure

The reactivity to transcranial magnetic stimulation (TMS) changes with development. For example, motor cortex TMS-evoked EEG response decreases significantly with age. Structurally, the grey matter of the motor cortex reaches maturity by the age of 10 years, whereas the maturation of superficial white matter continues until early adulthood. The relationship between these concurrent structural and functional changes remains unclear. We studied 10 healthy children (mean age 10.5), 10 adolescents (mean age 16.0 years) and 7 adults (mean age 26.5 years). Fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD) and radial diffusivity (RD) were defined from diffusion weighted MRI data obtained from the left hand knob area on motor cortex. Cortical thickness (grey matter, GM) of the same area was assessed from T1-weighted MRI. TMS was focused on the left hand knob with a stimulation intensity of 110% of the resting motor threshold. EEG was recorded with a 60-channel TMS-compatible amplifier. The total EEG activity was assessed using the global mean field power (GMFP) calculated across all electrodes and the local activation as a local mean field power (LMFPleft) computed across the electrodes surrounding the left hand knob. GMFP and LMFPleft areas in the 15–500 ms post stimulus interval were used for statistical analyses. Between-group differences in TMS-EEG, GM and DTI metrics were analyzed with one-way ANOVA, and Pearson’s correlation was used to analyze correlations between functional and structural data. GMFP area (F = 12.65, p < 0.001) as well as LMFPleft (F = 20.19, p < 0.001) differed between the groups, the values being largest in children and smallest in adults, as expected. AD decreased significantly with age (F = 7.30, p < 0.01), while FA and MD showed trend of age dependent changes (p = 0.05–0.07). However, GM at the left hand knob did not differ between the age groups (p > 0.8). GMFP and LMFPleft showed a significant correlation with MD (r = 0.421, p < 0.05 for the GMFP and r = 0.591, p < 0.01 for LMFPleft) and AD (r = 0.555, p < 0.01 for GMFP and r = 0.595, p < 0.01 for the LMFPleft) values. GM correlated significantly with RD (r = 0.443, p < 0.05) and MD (r = 0.411, p < 0.05) but not with GMFP or LMFPleft. Previously, it has been suggested that smaller EEG responses in adults compared with those in children may be associated with GM loss in the pre- and peripubescent period. In this study, a developmental decline of TMS evoked global and local EEG responses correlated with the maturation of local short-range microstructural changes revealed by DTI rather than GM in the motor cortex. These results indicate that the development profile of TMS-evoked EEG activity may associate with maturation of the microstructure of underlying short range white matter connections.

Lifespan Trajectories of White Matter Changes in Rhesus Monkeys.

Progress in neurodevelopmental brain research has been achieved through the use of animal models. Such models not only help understanding biological changes that govern brain development, maturation and aging, but are also essential for identifying possible mechanisms of neurodevelopmental and age-related chronic disorders, and to evaluate possible interventions with potential relevance to human disease. Genetic relationship of rhesus monkeys to humans makes those animals a great candidate for such models. With the typical lifespan of 25 years, they undergo cognitive maturation and aging that is similar to this observed in humans. Quantitative structural neuroimaging has been proposed as one of the candidate in vivo biomarkers for tracking white matter brain maturation and aging. While lifespan trajectories of white matter changes have been mapped in humans, such knowledge is not available for nonhuman primates. Here, we analyze and model lifespan trajectories of white matter microstructure using in vivo diffusion imaging in a sample of 44 rhesus monkeys. We report quantitative parameters (including slopes and peaks) of lifespan trajectories for 8 individual white matter tracts. We show different trajectories for cellular and extracellular microstructural imaging components that are associated with white matter maturation and aging, and discuss similarities and differences between those in humans and rhesus monkeys, the importance of our findings, and future directions for the field. Significance Statement: Quantitative structural neuroimaging has been proposed as one of the candidate in vivo biomarkers for tracking brain maturation and aging. While lifespan trajectories of structural white matter changes have been mapped in humans, such knowledge is not available for rhesus monkeys. We present here results of the analysis and modeling of the lifespan trajectories of white matter microstructure using in vivo diffusion imaging in a sample of 44 rhesus monkeys (age 4-27). We report and anatomically map lifespan changes related to cellular and extracellular microstructural components that are associated with white matter maturation and aging.

