Neuroimaging Patterns Research Articles

The association between cognitive reserve, cognition and brain age in Midlife: The CARDIA Study

AbstractBackgroundCognitive reserve (CR) factors have been suggested to be protective of cognitive function in older adults. Less is known about this relationship in midlife, and whether the protective effect of CR may depend on brain age (relative to chronological age) in midlife. We aimed to investigate whether CR factors are associated with cognition in midlife, independent of brain age.MethodsAs part of the ongoing prospective Coronary Artery Risk Development in Young Adults (CARDIA) study, we identified 612 Black and White participants (mean age 55 SD 3.5) with brain MRI and cognitive testing. We generated a CR composite score from structural equation modeling including four CR‐enhancing factors: education, cognitive activities, occupational cognitive complexity, and adult literacy. Cognitive function was assessed at Year 30 with a composite measure of tests of memory, processing speed, executive function, and language. Brain age was ascertained using a previously validated high dimensional neuroimaging pattern analysis, based on machine learning algorithms, that quantifies individual differences in age‐related atrophy using MRI‐derived structural brain characteristics. We used linear regression to assess the associations between CR composite above or below median (high versus low), brain aging, and cognitive function, adjusting for chronological age, sex, race, intracranial volume, and scanning site.ResultsThere was a modest association between the CR composite and brain age; higher CR was associated with lower brain age (β‐0.40, CI: ‐0.67 to ‐0.13). High CR was associated with better performance on all cognitive tests compared to low CR (p<0.001 for all). These associations remained with the inclusion of brain age as a covariate. Having high CR is associated with better cognitive performance regardless of brain age (Figure 1).ConclusionOur findings suggest that CR factors are associated with better cognitive function in midlife, and that brain aging and CR are two independent factors that may contribute to cognitive aging in midlife.

Depression in young adulthood to midlife and brain aging in midlife: A 30‐year follow‐up of The CARDIA Study

AbstractBackgroundEvidence suggests that depression is a risk factor for dementia in older adults, but the link between depressive symptoms and brain health earlier in life is poorly understood. We aimed to investigate the relationship between depressive symptoms in early adulthood through midlife and brain aging in midlife.MethodsFrom the prospective study of Coronary Artery Risk Development in Young Adults, we identified 649 Black and White participants (age 18‐30 at baseline) with brain MRI and cognitive testing 30 years later (mean age 55, SD 3.5). The participants underwent 6 repeated assessments for depressive symptoms measured with the Center for Epidemiological Studies Depression scale (CES‐D) over 30 years. The CES‐D range is 0‐60, a score of 16 points or more is considered depressed. Cumulative exposure of depressive symptoms was estimated by time‐weighted averages (TWA). We used a previously validated high dimensional neuroimaging pattern analysis, based on machine learning algorithms, that quantifies individual differences in age‐related atrophy using MRI‐derived structural brain characteristics. Linear regression was used to test the association between average cumulative depressive symptoms, brain aging, and cognition, adjusted chronological age, sex, race, education, intracranial volume, and scanning siteResultsEvery standard deviation (5‐points) higher average cumulative depression symptoms was associated with approximately one‐year greater brain age (Table 1). Participants with higher average cumulative depressive symptoms greater than the clinically significant cutoff of 16 points over the 30 years, had on average 3‐years greater brain age (95% CI: 0.74 to 4.96) compared to below the clinical cutoff. Adjusting for anti‐depressive medication use at any time during the follow‐up, slightly attenuated the association (Table 1).ConclusionHigher depressive symptoms across 30 years from early to mid‐adulthood are associated with accelerated brain aging in midlife. This suggests that elevated depressive symptoms in early adulthood can have implications for brain aging as early as in midlife.

