Posterior Limb Of Internal Capsule Research Articles

Neonatal meningitis: Preterm and term infants evaluated by magnetic-resonance-imaging-based score analysis

ObjectivesTo investigate the difference of brain damages between preterm and term infants with bacterial meningitis by using MRI-based score analysis. MethodsThe clinical information and MRI dataset of 65 newborns with meningitis were reviewed, including 18 preterm infants and 47 term ones. There were 13 basic brain injury patterns identified on cranial MRI. And the severity of these injuries was graded from score 1 to 3. These 13 patterns were further classified into three major groups – white matter abnormalities (WMA), gray matter abnormalities (GMA) and non-parenchyma abnormalities (NPA). ResultsOf all the newborns, 63% presented with cerebral lesions (41/65) and 3% presented with cerebral plus cerebellar damages (2/65). The incidence and MRI-based score of abnormal myelination of the posterior limb of internal capsules, ventricular dilatation and periventricular white matter volume loss were significantly higher in the preterm than the term group. Regarding WMA, GMA and NPA, the score of WMA in the preterm group was significantly higher than that of the term group (p = .000). While, the differences of GMA and NPA scores between the preterm and the term groups were not significant (p = .076, .224, respectively). ConclusionWhite matter abnormalities were more frequently seen in the preterm infants with meningitis.

Evaluation of Ataxia in Mild Ischemic Stroke Patients Using the Scale for the Assessment and Rating of Ataxia (SARA).

ObjectiveTo demonstrate the utility of Scale for the Assessment and Rating of Ataxia (SARA) for evaluation of posterior circulation-related features in patients with mild stroke.MethodsForty-five subjects, diagnosed with acute infarction in the cerebellum, basis pontis, thalamus, corona radiata, posterior limb of internal capsule, and their National Institutes of Health Stroke Scale (NIHSS) scores ≤5 were enrolled. SARA scores were graded by the cut-off value of severity in dependency of activities of daily living (ADL). SARA, Berg Balance Scale (BBS), Timed Up-and-Go (TUG), and Trunk Control Test (TCT) were correlated in regression analysis with the modified Rankin Scale (mRS) at discharge. Correlation between SARA and other tools was analyzed. Patients were divided based on mRS at admission (group A, mRS 0–2; group B, mRS 3–5). Scores between the two groups were compared.ResultsAmong the subjects, 48.9% (22/45) scored above 5.5 on SARA, and even 11.1% (5/45) scored higher than 14.25, which is the cut-off value of ‘severe dependency’ in ADL. SARA showed significant value for prediction of mRS at discharge. SARA was correlated with BBS (r=-0.946, p<0.001), TUG (r=-0.584, p<0.001), and TCT (r=-0.799, p<0.001). The SARA, BBS, TUG, and TCT scores between were lower in group B than in group A patients. SARA as well as BBS, TUG, and TCT reflect the functional severity of all patients. ConclusionSARA is a complementary tool for evaluation of the severity of ataxia in mild stroke patients with features of posterior circulation.

Late neuroimaging predicts neurodevelopmental outcomes in preterm infants.

Commentary on: Hintz S, Barnes P, Bulas D, Slovis T, Finer N, Wrage L, et al. Neuroimaging and neurodevelopmental outcome in extremely preterm infants. Pediatrics 2015; 135: e32–42. Neurodevelopmental outcomes are a crucial part of prognosis and are pivotal in ongoing conversations between neonatologists and parents 1, 2. Recent studies show greater predictive value in near-term cranial ultrasound (CUS) and MRI versus traditional CUS performed in the first few weeks of life 1-3. MRI detects white matter injury more accurately while US detects intraventricular haemorrhages, ventriculomegaly and cystic periventricular leukomalacia 2, 4, 5. However, studies have found former preterm infants with developmental impairments despite normal NICU ultrasounds, and, importantly, others have reported transient findings of cystic periventricular leukomalacia (resolving by near-term) are associated with developmental impairments 2, 6, 7. The NEURO prospective study by Hintz et al. 8 analysed the predictive ability of early CUS, near-term CUS and near-term MRI in a cohort of 480 extremely preterm neonates, born at 24–27 weeks. Negative outcomes were defined as neurodevelopmental impairment, significant gross motor impairment or death. The authors provided multivariable modelling to consider perinatal and neonatal demographic and clinical risk factors. Results were presented as OR and AUC of ROC curves. Further statistical calculations of Tables 2–5 show sensitivity and specificity of 0.27 and 0.92, respectively, for the association between major findings in early CUS and negative outcomes of neurodevelopmental impairment or death, compared to sensitivity of 0.28 and specificity of 0.97 for major findings in late CUS. The calculated sensitivity and specificity of MRI WMA are similar to that reported by Woodward et al. 4 in 2006 (92% vs 84% and 23% vs 34%, respectively), demonstrating that MRI has potential for higher sensitivity than CUS. The major findings of the NEURO study were that early CUS is not predictive of future neurodevelopmental outcomes, despite taking into account perinatal and neonatal demographic and clinical risk factors. The ability to predict outcomes is only mildly enhanced by the addition of MRI to late CUS. Therefore, in environments where MRI is not easily available, late CUS may be sufficient in predicting prognosis. The strengths of the NEURO study included large population size, blinded imaging evaluations, required temporal proximity of late CUS and MRI. Limitations included that CUS was obtained by local centre protocol with possibility for technical inconsistencies, and there were low rates of adverse outcomes, leading to wide confidence intervals. While multivariable modelling taking into account neonatal risk factors scrutinises results, a drawback is potential over-analysis. Near-term CUS and MRI have been shown to be more reliable alternatives to early CUS in predicting outcomes, but imaging is only mildly effective in formulating predictions of neurodevelopmental outcomes in extremely premature neonates 2, 4, 9. There is still considerable uncertainty regardless of imaging modality or combination of imaging modalities used. Studies have shown that MRI before discharge is too early to detect posterior limb internal capsule myelination abnormalities, which have been shown to be associated with gross motor deficits 3, 5. Extending outcomes to include cognitive and behavioural difficulties of school-age ex-premature neonates will detect deficits not fully appreciated on Bayley or GMFCS testing 2, 9. https://ebneo.org/2018/06/late-neuroimaging-predicts-neurodevelopmental-outcomes-in-preterm-infants/ None. None.