T201. THE STUDY OF WHITE MATTER MATURATION IN THREE POPULATIONS OF GENETIC HIGH RISK FOR SCHIZOPHRENIA INDIVIDUALS SPANNING THE DEVELOPMENTAL TIMELINE

BackgroundWhile the etiology of schizophrenia (SZ) is still unclear, it has been characterized as a neurodevelopmental disorder because patients exhibit deviations from normal maturational trajectories that are evident prior to the onset of psychotic symptoms. White matter (WM) has been purported to play a central role in the development of SZ, however, the timing and nature of WM changes in SZ is still poorly understood. This study uses diffusion imaging from three independent Genetic High Risk (GHR) populations spanning the developmental timeline from infancy to young adulthood. The aim of this study is to understand the extent and the time-course of WM maturational pathologies as a function of age and genetic risk for psychosis.MethodsTwo datasets of 3T diffusion-weighted images of children aged 7 to 12 (24 HC and 16 at GHR) and young adults aged 19 to 29 (26 HC and 43 GHR) were collected at the Massachusetts Institute of Technology. The third dataset of 3T images of infants aged 2 years (35 HC and 18 GHR) was collected at the University of North Carolina – Chapel Hill. Whole brain two-tensor tractography was performed and 4 bilateral WM tracts (arcuate fasciculus (AF); inferior longitudinal fasciculus (ILF); cingulum bundle (CB); superior longitudinal fasciculus-ii (SLF-ii)), were extracted utilizing an atlas-guided fiber clustering algorithm. The fractional anisotropy of the tissue (FA-t) was obtained. We carried out group comparisons of FA-t between GHR and HCs utilizing Mann-Whitney-U tests and Cohen’s d effect sizes for each WM tract.ResultsPreliminary analyses reveal significant reductions in FAt between GHR and HC in the right CB (p = 0.013) in the child GHR population. This is mirrored by medium to large effect sizes in the bilateral CB in GHR children (CB-left, d = 0.51; CB-right, d = 0.79). Reductions in FAt in the adult GHR population within the right CB was the largest effect observed in the adult analysis (CB-right, d = 0.46). Effect sizes in the bilateral CB were minimal in the infant GHR population (CB-left, d = 0.14, CB-right, d = 0.11). Significant decreases were also seen in the right SLF-ii in the adult GHR population (p = 0.012), but not in the infant or child GHR populations, though the reductions in FAt in the child GHR population exhibited a small effect (d = 0.35). All other white matter tracts in the adult analysis showed minor effects ranging from d = 0.033 (ILF-right) to 0.28 (ILF-left). The children and infant population also exhibited small effect sizes for all other tracts, with the child GHR dataset ranging from 0.036 (ILF-left) to 0.41 (ILF-right) and the infant GHR dataset ranging from d = 0.038 (SLF-left) to 0.34 (ILF-left).DiscussionOur preliminary results suggest that abnormal WM maturation may occur in the right CB and right SLF-ii in individuals with increased genetic risk for SZ, specifically after early childhood (7 to 12 years) and into adulthood (19 to 29 years). The CB and SLF-ii are highly implicated in working memory performance, an ability that retrospective studies have shown begins to decline during the peripubertal period in those that develop SZ (~7 to 9 years). The lack of structural findings in GHR infants, may suggest that WM alterations are more likely to arise later in development, thereby possibly identifying childhood as a vulnerable period. Taken together, the preliminary results of this study provide possible evidence of subtle divergences from a healthy WM maturational trajectory in the right CB and right SLF-ii in early to late childhood that may persist into adulthood and these deviations may contribute to cognitive phenotypes described in other studies.