Early neuroimaging findings of infants diagnosed with inherited metabolic disorders in neonatal period: A case-control study

ObjectiveMost IMDs are diagnosed in the neonatal period and have severe neurological findings. Neuroimaging plays an essential role in the diagnosis. We aim to investigate early cranial MRI findings of newborns suspected with IMDs to determine IMD-related neuroimaging patterns in the early infant period. MethodsThe medical records of a total of 195 infants with suspected IMDs were screened, and 56 patients who underwent a cranial MRI within the first three months of life were included in the study. The 56 patients were categorized into those diagnosed (Group I) and those not diagnosed (Group II) with IMDs. The patient's clinical findings and radiological imaging reports were extracted to a database. ResultsThe most common IMDs were mitochondrial diseases, urea cycle disorders, and organic acidemias. In the cranial MRI evaluations, the T2-hyperintensity of white matter and the T2-hyperintensity of basal ganglia were higher in Group I. It was found that high lactate/lipid peaks on 1H-MRS (10.68 times), T2-hyperintensity of white matter (5.75 times), and T2-hyperintensity of the basal ganglia (5.71 times) were more likely to be identified in Group I. Furthermore, no difference was noted between the groups in terms of the diffusion restriction of white matter, basal ganglia, cerebellum, and brainstem, and no statistically significant difference was noted in the T2-hyperintensity of the cerebellum and the brainstem. ConclusionEarly neuroimaging findings are essential in evaluations of IMDs, so familiarity with neuroimaging findings is essential for diagnosis, especially in countries that lack an expanded neonatal screening program.

Long-term depressive symptoms and midlife brain age

BackgroundEvidence suggests that depression may be a risk factor for dementia in older adults, but the link between depressive symptoms and brain health earlier in life is less understood. Our aim was to investigate the association between long-term depressive symptoms in young to mid-adulthood and a measure of brain age derived from structural MRI. MethodsFrom the Coronary Artery Risk Development in Young Adults study, we identified 649 participants (age 23–36 at baseline) with brain MRI and cognitive testing. Long-term depressive symptoms were measured with the Center for Epidemiological Studies Depression scale (CESD) six times across 25 years and analyzed as time-weighted averages (TWA). Brain age was derived using previously validated high dimensional neuroimaging pattern analysis, quantifying individual differences in age-related atrophy. Elevated depressive symptoms were defined as CES-D ≥16. Linear regression was used to test the association between TWA depressive symptoms, brain aging, and cognition. ResultsEach standard deviation (5-points) increment in TWA depression symptoms over 25 years was associated with one-year greater brain age (β: 1.14, 95 % confidence interval [CI]: 0.57 to 1.71). Participants with elevated TWA depressive symptoms had on average a 3-year greater brain age (β: 2.75, 95 % CI: 0.43 to 5.08). Moreover, elevated depressive symptoms were associated with higher odds of poor cognitive function in midlife (OR: 3.30, 95 % CI: 1.37 to 7.97). LimitationsBrain age was assessed at one time, limiting our ability to evaluate the temporality of depressive symptoms and brain aging. ConclusionsElevated depressive symptoms in early adulthood may have implications for brain health as early as in midlife.

Connectome-based prediction of eating disorder-associated symptomatology.

Despite increasing knowledge on the neuroimaging patterns of eating disorder (ED) symptoms in non-clinical populations, studies using whole-brain machine learning to identify connectome-based neuromarkers of ED symptomatology are absent. This study examined the association of connectivity within and between large-scale functional networks with specific symptomatic behaviors and cognitions using connectome-based predictive modeling (CPM). CPM with ten-fold cross-validation was carried out to probe functional networks that were predictive of ED-associated symptomatology, including body image concerns, binge eating, and compensatory behaviors, within the discovery sample of 660 participants. The predictive ability of the identified networks was validated using an independent sample of 821 participants. The connectivity predictive of body image concerns was identified within and between networks implicated in cognitive control (frontoparietal and medial frontal), reward sensitivity (subcortical), and visual perception (visual). Crucially, the set of connections in the positive network related to body image concerns identified in one sample was generalized to predict body image concerns in an independent sample, suggesting the replicability of this effect. These findings point to the feasibility of using the functional connectome to predict ED symptomatology in the general population and provide the first evidence that functional interplay among distributed networks predicts body shape/weight concerns.

Imaging findings in abusive head trauma (AHT).