Conventional MRI scan and DTI imaging show more severe brain injury in neonates with hypoxic-ischemic encephalopathy and seizures

BackgroundNeonates with hypoxic-ischemic encephalopathy (HIE) and seizures have poorer outcome for undetermined reasons. AimsOur aim was to determine if brain imaging was more abnormal in neonates with HIE and electrographically confirmed seizures and whether this was impacted by seizure burden. Study designSingle center retrospective review. SubjectsForty-eight term neonates with HIE (with and without seizures) underwent MRI brain scans before age 14 days between the years 2008 and 2013. Outcome measuresImages were rated using a MRI injury score and fractional anisotropy (FA) values were extracted from diffusion tensor imaging (DTI). ResultsThe seizure group (n = 25) had significantly more injury within white matter, basal ganglia, posterior limb of internal capsule, and watershed areas compared to the group without seizures (n = 23). The severity of injury in all measured areas increased with increasing seizure severity. The seizure group also had lower FA values in posterior limb of the internal capsule and the splenium of corpus callosum. ConclusionsNeonates with HIE and seizures had more brain injury that occurred in areas typically affected by HIE and was greater with higher seizure burden. Seizures may be a marker of more severe brain injury or seizures themselves may amplify brain damage from HIE.

Preliminary Study of Diffusion Kurtosis Imaging in Mild Traumatic Brain Injury

Background: Traumatic brain injury (TBI) can result from blunt trauma or acceleration/deceleration force and is considered to be one of the most important public health problems. Many patients of TBI lose professional competence and independence. They may eventually suffer serious sequelae, such as cognitive impairment, memory loss, and long-term headache. In craniocerebral trauma patients, mild traumatic brain injury accounts for 70% - 80% of the cases. Early diagnosis and intervention can decrease the post-concussional sequelae for mild TBI (mTBI). Objectives: To investigate the value of diffusion kurtosis imaging (DKI) in mild traumatic brain injury (mTBI) patients. Patients and Methods: Conventional MRI sequences (T1 and T2 weighted images) and DKI scans of 25 healthy controls and 24 mTBI patients were obtained. Regions of interests (ROIs) were drawn and analyzed on several planes including white matter, deep gray matter nuclei, peri-contusion and contusion lesion on fused fractional anisotropy (FA), mean diffusion (MD) maps, and mean kurtosis (MK) maps, respectively. FA, MD, and MK values were measured in a certain region (he area of bilateral centrum semiovale (CS), corona radiate (CR), caudate nucleus head (CNH), genu of corpus callosum (CCG), corpus callosum splenium (CCS), anterior limb of the internal capsule (ALIC), posterior limb of internal capsule (PLIC), external capsule (EC), lenticular nucleus (LN), and thalamus). Student’s t test was used to compare the average values of FA, MD, and MK between mTBI patients and healthy controls. Paired t-test was also used to compare contusion lesions and mirror symmetrical areas. Results: FA and MK values were significantly different in all of the white matter and grey matter, while MD values among the various ROIs were insignificantly different in the healthy control group. In mTBI patients, the FA values of genu of corpus callosum, splenium of corpus callosum, and external capsule were decreased. Whereas, MD value of genu of corpus callosum in trauma group was increased. Except for the head of the caudate nucleus and posterior limb of the internal capsule, the MK values of the rest of the ROIs in the trauma group decreased significantly. Moreover, compared with the contra-lateral, there were more significant contusion lesions of FA and MK reductions than increased MD values. FA and MD values of peri-contusion had no significant difference compared with the contra-lateral while MK values decreased significantly. Conclusion: Compared with conventional MRI sequences, DKI can detect micro white matter injury, and MK parameter is more sensitive than FA and MD. In addition, DKI can find these changes not only in the white matter but also in deep gray matter nucleus, making it a promising imaging tool to assist the detection of mild traumatic brain injury.