T52. N-ACETYL-CYSTEINE ADD-ON TREATMENT LEADS TO AN IMPROVEMENT OF FORNIX WHITE MATTER INTEGRITY IN EARLY PSYCHOSIS

BackgroundBeneficial effects of N-acetyl-cysteine (NAC) on negative symptoms in chronic schizophrenia have been reported in two studies. A recent study in early psychosis from our group, did not report significant improvement in negative symptoms (potentially linked to the modest baseline levels) but showed improvement in cognition (i.e. processing speed) and an increase in the brain antioxidant glutathione (GSH) levels, indicating good target engagement.1 Indeed, research in animal models highlights the critical role of redox regulation by brain GSH for white matter maturation and maintenance. Given the strong evidence of white matter (WM) alterations in schizophrenia as well as the current lack of etiological treatments, redox dysregulation is an interesting target. The current study aims at investigating the impact of NAC, a precursor of GSH, the main antioxidant in the brain, on WM integrity in patients in the early psychosis phase. We focused on the fornix bundle that has been shown to be impaired in an animal model of oxidative stress2 (i.e. impaired GSH synthesis) as well as in early psychosis patients.3MethodsWM diffusion properties were estimated using generalized fractional anisotropy (gFA) computed from diffusion spectrum imaging (DSI) brain scans acquired in patients who received either NAC (n=10; mean age=25.3 ± 5.7; males/females 9/1) or placebo (n=10; mean age=24.8 ± 7.9; males/females 5/5) as add-on treatment over 6-months. GSH levels were measured in the medial prefrontal cortex using Magnetic Resonance Spectroscopy (MRS).ResultsA non-parametric longitudinal voxel-based analysis limited to the fornix revealed a time x treatment interaction which reached significance in the body of the fornix (corrected p<.04) with NAC patients showing an increase in gFA over 6-month of treatment. Importantly, improvement of gFA (i.e. increase) in the fornix of early psychosis patients (NAC and placebo) correlated with increase in cerebral GSH levels (r=.67; p<.005).DiscussionThis study is the first to assess the effect of NAC on WM integrity as assessed by diffusion weighted-imaging in the early phase of psychosis. WM alterations appear early in the illness and become widespread in a more chronic phase of the disease.4 To the best of our knowledge there is currently no approved medication for schizophrenia that show significant effect on WM integrity. In this study, effects of NAC on WM integrity in the fornix were significant despite the limited sample size. This is a small-scale proof of concept study, which was very demanding for early psychosis patients and needs replication in a larger study. Its potential properties to counteract WM deficits may be even more important in individuals at clinical high risk for psychosis. As NAC add-on treatment is safe with no side effects, this study paves the way for preventive approach at the early stages of psychosis.

Nutrient Intake in the First Two Weeks of Life and Brain Growth in Preterm Neonates.

Optimizing early nutritional intake in preterm neonates may promote brain health and neurodevelopment through enhanced brain maturation. Our objectives were (1) to determine the association of energy and macronutrient intake in the first 2 weeks of life with regional and total brain growth and white matter (WM) maturation, assessed by 3 serial MRI scans in preterm neonates; (2) to examine how critical illness modifies this association; and (3) to investigate the relationship with neurodevelopmental outcomes. Forty-nine preterm neonates (21 boys, median [interquartile range] gestational age: 27.6 [2.3] weeks) were scanned serially at the following median postmenstrual weeks: 29.4, 31.7, and 41. The total brain, basal nuclei, and cerebellum were semiautomatically segmented. Fractional anisotropy was extracted from diffusion tensor imaging data. Nutritional intake from day of life 1 to 14 was monitored and clinical factors were collected. Greater energy and lipid intake predicted increased total brain and basal nuclei volumes over the course of neonatal care to term-equivalent age. Similarly, energy and lipid intake were significantly associated with fractional anisotropy values in selected WM tracts. The association of ventilation duration with smaller brain volumes was attenuated by higher energy intake. Brain growth predicted psychomotor outcome at 18 months' corrected age. In preterm neonates, greater energy and enteral feeding during the first 2 weeks of life predicted more robust brain growth and accelerated WM maturation. The long-lasting effect of early nutrition on neurodevelopment may be mediated by enhanced brain growth. Optimizing nutrition in preterm neonates may represent a potential avenue to mitigate the adverse brain health consequences of critical illness.

