Pyramidal tract maturation after brain injury in newborns with heart disease

Authors

  • Savannah C. Partridge PhD,

    1. Department of Radiology, University of California, San Francisco, San Francisco, CA
    2. Department of Radiology, University of Washington, Seattle, WA
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  • Daniel B. Vigneron PhD,

    1. Department of Radiology, University of California, San Francisco, San Francisco, CA
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  • Natalie N. Charlton,

    1. Department of Radiology, University of California, San Francisco, San Francisco, CA
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  • Jeffrey I. Berman PhD,

    1. Department of Radiology, University of California, San Francisco, San Francisco, CA
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  • Roland G. Henry PhD,

    1. Department of Radiology, University of California, San Francisco, San Francisco, CA
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  • Pratik Mukherjee MD, PhD,

    1. Department of Radiology, University of California, San Francisco, San Francisco, CA
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  • Patrick S. McQuillen MD,

    1. Department of Pediatrics, University of California, San Francisco, San Francisco, CA
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  • Tom R. Karl MD,

    1. Department of Pediatrics, University of California, San Francisco, San Francisco, CA
    2. Department of Pediatric Cardiac Surgery, University of California, San Francisco, San Francisco, CA
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  • A. James Barkovich MD,

    1. Department of Radiology, University of California, San Francisco, San Francisco, CA
    2. Department of Pediatrics, University of California, San Francisco, San Francisco, CA
    3. Department of Neurology, University of California, San Francisco, San Francisco, CA
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  • Steven P. Miller MD

    Corresponding author
    1. Department of Pediatrics, University of California, San Francisco, San Francisco, CA
    2. Department of Neurology, University of California, San Francisco, San Francisco, CA
    3. Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
    • Division of Pediatric Neurology, 4480 Oak Street, 3K-180, Vancouver, British Columbia V6H3V4, Canada
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Abstract

Objective

Our objective was to quantify white matter tract development in term newborns with congenital heart disease, a population at high risk for perioperative brain injury, using magnetic resonance imaging diffusion tensor tractography (DTT).

Methods

Twenty-five newborns with congenital heart disease were imaged before and after surgery, with a median of 2 weeks between serial magnetic resonance imaging examinations. DTT was performed to segment bilateral pyramidal tracts using semiautomated fiber tracking software, and manual region of interest measurements were taken for comparison.

Results

Significant maturational rates of increasing fractional anisotropy (median, 4.4% per week) and decreasing mean diffusivity (Dav) (median, −2.0% per week) in the pyramidal tract were measured in infants without brain injury. Fractional anisotropy maturation rates were highest in newborns with normal scans, intermediate (median, 2.4% per week) in those with postoperative injury, and lowest (median, 0.9% per week) in those with preoperative injury, indicating a significant trend across brain injury groups (p = 0.015). Dav maturation rates did not differ across injury groups (p = 0.15). Manual region of interest measures showed greater variability in serial measurements, and no significant differences were identified between injury groups, suggesting that DTT may provide more sensitive measures.

Interpretation

DTT is feasible in term newborns and may help to characterize abnormal white matter tract development following acquired brain injury. Ann Neurol 2006

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