Brain imaging plays a key role in accurately identifying abusive head trauma (AHT). An exact and rapid diagnosis is needed due to the extreme severity of AHT, since there is a risk of neurological sequelae and potentially fatal recurrence. Several medical specialists will work collaboratively to detect and confirm abuse in children: the radiologist has a leading role in this approach. This article describes the most common neuro-imaging patterns of AHT, including extra axial, intra axial, bony, and ligamentous lesions, with a special focus on the dating issue and the differential diagnosis.

The development of cortical functional hierarchy is associated with the molecular organization of prenatal/postnatal periods.

The human cerebral cortex conforms to specific functional hierarchies facilitating information processing and higher-order cognition. Prior studies in adults have unveiled a dominant functional hierarchy spanning from sensorimotor regions to transmodal regions, which is also present in younger cohorts. However, how the functional hierarchy develops and the underlying molecular mechanisms remain to be investigated. Here, we set out to investigate the developmental patterns of the functional hierarchy for preschool children (#scans = 141, age = 2.41-6.90years) using a parsimonious general linear model and the underlying biological mechanisms by combining the neuroimaging developmental pattern with two separate transcriptomic datasets (i.e. Allen Human Brain Atlas and BrainSpan Atlas). Our results indicated that transmodal regions were further segregated from sensorimotor regions and that such changes were potentially driven by two gene clusters with distinct enrichment profiles, namely prenatal gene cluster and postnatal gene cluster. Additionally, we found similar developmental profiles manifested in subsequent developmental periods by conducting identical analyses on the Human Connectome Projects in Development (#scans = 638, age = 5.58-21.92years) and Philadelphia Neurodevelopment Cohort datasets (#scans = 795, age = 8-21years), driven by concordant two gene clusters. Together, these findings illuminate a comprehensive developmental principle of the functional hierarchy and the underpinning molecular factors, and thus may shed light on the potential pathobiology of neurodevelopmental disorders.

From Fetal to Neonatal Neuroimaging in TORCH Infections: A Pictorial Review.

Congenital infections represent a challenging and varied clinical scenario in which the brain is frequently involved. Therefore, fetal and neonatal neuro-imaging plays a pivotal role in reaching an accurate diagnosis and in predicting the clinical outcome. Congenital brain infections are characterized by various clinical manifestations, ranging from nearly asymptomatic diseases to syndromic disorders, often associated with severe neurological symptoms. Brain damage results from the complex interaction among the infectious agent, its specific cellular tropism, and the stage of development of the central nervous system at the time of the maternal infection. Therefore, neuroradiological findings vary widely and are the result of complex events. An early detection is essential to establishing a proper diagnosis and prognosis, and to guarantee an optimal and prompt therapeutic perinatal management. Recently, emerging infective agents (i.e., Zika virus and SARS-CoV2) have been related to possible pre- and perinatal brain damage, thus expanding the spectrum of congenital brain infections. The purpose of this pictorial review is to provide an overview of the current knowledge on fetal and neonatal brain neuroimaging patterns in congenital brain infections used in clinical practice.

Severe cerebellar malformations in mutant mice demonstrate a role for PDGF-C/PDGFRα signalling in cerebellar development.

ABSTRACTFormation of the mouse cerebellum is initiated in the embryo and continues for a few weeks after birth. Double-mutant mice lacking platelet-derived growth factor C (PDGF-C) and that are heterozygous for platelet-derived growth factor receptor alpha (Pdgfc-/-; PdgfraGFP/+) develop cerebellar hypoplasia and malformation with loss of cerebellar lobes in the posterior vermis. This phenotype is similar to those observed in Foxc1 mutant mice and in a human neuroimaging pattern called Dandy Walker malformation. Pdgfc-Pdgfra mutant mice also display ependymal denudation in the fourth ventricle and gene expression changes in cerebellar meninges, which coincide with the first visible signs of cerebellar malformation. Here, we show that PDGF-C/PDGFRα signalling is a critical component in the network of molecular and cellular interactions that take place between the developing meninges and neural tissues, and which are required to build a fully functioning cerebellum.