T1 white/gray contrast as a predictor of chronological age, and an index of cognitive performance

Knowing the maturational schedule of typical brain development is critical to our ability to identify deviations from it; such deviations have been related to cognitive performance and even developmental disorders. Chronological age can be predicted from brain images with considerable accuracy, but with limited spatial specificity, particularly in the case of the cerebral cortex. Methods using multi-modal data have shown the greatest accuracy, but have made limited use of cortical measures. Methods using complex measures derived from voxels throughout the brain have also shown great accuracy, but are difficult to interpret in terms of cortical development. Measures based on cortical surfaces have yielded less accurate predictions, suggesting that perhaps cortical maturation is less strongly related to chronological age than is maturation of deep white matter or subcortical structures. We question this suggestion. We show that a simple metric based on the white/gray contrast at the inner border of the cortex is a good predictor of chronological age. We demonstrate this in two large datasets: the NIH Pediatric Data, with 832 scans of typically developing children, adolescents, and young adults; and the Pediatric Imaging, Neurocognition, and Genetics data, with 760 scans of individuals in a similar age-range. Further, our usage of an elastic net penalized linear regression model reveals the brain regions which contribute most to age-prediction. Moreover, we show that the residuals of age-prediction based on this white/gray contrast metric are not merely random errors, but are strongly related to IQ, suggesting that this metric is sensitive to aspects of brain development that reflect cognitive performance.

THE CAPABILITIES OF MRI IN STUDYING FORMATION OF THE FETAL BRAIN

Differential diagnosis of normal and pathological development of the fetal brain in accordance with gestational period is an actual problem of prenatal medicine. The basic brain structures of the fetus, including gyrus and sulcus are forming during the pregnancy, such processes as lamination and myelination of white matter starts. The paper analyzed the diagnostic capabilities of magnetic resonance imaging (MRI) to study the sequence of formation of sulcus and gyrus of the fetal brain at various stages of its development, shows the value of the method in assessing maturation of white matter. Prenatal MRI data were compared to ultrasound and postmortem studies.

Multiple Postnatal Infections in Newborns Born Preterm Predict Delayed Maturation of Motor Pathways at Term-Equivalent Age with Poorer Motor Outcomes at 3 Years

To evaluate whether the number of postnatal infections is associated with abnormal white matter maturation and poorer motor neurodevelopmental outcomes at 36 months of corrected age. A prospective longitudinal cohort study was undertaken of 219 newborns born preterm at 24-32 weeks of gestational age recruited between 2006 and 2013 with magnetic resonance imaging of the brain both early in life and at term-equivalent age. Postnatal infection was defined as any clinical infection or positive culture ≥72 hours after birth. White matter maturation was assessed by magnetic resonance spectroscopic imaging, magnetic resonance diffusion tensor imaging, and tract-based spatial statistics. Neurodevelopmental outcomes were assessed in 175 (82% of survivors) infants with Bayley Scales of Infant and Toddler Development-III composite scores and Peabody Developmental Motor Scales at 35 months of corrected age (IQR 34-37 months). Infection groups were compared via the Fisher exact test, Kruskal-Wallis test, and generalized estimating equations. Of 219 neonates born preterm (median gestational age 27.9 weeks), 109 (50%) had no postnatal infection, 83 (38%) had 1 or 2 infections, and 27 (12%) had ≥3 infections. Infants with postnatal infections had more cerebellar hemorrhage. Infants with ≥3 infections had lower N-acetylaspartate/choline in the white matter and basal ganglia regions, lower fractional anisotropy in the posterior limb of the internal capsule, and poorer maturation of the corpus callosum, optic radiations, and posterior limb of the internal capsule on tract-based spatial statistics analysis as well as poorer Bayley Scales of Infant and Toddler Development-III (P = .02) and Peabody Developmental Motor Scales, Second Edition, motor scores (P < .01). In newborns born preterm, ≥3 postnatal infections predict impaired development of the motor pathways and poorer motor outcomes in early childhood.