White matter asymmetries in patients with cerebral small vessel disease.

White matter asymmetries of the human brain have been well documented using diffusion tensor imaging. The purpose of this study was to investigate white matter asymmetry across the whole brain in cerebral small vessel disease patients and evaluate the relation between the factors which often represent disease existence and white matter asymmetry. A total of 105 nondemented elderly subjects with cerebral small vessel disease aged between 60 and 85 years were included in this study. All subjects underwent T1 MPRAGE, fluid-attenuated inversion recovery, and diffusion tensor imaging scanning. With tract-based spatial statistics in diffusion tensor imaging, this study examined the white matter asymmetries and the correlations between white matter asymmetries and four distinct factors such as deep white matter hyperintensities score, periventricular hyperintensities score, cerebral microbleed number and lacune number. The study suggested the asymmetric microstructural change in small vessel disease patients involving the right side being more injured than the left. The four factors jointly affect right brain anisotropy decrease in the middle cerebellar peduncle, the cerebral peduncle, the pontine crossing tract, the corticospinal tract, the medial lemniscus, the posterior limb of internal capsule, and the frontal pattern of white matter. Results of the study demonstrated the lost right white matter may be the main origin of dysfunction in small vessel disease patients. This asymmetry should help with the evaluation of prognostic indicators of disease progression in lesion-based neuropathology..

Therapeutic hypothermia for neonatal hypoxic-ischemic encephalopathy: magnetic resonance imaging findings and neurological outcomes in a Brazilian cohort

Objective: To determine the neurodevelopment outcomes after therapeutic hypothermia for neonatal hypoxic-ischemic encephalopathy (HIE) and identify the neonatal magnetic resonance imaging (MRI) findings associated with neurological outcome in a middle-income country.Study design: All infants born after 35 completed weeks’ gestation with signs of moderate to severe encephalopathy and evidence of perinatal asphyxia before 6 hours of life were submitted to whole-body hypothermia and were imaged at 18 ± 8.4 days of life (range 7–33 days) after birth. Surviving infants had the neurodevelopment outcome assessed at 12 to 18 months of age by trained professional masked to MRI findings.Results: Forty-eight infants included, MRI scans were obtained from 34 infants; 14 (29.1%) patients died during hospitalization before MRI was performed. Nine (64.3%) of 14 patients were classified as severe encephalopathy presented Posterior Limb Internal Capsule (PLIC) sign at the MRI, 10 (71.4%) thalamus and basal ganglia (TBG) lesion, 9 (64.3%) white matter (WM) lesion, and 7 (50.0%) cortical lesion. Severe encephalopathy was associated with the motor delay at 12–18 months by Bayley III, Alberta Infant Motor Scale (AIMS), and Gross Motor Function Classification System (GMFCS) scores (p = .020, p = .048, p = .033, respectively), but not for the cognitive (p = .167) or language skills (p = .309). Lower BSID-III motor, cognitive, and language composite scores were associated with PLIC sign (p = .047; p = .006 and p = .003, respectively). TBG lesion (p = .051) and cortical lesion (p = .030) were associated with lower language composite score. Motor delay by AIMS and the presence of PLIC sign, TBG lesion, WM lesion, and Cortical lesion on MRI were observed (p < .001; p = .002; p = .001 and p = .027, respectively); as well as higher GMFCS score were associated with the presence of PLIC sign, TBG lesion, WM lesion, and Cortical lesion on MRI (p < .001; p = .001; p = .001, and p = .011, respectively).Conclusions: Brain MRI in neonates with HIE after therapeutic hypothermia is a valuable tool for diagnosis of encephalopathy cerebral abnormalities and is an early predictor of outcome in infants treated with whole body hypothermia for HIE in the Brazilian experience.

White matter integrity correlates with residual consciousness in patients with severe brain injury.

Previous studies have suggested that white matter disruption plays an important role in disorders of consciousness (DOC) after severe brain injury. Nevertheless, the integrity of white matter architecture supporting consciousness and its relations with clinical severity in patients with DOC remain to be established. In this study, diffusion tensor imaging (DTI) data was collected from 14 DOC patients and 15 healthy control subjects. We combined tract-based spatial statistics (TBSS) with region of interest (ROI) analysis to examine differences of DTI metrics on white matter skeletons between DOC patients and healthy controls, and the association between white matter integrity and patients' residual consciousness assessed by Coma Recovery Scale-Revised (CRS-R). We found that: (1) patients with DOC had widespread white matter integrity disruptions, especially in the fornix; (2) the alteration of white matter microstructure was mainly attributed to the increase in radial diffusivity, possibly reflecting demyelination; (3) the behavioral CRS-R assessment score was positively correlated with white matter integrity in the fornix, uncinate fasciculus, pontine crossing tract, and posterior limb of internal capsule. Our results suggest that despite the widespread abnormalities of white matter following severe brain injury, the impairment of consciousness is likely to result from disruptions of key pathways that link brain regions in distributed networks.