Beyond the caudate nucleus: Early atypical neuroimaging findings in biotin-thiamine- responsive basal ganglia disease

BackgroundBiotin-thiamine-responsive basal ganglia disease (BTBGD) is a treatable neurometabolic disease caused by variants in SLC19A3. Typical imaging features include symmetrical involvement of the caudate nuclei and putamina. ObjectiveThe study sought to explore classical BTBGD without caudate nucleus involvement, to highlight the importance of recognizing this new pattern early in the disease. MethodsIndividuals with genetically confirmed BTBGD who harbored the same homozygous variant: NM_025243.4 (SLC19A3): c.1264A > G (p.Thr422Ala) and had atypical neuroimaging were recruited. ResultsNine patients with BTBGD had atypical neuroimaging findings on the first MRI scan. The median age at symptom onset was 3 years. All patients presented with classical clinical features of subacute encephalopathy, dystonia, ataxia, and seizures. During the acute crisis, MRI revealed bilateral and symmetric involvement of the putamina in all patients; one showed small caudate nuclei involvement. In addition, the thalami, cerebellum, and brain stem were involved in six patients, seven patients, and three patients, respectively. Treatment included a combination of high doses of thiamine and biotin. One patient died; he did not receive any vitamin supplementation. Two patients who were treated late had severe neurological sequelae, including generalized dystonia and quadriplegia. Six patients treated early had good outcomes with minimal sequelae, including mild dystonia and dysarthria. Two patients showed the classical chronic atrophic and necrotic changes already described. ConclusionThe early atypical neuroimaging pattern of BTBGD described here, particularly the lack of caudate nucleus involvement, should not dissuade the clinician and radiologist from considering a diagnosis of BTBGD.

Surface-based morphological patterns associated with neuropsychological performance, symptom severity, and treatment response in Parkinson's disease.

BackgroundSurface-based cortical morphological patterns provide insight into the neural mechanisms of Parkinson’s disease (PD). Explorations of the relationship between these patterns and the clinical assessment and treatment effects could be used to inform early intervention and treatment planning.MethodsWe recruited 78 PD patients who underwent presurgical evaluation and 55 healthy controls. We assessed neocortical sulcal depth, gyrification index, and fractal dimension and applied a general linear model using the multivariate Hotelling’s t-test to determine the joint effect of surface-based shape abnormalities in PD. The relationship between the neuroimaging pattern and clinical assessment was investigated using a multivariate linear regression model. A machine learning model based on surfaced-based features was used to predict responses to medication and deep brain stimulation (DBS).ResultsThe surface-based neuroimaging pattern of PD included decreases in morphological metrics in the gyrus (left: F=4.32; right: F=4.13), insular lobe (left: F=4.87; right: F=4.53), paracentral lobe (left: F=4.01; right: F=4.26), left posterior cingulate cortex (F=4.48), and left occipital lobe (F=4.27, P<0.01). This pattern was significantly associated with cognitive performance and motor symptoms (P<0.01). The machine learning model using morphological metrics was able to predict the drug response in the tremor score (R=−0.34, P<0.01) and postural instability and gait disorders score (R=0.24, P=0.04).ConclusionsWe identified the surface-based neuroimaging pattern associated with PD and explored its association with clinical assessment. Our findings suggest that these morphological indicators have potential value in informing personalized medicine and patient management.

Phosphatase and tensin homolog (PTEN) variants and epilepsy: A multicenter case series

