Athetotic and Spastic Cerebral Palsy: Anatomic Characterization Based on Diffusion-Tensor Imaging

Published Online:https://doi.org/10.1148/radiol.11101783

Diffusion tensor imaging–based analysis showed that the extent of change due to early brain damage in children with athetotic cerebral palsy tends to be more diffuse, with involvement of deep gray and white matter structures, than that in children with spastic cerebral palsy or healthy children.

Purpose

To evaluate the anatomy of deep gray and white matter structures in children with athetotic cerebral palsy (CP) and those with spastic CP by using diffusion-tensor (DT) imaging and to investigate whether these types of CP have unique anatomic correlates that can support their diagnosis and prognosis.

Materials and Methods

This study was approved by the institutional review board of each participating institution, and written informed consent was obtained from the parents of each patient. DT imaging was used to retrospectively evaluate 19 children with clinically diagnosed athetotic CP (mean age, 3.4 years ± 3.3 [standard deviation]), 26 children with spastic CP (mean age, 3.3 years ± 3.2), and 31 healthy control subjects (mean age, 3.2 years ± 3.0). Fractional anisotropy (FA) and mean diffusivity (MD) were measured with a region of interest (ROI) method. The ROIs were drawn on bilateral deep gray and white matter structures, including projection fibers, association fibers, and commissural fibers. Statistical analysis was performed by using the Kruskal-Wallis test with Bonferroni correction. P < .05 indicated a significant difference.

Results

FA values in the athetotic CP group were significantly lower than those in the control and spastic CP groups for multiple structures, including deep gray and white matter (P < .05 and P = .0001, respectively); these differences were also associated with increasing MD (P < .05 and P < .001, respectively). On the other hand, in the spastic CP group, the significantly decreased FA values, compared with those of the normal group, were limited to several white matter structures (P < .05 and P = .0001).

Conclusion

In children with athetotic CP, the extent of change on DT images due to early brain damage tends to be more diffuse, including multiple brain structures, compared with the changes in children with spastic CP.

© RSNA, 2011

Supplemental material: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.11101783/-/DC1