Abstract WP413: White Matter Tract Disruption on Diffusor Tensor Imaging is Associated With Serum Ceramides in a Healthy Middle-Aged High Risk Population

Introduction: White matter tract disruption (WMTD) on Diffusion Tensor Imaging (DTI) may reflect early axonal disruption and tract injury and identify risk for dementia. Brain ceramides play a role in processes also associated with dementia risk. We hypothesized that circulating ceramide levels might serve as biomarkers of WMTD in a population at high risk for early vascular disease. We studied six ceramides and WMTD using fractional anisotropy (FA) on DTI in healthy relatives of patients with early coronary disease. We have previously shown a high prevalence of white matter hyperintensities (WMH) and significant associations between WMH volumes, FA, and lower cognitive function in healthy relatives. Methods: DTI was acquired with Phillips 3T MRI. FA was measured for 181 regions of the segmented brain using Eve atlas. 48 relevant regions with susceptibility for WMTD were analyzed. Serum ceramides were measured using high performance liquid chromatography. Spearman correlations and GEE linear regression analyses (adjusted for age, sex, race, education and family relatedness) were used. We set the significance level to meet the Bonferroni threshold of 0.00017 (0.05 / 48 regions/6 ceramides). Results: Subjects, N=112, had a mean age of 49± 11 years; education 14 ± 3 years; 49% male; 39% African American, 61% European American). Serum levels for ceramides designated C18:0, C20:0, and C22:0 were significantly negatively correlated with FA in the right fornix (C18:0, R=-0.40, p=1.3 x10 -5 , C20:0, R=-0.41, p= 6.1 x 10 -6 , C22:0, R=-0.33, p=4.3 x10 -4 ). C18:0 was negatively correlated with the left genu of corpus callosum (R=-0.39, p=2.6 x10 -5 ) and right body of corpus callosum (R=-0.31, p=8.5 x10 -4 ). An additional ceramide, C24:0, was correlated with both sides of the posterior limb of internal capsule (left R=0.34, p=2.5 x10 -4 ; right R=0.34, p=2.8 x10 -4 ). All ceramide-FA associations were significant (p&lt;0.05) after fully adjusted GEE regression. Conclusions: We show a robust relationship between serum ceramides and WMTD using FA in a middle-aged, cognitively intact at-risk population enriched for early WMH. Thus, serum ceramide levels may reflect subtle alterations in white matter tract microstructure at an early preclinical stage. &lt;!--EndFragment--&gt;

Differential effect of disease-associated ST8SIA2 haplotype on cerebral white matter diffusion properties in schizophrenia and healthy controls

Brain white matter abnormalities are evident in individuals with schizophrenia, and also their first-degree relatives, suggesting that some alterations may relate to underlying genetic risk. The ST8 alpha-N-acetyl-neuraminide alpha-2,8-sialyltransferase 2 (ST8SIA2) gene, which encodes the alpha-2,8-sialyltransferase 8B enzyme that aids neuronal migration and synaptic plasticity, was previously implicated as a schizophrenia susceptibility gene. This study examined the extent to which specific haplotypes in ST8SIA2 influence white matter microstructure using diffusion-weighted imaging of individuals with schizophrenia (n = 281) and healthy controls (n = 172), recruited across five Australian sites. Interactions between diagnostic status and the number of haplotype copies (0 or ≥1) were tested across all white matter voxels with cluster-based statistics. Fractional anisotropy (FA) in the right parietal lobe was found to show a significant interaction between diagnosis and ST8SIA2 protective haplotype (p < 0.05, family-wise error rate (FWER) cluster-corrected). The protective haplotype was associated with increased FA in controls, but this effect was reversed in people with schizophrenia. White matter fiber tracking revealed that the region-of-interest was traversed by portions of the superior longitudinal fasciculus, corona radiata, and posterior limb of internal capsule. Post hoc analysis revealed that reduced FA in this regional juncture correlated with reduced IQ in people with schizophrenia. The ST8SIA2 risk haplotype copy number did not show any differential effects on white matter. This study provides a link between a common disease-associated haplotype and specific changes in white matter microstructure, which may relate to resilience or risk for mental illness, providing further compelling evidence for involvement of ST8SIA2 in the pathophysiology of schizophrenia.

Neuroimaging Identifies Patients Most Likely to Respond to a Restorative Stroke Therapy.