Purpose: EEG anomalies and epilepsy are a not so rare clinical manifestation in patients with Phosphatase and tensin homolog (PTEN) variants. The main aim of this study is to analyze the characteristics of EEG traces, neuroimaging findings and epilepsy to better define the neurological aspects in a set of patients with PTEN variants collected in four Italian Centres. As a secondary aim, we describe the neurodevelopmental profile and the psychiatric comorbidities of this cohort.Methods: Patients with PTEN variants, identified by Sanger sequencing or target resequencing, were enrolled. For each subjects, clinical data were retrospectively extracted from medical charts, with a focus on epilepsy and neuroimaging data.Results: 54 patients with PTEN variants were enrolled, with a mean age of 18.8 years. 72.2% have at least one psychiatric diagnosis, being Autism Spectrum Disorder and Intellectual Disability the most frequent diagnosis (29 and 25 cases, respectively). 22 subjects show an abnormal EEG and 8 received a diagnosis of epilepsy, mainly focal epilepsy (7/8), with a mean age at seizure onset of 3.8 years. 3/8 subjects have a drug resistant epilepsy, independently from the underlying neuroimaging pattern. The finding of a Focal cortical dysplasia is significantly associated with both an abnormal EEG (p = 0.02) and the occurrence of seizures (p = 0.002).Conclusion: EEG should be taken into consideration in the first-line diagnostic flowchart of subjects with PTEN variants. The onset of a focal epilepsy, independently from its response to antiepileptic drugs, highly recommends to carry out a neuroimaging exam.

Impact of Neuroimaging Patterns for the Detection of Atrial Fibrillation by Implantable Loop Recorders in Patients With Embolic Stroke of Undetermined Source.

ObjectivesAtrial fibrillation (AF) is a well-known etiology of embolic stroke of undetermined source (ESUS), although the optimal detection strategy of AF was not been fully evaluated yet. We assessed AF detection rate by implantable loop recorder (ILR) in patients with ESUS and compared the clinical characteristics and neuroimaging patterns between the patients with AF and AF-free patients.MethodsWe reviewed clinical characteristics and neuroimaging patterns of consecutive patients with who were admitted to our comprehensive stroke center for ESUS and underwent ILR insertion between August 1, 2019, and January 31, 202. The inclusion criteria were (1) 18 years of age or older; (2) classified as having cryptogenic stroke extracted from the group with undetermined stroke according to ESUS International Working Group; and (3) underwent ILR insertion during or after admission due to index ischemic events. Ischemic stroke pattern was classified as (1) tiny-scattered infarction, (2) whole-territorial infarction, (3) lobar infarction and (4) multiple-territorial infarction. Interrogations of data retrieved from the ILR were performed by cardiologists in every month after the implantation.ResultsIn this study, 41 ESUS patients who received an ILR implantation were enrolled (mean age, 64 years; male sex, 65.9%). The rate of AF detection at 6 months was 34% (14 patients), and the mean time from ILR insertion to AF detection was 52.5 days [interquartile range (IQR), 45.0–69.5]. The median initial NIH stroke scale scores were significantly greater in patients with AF than those without AF (6.5 vs. 3.0, p = 0.019). Whole-territorial infarction pattern was significantly more frequent in patients with AF than in those without AF (64.3% vs.11.1%, p = 0.002).ConclusionsHigher covert AF detection rates within the ESUS patients were most often associated with higher NIHSS and whole-territorial infarction patterns on brain imaging.

The Kernohan-Woltman Notch Phenomenon : A Systematic Review of Clinical and Radiologic Presentation, Surgical Management, and Functional Prognosis.

The Kernohan-Woltman notch phenomenon (KWNP) refers to an intracranial lesion causing massive side-to-side mass effect which leads to compression of the contralateral cerebral peduncle against the free edge of the cerebellar tentorium. Diagnosis is based on “paradoxical” motor deficit ipsilateral to the lesion associated with radiologic evidence of damage to the contralateral cerebral peduncle. To date, there is scarce evidence regarding KWNP associated neuroimaging patterns and motor function prognostic factors. A systematic review was conducted on Medline database from inception to July 2021 looking for English-language articles concerning KWNP, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The research yielded 45 articles for a total of 51 patients. The mean age was 40.7 years-old and the male/female sex ratio was 2/1. 63% of the patients (32/51) suffered from head trauma with a majority of acute subdural hematomas (57%, 29/51). 57% (29/51) of the patients were in the coma upon admission and 47% (24/51) presented pupil anomalies. KWNP presented the neuroimaging features of compression ischemic stroke located in the contralateral cerebral peduncle, with edema in the surrounding structures and sometimes compression stroke of the cerebral arteries passing nearby. 45% of the patients (23/51) presented a good motor functional outcome; nevertheless, no predisposing factor was identified. A Glasgow coma scale (GCS) of more than 3 showed a trend (p=0.1065) toward a better motor functional outcome. The KWNP is a regional compression syndrome oftentimes caused by sudden and massive uncal herniation and leading to contralateral cerebral peduncle ischemia. Even though patients suffering from KWNP usually present a good overall recovery, patients with a GCS of 3 may present a worse motor functional outcome. In order to better understand this syndrome, future studies will have to focus on more personalized criteria such as individual variation of tentorial notch width.

