White matter characteristics in children with cerebral palsy prior to selective dorsal rhizotomy: a multicenter diffusion tensor imaging study

Weihong Yuan Division of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio;
Departments of Radiology and

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Charles B. Stevenson Division of Pediatric Neurosurgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio;
Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio;

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Paolo Moretti Divisions of Physical Medicine and Rehabilitation,

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Francesco T. Mangano Division of Pediatric Neurosurgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio;
Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio;

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Marco Pavanello Pediatric Neurosurgery, and

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Armando Cama Pediatric Neurosurgery, and

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Domenico Tortora Neuroradiology, IRCCS Istituto Giannina Gaslini, Genoa, Italy;

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Chiara Tacchino Divisions of Physical Medicine and Rehabilitation,

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Amy F. Bailes Division of Occupational Therapy and Physical Therapy, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio;
Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio;

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Kelly R. Greve Division of Occupational Therapy and Physical Therapy, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio;
Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio;

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Jilda N. Vargus-Adams Division of Physical Medicine and Rehabilitation, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio;

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Jonathan A. Dudley Division of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio;

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Karen Harpster Division of Occupational Therapy and Physical Therapy, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio;
Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio;

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Brad G. Kurowski Division of Physical Medicine and Rehabilitation, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio;

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Alexis Mitelpunkt Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel;
Pediatric Rehabilitation Unit, Division of Rehabilitation, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; and

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Bruce Aronow Division of Biomedical Informatics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio

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OBJECTIVE

The aims of this study were to 1) assess and quantify white matter (WM) microstructural characteristics derived from diffusion tensor imaging (DTI) in children with cerebral palsy (CP) prior to selective dorsal rhizotomy (SDR), and 2) investigate potential associations between WM diffusion properties and gross motor function and spasticity in children with spastic CP who underwent SDR.

METHODS

This study is a multisite study based on DT images acquired prior to SDR as well as postoperative outcome data. DTI data collected from two sites were harmonized using the ComBat approach to minimize intersite scanner difference. The DTI abnormalities between children with spastic CP and controls were analyzed and correlated with the severity of impaired mobility based on the Gross Motor Function Classification System (GMFCS). The improvement in gross motor function and spasticity after SDR surgery was assessed utilizing the Gross Motor Function Measure-66 (GMFM-66), the Modified Tardieu Scale (MTS), and the modified Ashworth scale (MAS). Alterations in these outcome measures were quantified in association with DTI abnormalities.

RESULTS

Significant DTI alterations, including lower fractional anisotropy (FA) in the genu of the corpus callosum (gCC) and higher mean diffusivity (MD) in the gCC and posterior limb of the internal capsule (PLIC), were found in children in the SDR group when compared with the age-matched control group (all p < 0.05). Greater DTI alterations (FA in gCC and MD in gCC and PLIC) were associated with lower mobility levels as determined based on GMFCS level (p < 0.05). The pre- to post-SDR improvement in motor function based on GMFM-66 was statistically significant (p = 0.006 and 0.002 at 6-month and 12-month follow-ups, respectively). The SDR efficacy was also identified as improving spasticity in lower-extremity muscle groups assessed with the MTS and MAS. Partial correlation analysis presented a significant association between pre- to post-SDR MTS alteration and DTI abnormalities.

CONCLUSIONS

The findings in the present study provided initial quantitative evidence to establish the WM microstructural characteristics in children with spastic CP prior to SDR surgery. The study generated data for the association between baseline DTI characteristics and mobility in children with CP prior to SDR surgery. The study also demonstrated SDR efficacy in improving motor function and spasticity based on the GMFM-66, MTS, and MAS, respectively, in association with DTI data.

ABBREVIATIONS

CCHMC = Cincinnati Children’s Hospital Medical Center; CP = cerebral palsy; DTI = diffusion tensor imaging; FA = fractional anisotropy; gCC = genu of the corpus callosum; GMFCS = Gross Motor Function Classification System; GMFM-66 = Gross Motor Function Measure-66; IGG = Istituto Giannina Gaslini; MAS = modified Ashworth scale; MD = mean diffusivity; MTS = Modified Tardieu Scale; PLIC = posterior limb of the internal capsule; SDR = selective dorsal rhizotomy; WM = white matter.
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