Patient heterogeneity reduces statistical power in clinical trials of restorative therapies. Valid predictors of treatment responsiveness are needed, and several have been studied with a focus on corticospinal tract (CST) injury. We studied performance of 4 such measures for predicting behavioral gains in response to motor training therapy. Patients with subacute-chronic hemiparetic stroke (n=47) received standardized arm motor therapy, and change in arm Fugl-Meyer score was calculated from baseline to 1 month post-therapy. Injury measures calculated from baseline magnetic resonance imaging included (1) percent CST overlap with stroke, (2) CST-related atrophy (cerebral peduncle area), (3) CST integrity (fractional anisotropy) in the cerebral peduncle, and (4) CST integrity in the posterior limb of internal capsule. Percent CST overlap with stroke, CST-related atrophy, and CST integrity did not correlate with one another, indicating that these 3 measures captured independent features of CST injury. Percent injury to CST significantly predicted treatment-related behavioral gains (r=-0.41; P=0.004). The other CST injury measures did not, neither did total infarct volume nor baseline behavioral deficits. When directly comparing patients with mild versus severe injury using the percent CST injury measure, the odds ratio was 15.0 (95% confidence interval, 1.54-147; P<0.005) for deriving clinically important treatment-related gains. Percent CST injury is useful for predicting motor gains in response to therapy in the setting of subacute-chronic stroke. This measure can be used as an entry criterion or a stratifying variable in restorative stroke trials to increase statistical power, reduce sample size, and reduce the cost of such trials.

Aphasia Following Left Putaminal Hemorrhage at a Rehabilitation Hospital

Objective: We aimed to clarify the relationship between aphasia and hematoma type/volume in patients with left putaminal hemorrhage admitted to a rehabilitation facility. Methods: We evaluated the relationship between the presence, type, and severity of aphasia and hematoma type/volume in 92 patients with putaminal hemorrhage aged 29-83 years. Hematoma type and volume were evaluated on the basis of CT images obtained at stroke onset. The Standard Language Test for Aphasia was conducted as part of the initial assessment. Results: Aphasia was observed in 79 of 92 patients. A total of 31 patients had fluent aphasia, while 48 had non-fluent aphasia. Non-fluent aphasia often involved hematoma on the anterior limb of the internal capsule, while fluent aphasia often involved hematoma on the posterior limb of internal capsule. When the hematoma volume exceeded 20 mL, patients experienced difficulty in repeating spoken words. When hematoma volume exceeded 40 mL, non-fluent aphasia was observed in all patients. Conclusion: Our findings suggest that hematoma type and volume not only influence the development of aphasia following putaminal hemorrhage but also play a major role in determining the patient's fluency and repetition ability.

Effects of early nutrition and growth on brain volumes, white matter microstructure, and neurodevelopmental outcome in preterm newborns.

BackgroundThis study aimed to investigate the effect of nutrition and growth during the first 4 weeks after birth on cerebral volumes and white matter maturation at term equivalent age (TEA) and on neurodevelopmental outcome at 2 years' corrected age (CA), in preterm infants.MethodsOne hundred thirty-one infants born at a gestational age (GA) <31 weeks with magnetic resonance imaging (MRI) at TEA were studied. Cortical gray matter (CGM) volumes, basal ganglia and thalami (BGT) volumes, cerebellar volumes, and total brain volume (TBV) were computed. Fractional anisotropy (FA) in the posterior limb of internal capsule (PLIC) was obtained. Cognitive and motor scores were assessed at 2 years' CA.ResultsCumulative fat and enteral intakes were positively related to larger cerebellar and BGT volumes. Weight gain was associated with larger cerebellar, BGT, and CGM volume. Cumulative fat and caloric intake, and enteral intakes were positively associated with FA in the PLIC. Cumulative protein intake was positively associated with higher cognitive and motor scores (all P<0.05).ConclusionOur study demonstrated a positive association between nutrition, weight gain, and brain volumes. Moreover, we found a positive relationship between nutrition, white matter maturation at TEA, and neurodevelopment in infancy. These findings emphasize the importance of growth and nutrition with a balanced protein, fat, and caloric content for brain development.

Neurological prognostic value of gray-white-matter ratio in patients after respiratory and cardiac arrest