Markers of emotion regulation processes: A neuroimaging and behavioral study of reappraising abilities

Emotion regulation (ER) is a core element for individual well-being, and dysregulated emotional states are prominent in several mental disorders. Moreover, dispositional use of adaptive ER strategies, such as cognitive reappraisal, is usually associated to better psychological outcomes and less emotional problems. Thus, identifying markers of emotion dysregulation could serve as a key point for developing treatments against risks of psychopathological outcomes. Neuroimaging techniques could represent a useful tool within these aims, focusing on neurobiological markers of psychopathological illness. Given the well known gender differences in using ER strategies, we examined behavioral and neuroimaging patterns associated with dispositional use of reappraisal among a non-clinical female sample. We found that the individual predisposition to use cognitive reappraisal as an emotion regulation strategy was associated with decreased levels of dysregulation. From a neurobiological perspective, difficulties in using reappraisal were associated with decreased resting-state functional connectivity (rs-FC) between the Middle Temporal Gyrus and occipito-parietal regions. Moreover, rs-FC between prefrontal and occipito-parietal brain regions was negatively associated with emotion dysregulation levels. Microstructural anomalies across white matter tracts connecting temporal, parietal, and occipital brain regions were associated to difficulties in using reappraisal. Our findings suggest that specific behavioral and neurobiological substrates are linked to reappraising abilities. Furthermore, the ability to implement adaptive ER strategies could serve as protective factor against developing emotion dysregulation.

350 Investigating the Architecture of Speech Processing Pathways in the Brain

OBJECTIVES/GOALS: Speech production requires mapping between sound-based and motor-based neural representations of a word – accomplished by learning internal models. However, the neural bases of these internal models remain unclear. The aim of this study is to provide experimental evidence for these internal models in the brain during speech production. METHODS/STUDY POPULATION: 16 healthy human adults were recruited for this electrooculography speech study. 20 English pseudowords were designed to vary on confusability along specific features of articulation (place vs manner). All words were controlled for length and voicing. Three task conditions were performed: speech perception, covert and overt speech production. EEG was recorded using a 64-channel Biosemi ActiveTwo system. EMG was recorded on the orbicularis orbis inferior and neck strap muscles. Overt productions were recorded with a high-quality microphone to determine overt production onset. EMG during was used to determine covert production onset. Neuroimaging: Representational Similarity Analysis (RSA), was used to probe the sound- and motor-based neural representations over sensors and time for each task. RESULTS/ANTICIPATED RESULTS: Production (motor) and perception (sound) neural representations were calculated using a cross-validated squared Euclidean distance metric. The RSA results in the speech perception task show a strong selectivity around 150ms, which is compatible with recent human electrocorticography findings in human superior temporal gyrus. Parietal sensors showed a large difference for motor-based neural representations, indicating a strong encoding for production related processes, as hypothesized by previous studies on the ventral and dorsal stream model of language. Temporal sensors, however, showed a large change for both motor- and sound-based neural representations. This is a surprising result since temporal regions are believed to be primarily engaged in perception (sound-based) processes. DISCUSSION/SIGNIFICANCE: This study used neuroimaging (EEG) and advanced multivariate pattern analysis (RSA) to test models of production (motor-) and perception (sound-) based neural representations in three different speech task conditions. These results show strong feasibility of this approach to map how the perception and production processes interact in the brain.

