Feasibility of fast brain diffusion MRI to quantify white matter injury in pediatric hydrocephalus

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OBJECTIVE

Traditionally, diffusion MRI (dMRI) has been performed in parallel with high-resolution conventional MRI, which requires long scan times and may require sedation or general anesthesia in infants and young children. Conversely, fast brain MRI permits image acquisition without the need for sedation, although its short pulse sequences, susceptibility to motion artifact, and contrast resolution have limited its use to assessing ventricular size or major structural variations. Here, the authors demonstrate the feasibility of leveraging a 3-direction fast brain MRI protocol to obtain reliable dMRI measures.

METHODS

Fast brain MRI with 3-direction dMRI was performed in infants and children before and after hydrocephalus treatment. Regions of interest in the posterior limbs of the internal capsules (PLICs) and the genu of the corpus callosum (gCC) were drawn on diffusion-weighted images, and mean diffusivity (MD) data were extracted. Ventricular size was determined by the frontal occipital horn ratio (FOHR). Differences between and within groups pre- and posttreatment, and FOHR-MD correlations were assessed.

RESULTS

Of 40 patients who met inclusion criteria (median age 27.5 months), 15 (37.5%), 17 (42.5%), and 8 (20.0%) had posthemorrhagic hydrocephalus (PHH), congenital hydrocephalus (CH), or no intracranial abnormality (controls), respectively. A hydrocephalus group included both PHH and CH patients. Prior to treatment, the FOHR (p < 0.001) and PLIC MD (p = 0.027) were greater in the hydrocephalus group than in the controls. While the mean gCC MD in the hydrocephalus group (1.10 × 10−3 mm2/sec) was higher than that of the control group (0.98), the difference was not significant (p = 0.135). Following a median follow-up duration of 14 months, decreases in FOHR, PLIC MD, and gCC MD were observed in the hydrocephalus group and were similar to those in the control group (p = 0.107, p = 0.702, and p = 0.169, respectively). There were no correlations identified between FOHR and MDs at either time point.

CONCLUSIONS

The utility of fast brain MRI can be extended beyond anatomical assessments to obtain dMRI measures. A reduction in PLIC and gCC MD to levels similar to those of controls was observed within 14 months following shunt surgery for hydrocephalus in PHH and CH infants. Further studies are required to assess the role of fast brain dMRI for assessing clinical outcomes in pediatric hydrocephalus patients.

ABBREVIATIONS CH = congenital hydrocephalus; dMRI = diffusion MRI; FOHR = frontal occipital horn ratio; gCC = genu of the corpus callosum; MD = mean diffusivity; PHH = posthemorrhagic hydrocephalus; PLIC = posterior limb of the internal capsule; PVWM = periventricular white matter; ROI = region of interest.

Article Information

Correspondence Albert M. Isaacs: Washington University School of Medicine, St. Louis, MO. albert.isaacs@wustl.edu.

INCLUDE WHEN CITING Published online July 19, 2019; DOI: 10.3171/2019.5.PEDS18596.

Disclosures Dr. Castaneyra-Ruiz reports receiving support for non–study-related clinical or research efforts that he oversees from Microbot Medical. Dr. McAllister reports receiving clinical or research support for the present study from the following: Rudi Schulte Research Institute, Hydrocephalus Association, National Institutes of Health, and Microbot Medical; he also reports owning stock in Aqueduct Neuroscience, Inc. Dr. Limbrick reports receiving support for non–study-related clinical or research efforts that he oversees from Microbot Medical.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Representative axial T1-weighted (left) and apparent diffusion coefficient (right) MR images demonstrating measurement of FOHR [(a+b)/2c] (left), and ROIs drawn to measure MDs in the gCC and right and left PLIC (right). Figure is available in color online only.

  • View in gallery

    FOHR and MD differences between hydrocephalus and control groups. At baseline, the CH and PHH groups had significantly larger ventricles than the controls, but this difference had resolved following treatment (A). Similar trends were observed in their PLIC (B) and gCC (C) measures at 5- and 14-month median follow-up. **p < 0.001 and ***p < 0.01, Benjamini-Hochberg corrected. Figure is available in color online only.

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