To evaluate the role of gray-white-matter ratio (GWR) on neurological outcome in patients with coma after cardiopulmonary resuscitation (CPR) post-respiratory and cardiac arrest (CA). Respiratory and CA patients with restoration of spontaneous circulation (ROSC) and coma after CPR admitted to Nanjing Drum Tower Hospital Clinical Medical College of Nanjing Medical University from February 2013 to June 2016 were enrolled. All patients were subjected to target temperature management (TTM) after CPR, and received cranial CT within 5 days after ROSC. Attenuation (hounsfield units) was measured at special sites (basal ganglia, centrum semiovale), and specific locus (caudate nucleus, put amen, corpus callosum, posterior limb of internal capsule, medial cortex, medial white matter). The GWR was calculated for basal ganglia and cerebrum. Neurological outcome was judged according to the Glasgow-Pittsburgh cerebral performance category (CPC) at 3 months after ICU discharge. CPC 1-3 were divided into good prognosis, CPC 4-5 were divided into poor prognosis. The receiver-operating characteristic (ROC) curve was drawn to evaluate the prognostic value of GWR in patients with respiratory and CA. Forty-three patients were enrolled, including 26 males and 17 females; age (63±15) years old; 14 good prognosis and 29 poor prognosis. Compared with the good prognosis group, the basal ganglia GWR (GWRbg) and the average GWR (GWRav) were significantly lowered in the poor prognosis group (1.064±0.103 vs. 1.163±0.818, 1.068±0.087 vs. 1.128±0.071, both P < 0.05), the centrum semiovale GWR (GWRce) was similar to that in the good prognosis group (1.072±0.077 vs. 1.092±0.075, P > 0.05). It was shown by ROC curve analysis that the GWRbg, GWRav could evaluate the neurological outcomes of patients, but GWRce could not. The area under the ROC curve (AUC) of GWRbg was 0.756 [95% confidence interval (95%CI) = 0.607-0.905, P = 0.007], the cut-off value was 1.13, the sensitivity was 71.4%, and specificity was 69.0%; the AUC of GWRav was 0.701 (95%CI = 0.532-0.869, P = 0.035), the cut-off value was 1.13, the sensitivity was 71.4%, and specificity was 65.5%; the AUC of GWRce was 0.590 (95%CI = 0.405-0.775, P = 0.344). Respiratory and CA patients receiving TTM with high GWR had favorable neurological outcome. GWR, especially GWRbg could provide help for clinical treatment and prognostic value of survival after CA.

Comparison of fractional anisotropy and apparent diffusion coefficient among hypoxic ischemic encephalopathy stages 1, 2, and 3 and with nonasphyxiated newborns in 18 areas of brain.

Purpose:To determine the area and extent of injury in hypoxic encephalopathy stages by diffusion tensor imaging (DTI) using parameters apparent diffusion coefficient (ADC) and fractional anisotropy (FA) values and their comparison with controls without any evidence of asphyxia. To correlate the outcome of hypoxia severity clinically and significant changes on DTI parameter.Materials and Methods:DTI was done in 50 cases at median age of 12 and 20 controls at median age of 7 days. FA and apparent diffusion coefficient (ADC) were measured in several regions of interest (ROI). Continuous variables were analyzed using Student's t-test. Categorical variables were compared by Fisher's exact test. Comparison among multiple groups was done using analysis of variance (ANOVA) and post hoc Bonferroni test.Results:Abnormalities were more easily and accurately determined in ROI with the help of FA and ADC values. When compared with controls FA values were significantly decreased and ADC values were significantly increased in cases, in ROI including both right and left side of thalamus, basal ganglia, posterior limb of internal capsule, cerebral peduncle, corticospinal tracts, frontal, parietal, temporal, occipital with P value < 0.05. The extent of injury was maximum in stage-III. There was no significant difference among males and females.Conclusion:Compared to conventional magnetic resonance imaging (MRI), the evaluation of FA and ADC values using DTI can determine the extent and severity of injury in hypoxic encephalopathy. It can be used for early determination of brain injury in these patients.

Role of magnetic resonance diffusion tensor imaging on prognostic evaluation of term neonates with asphyxia

Objective To discuss the prognostic evaluation of magnetic resonance diffusion tensor imaging (DTI)in term neonates with mild and severe asphyxia. Methods Eleven neonates with mild asphyxia, 14 neonates with severe asphyxia and 10 control neonates were studied.All the neonates were examined by conventional magnetic resonance imaging(MRI) and DTI.Fraction anisotropy (FA) values, apparent diffusion coefficient (ADC) values, voxel numbers and fiber numbers were calculated in seven regions of interest(ROI) and compared among the 3 groups.The correlation between FA values and neonatal behavioral neurological assessment(NBNA)scores were analyzed. Results (1) FA values in the left and the right thalamus were 0.54±0.08 and 0.56±0.15 in control group, 0.45±0.03 and 0.44±0.10 in mild group, and 0.21±0.11 and 0.25±0.13, respectively in severe group .FA values in posterior limbs of internal capsule were 0.49±0.09 and 0.48±0.08 in control group, 0.37±0.08 and 0.38±0.03 in mild group, and 0.20±0.04, 0.19±0.13 in severe group; FA values in thalamus and posterior limbs of internal capsule had statistical differences among the 3 groups(F=9.12, 9.11, 8.18, 8.55, all P<0.05). Voxel numbers in the left and the right superior longitudinal fasciculus were 1 094±112 and 1 123±113 in control group, 986±111 and 1 009±144 in mild group, 450±116 and 671±126 in severe group.Voxel numbers in anterior limbs of internal capsule were 947±104 and 1 237±184 in control group, 854±118 and 799±114 in mild group, 324±110 and 311±126 in severe group.Voxel numbers in posterior limbs of internal capsule were 2 047±129 and 2 137±238 in control group, 1 843±233 and 1 753±247 in mild group, 867±118 and 999±167 in severe group.Voxel numbers in superior longitudinal fasciculus, anterior and posterior limbs of internal capsule had statistical differences among the 3 groups(F=10.11, 9.45, 7.33, 8.45, 12.65, 11.23, all P<0.05); Fiber numbers in the left and the right cingulate gyrus were 245±72 and 405±94 in control group, 225±52 and 365±114 in mild group, 145±62 and 185±84 in severe group.Fiber numbers in inferior front-occipital fasciculus were 56±19 and 212±33 in control group, 49±22 and 197±33 in mild group , 33±12 and 156±39 in severe group.Fiber numbers in posterior limbs of internal capsule were 284±112 and 988±233 in control group, 234±67 and 678±234 in mild group, 114±67 and 188±84 in severe group.Fiber numbers in cingulate gyrus, inferior front-occipital fasciculus and posterior limbs of internal capsule had statistical differences among the 3 groups (F=3.11, 3.45, 9.88, 9.12, 7.45, 8.88, all P<0.05). (2)The correlation between FA value and NBNA scores was analyzed: the correlation coefficient in posterior limbs of internal capsule was 0.666 which was higher than those of the other areas.The area under the ROC curve of FA values in anterior limbs of internal capsule was 0.816 (P=0.005), used NBNA scores≥35 as a good outcome.FA values (≥0.375) in the posterior limbs of the internal capsules predicted a good outcome and the corresponding sensitivity and specificity was 73.1% and 77.8%, respectively. Conclusion In some ROIs, FA values, voxel numbers, and fiber numbers can quantitatively reflect the degree of white matter injury in neonates with asphyxia.Furthermore, the FA values in the posterior limbs of the internal capsules are closely correlated with NBNA scores, so it has more important clinical significance, and can accurately and objectively assess the prognosis in neonates with asphyxia. Key words: Infant, newborn; Asphyxia; Diffusion tensor imaging; Fraction anisotropy; White matter fiber tractography