Study of clinicodemographic profile of acute central nervous system infection in children and its correlation with neuroimaging

Background: Infection of central nervous system (CNS) is most common cause of fever associated with signs and symptoms of CNS disease in children. Viral infections of CNS are more common than other infections. Radiology and pathology go together in understanding etiology causing CNS infections which have similar clinical manifestations making specific diagnosis difficult. The present study aims to study the utility of different neuroimaging patterns in diagnosis of acute CNS infection. Aims include: to study utility and pattern of neuroimaging in CNS infection in paediatric age group, and to study socio-demographic and clinical profile of CNS infection in children.Methods: Prospective observational study in children 1 month-12 years who presented with CNS infection.Results: Total 58 cases were suspected to have CNS infection, which was more prevalent in 1 month-1 year (27.58%), followed by 5-8 year (24.13%), 1-3 year (22.41), &gt;8 year (20.68%) and 3-5 year (5.17%). Neuroimaging was done in all suspected case (58) of CNS infection in which 30 (51.7%) had abnormal neuroimaging where 3(10%) showed pyogenic meningitis, 7 (23.23%) tubercular meningitis (TBM), 4 (13.13%) tuberculoma, 3 (10%) TBM and tuberculoma, 4 (13.3%) viral meningitis, 1 (3.3%) herpes simplex encephalitis (HSE), 1 (3.3%) COVID encephalitis, 4 (13.3%) acute disseminated encephalomyelitis (ADEM) while 2 (6.66%) brain abscess. Correlation between final diagnosis and neuroimaging was 100% in ADEM, brain abscess, tuberculoma, TB spine, HSV followed by TBM (77.77%), pyogenic meningitis (27.27%) and viral encephalitis (26.66%). Clinically diagnosed acute CNS infection was confirmed in 51.72% and wrong in 48.27%.Conclusions: CNS infections were more common in less than 5 years age. Approximately 50% patients had abnormal neuroimaging finding. It was found that neuroimaging was more accurate in early diagnosis, categorization of CNS infection and detection of complications with high sensitivity.

Random Network and Non-rich-club Organization Tendency in Children With Non-syndromic Cleft Lip and Palate After Articulation Rehabilitation: A Diffusion Study.

ObjectiveThe neuroimaging pattern in brain networks after articulation rehabilitation can be detected using graph theory and multivariate pattern analysis (MVPA). In this study, we hypothesized that the characteristics of the topology pattern of brain structural network in articulation-rehabilitated children with non-syndromic cleft lip and palate (NSCLP) were similar to that in healthy comparisons.MethodsA total of 28 children with NSCLP and 28 controls with typical development were scanned for diffusion tensor imaging on a 3T MRI scanner. Structural networks were constructed, and their topological properties were obtained. Besides, the Chinese language clear degree scale (CLCDS) scores were used for correlation analysis with topological features in patients with NSCLP.ResultsThe NSCLP group showed a similar rich-club connection pattern, but decreased small-world index, normalized rich-club coefficient, and increased connectivity strength of connections compared to controls. The univariate and multivariate patterns of the structural network in articulation-rehabilitated children were primarily in the feeder and local connections, covering sensorimotor, visual, frontoparietal, default mode, salience, and language networks, and orbitofrontal cortex. In addition, the connections that were significantly correlated with the CLCDS scores, as well as the weighted regions for classification, were chiefly distributed in the dorsal and ventral stream associated with the language networks of the non-dominant hemisphere.ConclusionThe average level rich-club connection pattern and the compensatory of the feeder and local connections mainly covering language networks may be related to the CLCDS in articulation-rehabilitated children with NSCLP. However, the patterns of small-world and rich-club structural organization in the articulation-rehabilitated children exhibited a random network and non-rich-club organization tendency. These findings enhanced the understanding of neuroimaging patterns in children with NSCLP after articulation rehabilitation.