Diffusion tensor imaging study on white matter structure in children with autism spectrum disorder

Objective To explore the white matter microstructural change between autism spectrum disorder(ASD) children and the healthy controls and it's correlation with the age and the clinical symptoms. Methods Thirty-three patients with ASD and thirty-three healthy controls (HC) matched for sex-, age- and handedness underwent diffusion tensor imaging (DTI) scans. Use the Autism Diagnostic Observation Schedule(ADOS)and the Neuropsychological Development Inventory for Children Aged 0-6 Years Old (SLAS) to assess the clinical symptoms. Use tract-based spatial statistics (TBSS) based on fiber skeleton to analyze the fractional anisotropy (FA) of the whole brain DTI then to identify the differentiated brain regions.And analyze the correlation with age and clinical symptoms. Results (1) FA value of the body of corpus callosum(BCC)(x=-10, y=11, z=26; P=0.0012), left posterior limb of internal capsule(LPLI)(x=-23, y=-11, z=12; P<0.01), left anterior corona radiata(LACR)(x=-28, y=28, z=16; P<0.01), lift superior corona radiata(LSCR)(x=-27, y=-1, z=21; P=0.0017) was significantly lower in ASD group .(2) There was a positive correlation between the FA value of LPLI and the LACR、LSCR with age among the ASD group(r=0.436, P=0.012; r=0.443, P=0.010; r=0.475, P=0.005). There was a negative correlation between the FA value of the BCC, LPLI and the LACR, LSCR with the age among the HC children. (3) There was a correlation between the LPLI with the score of ADOS (communication: r=0.406, P=0.025; communication+ social behavior: r=0.377, P=0.039; restrictive interests and repetitive behaviors: r=0.375, P=0.041) and SLAS(gross motor: r=-0.409, P=0.024), There was a correlation between the LSCR with the score of the SLAS (gross motor: r=-0.539, P=0.002, adaptive capacity: r=-0.373, P=0.041, mental age: r=-0.388, P=0.034) . Conclusion The brain white matter microstructure change of BCC, LPLI, LACR, LSCR may be the pathophysiological basis of ASD.The development trend of brain white matter structure varied with age in ASD children is different from that of normal children. Brain white matter microstructure of the LPLI, LSCR is correlation with ASD symptoms. Key words: Autism spectrum disorder(ASD); Diffusion tensor imaging(DTI); Tract-based spatial statistics (TBSS)

Concomitant unruptured intracranial aneurysms and ischemic cerebrovascular diseases: a surgical experience of 31 cases