Abstract TP172: Clinical And Neuroimaging Predictors Of Dyskinetic Cerebral Palsy

Background: Dyskinetic cerebral palsy (DCP) is a non-progressive disorder that results from lesions to the developing fetal brain. Neuroimaging patterns and risk factors for DCP in pre-term infants are poorly understood. Furthermore, neuroimaging differences between preterm and term infants with DCP and its relationship to clinical outcomes are not well established. Objectives: 1) To describe neuroimaging differences between term and preterm infants with DCP. 2) To investigate relationships between neuroimaging patterns and clinical motor outcome of infants with DCP. Methods: Patients with DCP were identified through The Cerebral Palsy Network where clinical details and magnetic resonance images (MRI) were collected on children with DCP. To determine lesion volume and location, manual segmentation was performed using ITK-SNAP software by study neuroradiologist. Lesion severity was graded using a semi-quantitative scale for structural MRIs(Laporta-Hoyos et al. 2018) based on the number of lobes and subcortical structures involved. Motor outcomes was assessed with the Gross Motor Function Classification System. Results: Twenty-nine patients with DCP were identified. Preterm infants (n=12, [male= 8, female=4]), and term infants (n=16 term, [male= 6, female=10]) differed in mean gestational age (30.5 versus 39.1 weeks respectively, p=.02). The frequency of periventricular leukomalacia in preterm (89%) and term-born (58%) infants differed (p = 0.02). Lesion severity was associated with: the ventral posterior lateral (VPL) thalamus (r=0.574,p =.01), the posterior limb of the internal capsule (PLIC) (r=0.437p = .04) in term infants, and the right (r = 0.504, p = .01) and left putamen r = 0.629, p = .002) in term infants. Significant negative correlations were found between lesion severity and gross motor function in the VPL thalamus (r= -0.624, p = .001), PLIC (r= -0.735, p &lt; .001), right (r= -0.50, p= .016) and left putamen (r= -0.54 p = .008). Conclusion: Our results suggest the timing of lesions in term-born and preterm infants with DCP are associated with neuroimaging lesion patterns. Involvement of subcortical structures and lesion severity scores were associated with gross motor function in this cohort of patients with DCP.

Abstract TMP20: Cerebrovascular Injury Associated With COVID-19 And Non-COVID-19 Acute Respiratory Distress Syndrome

Background: Neurologic complications of Coronavirus Disease 2019 (COVID-19) may be associated with neurotropism of the virus or secondary brain injury from systemic inflammation. Acute respiratory distress syndrome (ARDS) is associated with cerebrovascular injury, including both ischemia and hemorrhage. We aimed to compare brain MRI findings of COVID-19 associated ARDS with non-COVID-19 ARDS. Methods: A registry of patients with COVID-19 from March 2020 through July 2021 from a hospital network was reviewed. Patients who met criteria for ARDS by Berlin definition and underwent MRI during their hospitalization were included. These patients were matched 1:1 by age and sex with patients who underwent MRI from another registry of patients of ARDS in the same hospital between 2010 and 2018. Cerebrovascular injury was classified as either acute cerebral ischemia (ischemic infarct or hypoxic ischemic brain injury) or intracranial hemorrhage (ICH) including intraparenchymal hemorrhage, subarachnoid hemorrhage, subdural hematoma, and cerebral microbleeds (CMBs). Results: Of 13,319 patients with COVID-19 infection, 26 patients had ARDS and MRI. Sixty-six of 678 non-COVID-19 ARDS patients had an MRI and were matched 1:1 by age and sex resulting in 23 matched pairs. The median age was 66 and 59% of patients were male. Patients with COVID-19 ARDS were more likely to have hypertension and chronic kidney disease but otherwise baseline medical characteristics were similar. ARDS severity as determined by PaO2/FiO2 ratio at ICU admission was similar between both groups. No difference was seen in the prevalence of cerebrovascular injury (52% vs 61%, p=0.8), cerebral ischemia (35% vs 43%, p=0.8), ICH (43% vs 48%, p=1.0), or CMBs (43% vs 39% p=1.0) on MRI between the COVID-19 and non-COVID-19 cohorts. However, two unique patterns of injury were seen only among COVID-19 patients: hemorrhagic leukoencephalitis (3 patients, 12%) and bilateral cerebral peduncular ischemia with microhemorrhage (2 patients, 8%). Conclusion: Cerebrovascular injury was common in both COVID-19 and non-COVID-19 ARDS without significant frequency difference. However, COVID-19 ARDS had unique neuroimaging patterns that may indicate distinct patterns of brain injury of COVID-19.