Objective: To summarize the clinic experience of preventing cerebral ischemic events during perioperative period in patients which concomitant unruptured intracranial aneurysms and ischemic cerebrovascular diseases. Methods: The clinical materials of 31 consecutive patients with concomitant unruptured intracranial aneurysms and ischemic cerebrovascular diseases from April 2010 to April 2014 were retrospectively reviewed.A total of 35 aneurysms were detected, and all of them were unruptured aneurysms.Among them, 17 cases were located on the ipsilateral side of artery stenosis or occlusion, and 18 cases were detected in the contralateral side. Minimal invasive surgical approaches such as small pterional approach and lateral sub-frontal approach were adopted.The better management of perioperative blood pressure was performed. Intraoperative electroencephalogram and somatosensory evoked potential monitoring, indocyanine green video angiography and/or microvascular Doppler ultrasonography were regularly used to guarantee the safety of the surgery. The follow-up by digital subtraction angiography or computed tomography angiography were made. Results: All of 35 aneurysms were clipped. Major infarction occurred in one patient with posterior communicating artery aneurysm concomitant with common cervical carotid artery stenosis.Large bone flap was resected and dural-matter were got enlarged to tolerate the edema period.Paralysis and aphasia accompanied at discharge.Minor infarction in posterior limb of internal capsule occurred in one patient.Twenty-nine patients were favorable with Glasgow Outcome Scale (GOS) score 5 at discharge, one patient with minor neurological defect (GOS 4), and one patient with severe neurological defect (GOS 3). The follow-up period was 6 to 40 months.Four patients were lost.The modified Rankin scale (MRS) of last follow-up were 0-1 in 25 patients, 2 in one patient and 3 in one patient.Third months after operation, 3 cases were performed carotid artery stenosis, 1 patients were performed carotid endarterectomy. Conclusion: Reinforcing the management of perioperative blood pressure, adjusting the perioperative blood coagulation function, and combine application of intraoperative monitoring technology can effectively prevent the occurrence of cerebral ischemia.

24-Hour Alberta Stroke Program Early CT Score Assessment in Post-Stroke Spasticity Development in Patients with a First Documented Anterior Circulation Ischemic Stroke

Neuroanatomic substrates responsible for development of post-stroke spasticity are still poorly understood. The study is focused on identification of brain regions within the territory of the middle cerebral artery associated with spasticity development. This is a single-center prospective cohort study of first documented anterior circulation ischemic strokes with a neurologic deficit lasting >7 days (from March 2014 to September 2016, all patients are involved in a registry). Ischemic cerebral lesions within the territory of middle cerebral artery were evaluated using the Alberta Stroke Program Early CT Score (ASPECTS) on control 24-hour computed tomography or magnetic resonance imaging. Spasticity was assessed with modified Ashworth scale. Seventy-six patients (mean age 72 years, 45% females; 30% treated with IV tissue plasminogen activator, 6.5% mechanical thrombectomy) fulfilled the study inclusion criteria. Forty-nine (64%) developed early elbow or wrist flexor spasticity defined as modified Ashworth scale >1 (at day 7-10), in 44 (58%) the spasticity remained present at 6 months. There were no differences between the patients who developed spasticity and those who did not when comparing admission stroke severity (National Institutes of Health Stroke Scale 5 [interquartile range {IQR} 4-8] versus 6 [IQR 4-10]) and vascular risk factors (hypertension, diabetes mellitus, dyslipidemia, atrial fibrillation, coronary artery disease). Nor was there a difference in 24-hour ASPECTS score (9 [IQR 8-10] versus 9 [IQR 7-10]). No differences were found between the groups with and without the early upper limb flexor spasticity of particular regions (M1, M2, M3, M4, M5, M6, lentiform, insula, caudate, internal capsule) and precentral-postcentral gyrus, premotor cortex, supplementary motor area, posterior limb of internal capsule, and thalamus were compared. We did not find any middle cerebral artery territory associated with post-stroke spasticity development by detailed evaluation of ASPECTS.

The neurobiology of brain recovery from traumatic stress: A longitudinal DTI study

BackgroundPrevious studies demonstrated decreased brain microstructure integrity in people that were exposed to extreme life stress but did not meet posttraumatic stress disorder (PTSD) diagnostic criteria. It is unclear how the brain recovers from traumatic stress in these trauma-exposed non-PTSD people (TENP). MethodsTwenty-two TENP individuals were recruited from the most affected area of Wenchuan quake, and scanned twenty-five days after the quake and at a two-year follow-up. Tract-based spatial statistics was used to examine brain microstructure changes over the two years. Correlation analyses were conducted to investigate relationships between brain microstructure changes and both stress recovery and demographic factors. To assess DTI stability, fifteen healthy subjects were scanned twice in a year and analysed similarly. ResultsSignificantly increased fractional anisotropy (FA) was found in the left posterior limb of internal capsule, left superior and posterior corona radiata (SCR and PCR), and left external capsule. The FA increase of these regions was primarily a result of radial diffusivity reduction. Recovery in symptoms was positively correlated with FA increase of SCR. Changes were related to participant age and sex. No DTI measures were changed for the healthy subjects. LimitationsGeneralizability of the findings was constrained by the relatively small sample size. ConclusionsThe TENP individuals showed a recovery from the trauma over the follow-up, and that was accompanied with increased brain microstructure integrity in fiber tracts primarily involving corticostriatal networks. These changes may contribute to the psychological resilience to a severe life stress that led to PTSD in quake victims. In particular，this study adds to Psychoradiology, which is a promising subspecialty for clinical radiology focusing on psychiatric disorders.