References

  • 1 Rosenbaum P, Paneth N, Leviton Aet al.. A report: the definition and classification of cerebral palsy April 2006. Dev Med Child Neurol Suppl 2007;109(suppl 109):8–14. MedlineGoogle Scholar
  • 2 Prevalence and characteristics of children with cerebral palsy in Europe. Dev Med Child Neurol 2002;44(9):633–640. MedlineGoogle Scholar
  • 3 Odding E, Roebroeck ME, Stam HJ. The epidemiology of cerebral palsy: incidence, impairments and risk factors. Disabil Rehabil 2006;28(4):183–191. Crossref, MedlineGoogle Scholar
  • 4 O’Shea TM. Diagnosis, treatment, and prevention of cerebral palsy. Clin Obstet Gynecol 2008;51(4):816–828. Crossref, MedlineGoogle Scholar
  • 5 Fennell EB, Dikel TN. Cognitive and neuropsychological functioning in children with cerebral palsy. J Child Neurol 2001;16(1):58–63. Crossref, MedlineGoogle Scholar
  • 6 Himmelmann K, McManus V, Hagberg Get al.. Dyskinetic cerebral palsy in Europe: trends in prevalence and severity. Arch Dis Child 2009;94(12):921–926. Crossref, MedlineGoogle Scholar
  • 7 Kanda T, Pidcock FS, Hayakawa K, Yamori Y, Shikata Y. Motor outcome differences between two groups of children with spastic diplegia who received different intensities of early onset physiotherapy followed for 5 years. Brain Dev 2004;26(2):118–126. Crossref, MedlineGoogle Scholar
  • 8 Mäenpää H, Salokorpi T, Jaakkola Ret al.. Follow-up of children with cerebral palsy after selective posterior rhizotomy with intensive physiotherapy or physiotherapy alone. Neuropediatrics 2003;34(2):67–71. Crossref, MedlineGoogle Scholar
  • 9 Volpe JJ. Neurology of the newborn. 5th ed. Philadelphia, Pa: Saunders, 2008. Google Scholar
  • 10 Korzeniewski SJ, Birbeck G, DeLano MC, Potchen MJ, Paneth N. A systematic review of neuroimaging for cerebral palsy. J Child Neurol 2008;23(2):216–227. Crossref, MedlineGoogle Scholar
  • 11 Prasad R, Verma N, Srivastava A, Das BK, Mishra OP. Magnetic resonance imaging, risk factors and co-morbidities in children with cerebral palsy. J Neurol 2011;258(3):471–478. Crossref, MedlineGoogle Scholar
  • 12 Mathur AM, Neil JJ, Inder TE. Understanding brain injury and neurodevelopmental disabilities in the preterm infant: the evolving role of advanced magnetic resonance imaging. Semin Perinatol 2010;34(1):57–66. Crossref, MedlineGoogle Scholar
  • 13 Woodward LJ, Anderson PJ, Austin NC, Howard K, Inder TE. Neonatal MRI to predict neurodevelopmental outcomes in preterm infants. N Engl J Med 2006;355(7):685–694. Crossref, MedlineGoogle Scholar
  • 14 Krägeloh-Mann I, Helber A, Mader Iet al.. Bilateral lesions of thalamus and basal ganglia: origin and outcome. Dev Med Child Neurol 2002;44(7):477–484. Crossref, MedlineGoogle Scholar
  • 15 Johnston MV, Hoon AH. Possible mechanisms in infants for selective basal ganglia damage from asphyxia, kernicterus, or mitochondrial encephalopathies. J Child Neurol 2000;15(9):588–591. Crossref, MedlineGoogle Scholar
  • 16 Yokochi K, Aiba K, Horie Met al.. Magnetic resonance imaging in children with spastic diplegia: correlation with the severity of their motor and mental abnormality. Dev Med Child Neurol 1991;33(1):18–25. Crossref, MedlineGoogle Scholar
  • 17 Barkovich AJ. MR and CT evaluation of profound neonatal and infantile asphyxia. AJNR Am J Neuroradiol 1992;13(3):959–972; discussion 973–975. MedlineGoogle Scholar
  • 18 Rademakers RP, van der Knaap MS, Verbeeten B, Barth PG, Valk J. Central cortico-subcortical involvement: a distinct pattern of brain damage caused by perinatal and postnatal asphyxia in term infants. J Comput Assist Tomogr 1995;19(2):256–263. Crossref, MedlineGoogle Scholar
  • 19 Maller AI, Hankins LL, Yeakley JW, Butler IJ. Rolandic type cerebral palsy in children as a pattern of hypoxic-ischemic injury in the full-term neonate. J Child Neurol 1998;13(7):313–321. Crossref, MedlineGoogle Scholar
  • 20 Ashwal S, Russman BS, Blasco PAet al.. Practice parameter: diagnostic assessment of the child with cerebral palsy—report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology 2004;62(6):851–863. Crossref, MedlineGoogle Scholar
  • 21 Hüppi PS, Murphy B, Maier SEet al.. Microstructural brain development after perinatal cerebral white matter injury assessed by diffusion tensor magnetic resonance imaging. Pediatrics 2001;107(3):455–460. Crossref, MedlineGoogle Scholar
  • 22 Neil JJ, Shiran SI, McKinstry RCet al.. Normal brain in human newborns: apparent diffusion coefficient and diffusion anisotropy measured by using diffusion tensor MR imaging. Radiology 1998;209(1):57–66. LinkGoogle Scholar
  • 23 Arzoumanian Y, Mirmiran M, Barnes PDet al.. Diffusion tensor brain imaging findings at term-equivalent age may predict neurologic abnormalities in low birth weight preterm infants. AJNR Am J Neuroradiol 2003;24(8):1646–1653. MedlineGoogle Scholar
  • 24 Thomas B, Eyssen M, Peeters Ret al.. Quantitative diffusion tensor imaging in cerebral palsy due to periventricular white matter injury. Brain 2005;128(Pt 11):2562–2577. Crossref, MedlineGoogle Scholar
  • 25 Hoon AH, Lawrie WT, Melhem ERet al.. Diffusion tensor imaging of periventricular leukomalacia shows affected sensory cortex white matter pathways. Neurology 2002;59(5):752–756. Crossref, MedlineGoogle Scholar
  • 26 Nagae LM, Hoon AH, Stashinko Eet al.. Diffusion tensor imaging in children with periventricular leukomalacia: variability of injuries to white matter tracts. AJNR Am J Neuroradiol 2007;28(7):1213–1222. Crossref, MedlineGoogle Scholar
  • 27 Glenn OA, Ludeman NA, Berman JIet al.. Diffusion tensor MR imaging tractography of the pyramidal tracts correlates with clinical motor function in children with congenital hemiparesis. AJNR Am J Neuroradiol 2007;28(9):1796–1802. Crossref, MedlineGoogle Scholar
  • 28 Murakami A, Morimoto M, Yamada Ket al.. Fiber-tracking techniques can predict the degree of neurologic impairment for periventricular leukomalacia. Pediatrics 2008;122(3):500–506. Crossref, MedlineGoogle Scholar
  • 29 Ludeman NA, Berman JI, Wu YWet al.. Diffusion tensor imaging of the pyramidal tracts in infants with motor dysfunction. Neurology 2008;71(21):1676–1682. Crossref, MedlineGoogle Scholar
  • 30 Hoon AH, Stashinko EE, Nagae LMet al.. Sensory and motor deficits in children with cerebral palsy born preterm correlate with diffusion tensor imaging abnormalities in thalamocortical pathways. Dev Med Child Neurol 2009;51(9):697–704. Crossref, MedlineGoogle Scholar
  • 31 Yoshida S, Hayakawa K, Yamamoto Aet al.. Quantitative diffusion tensor tractography of the motor and sensory tract in children with cerebral palsy. Dev Med Child Neurol 2010;52(10):935–940. Crossref, MedlineGoogle Scholar
  • 32 Frye RE, Hasan K, Malmberg Bet al.. Superior longitudinal fasciculus and cognitive dysfunction in adolescents born preterm and at term. Dev Med Child Neurol 2010;52(8):760–766. Crossref, MedlineGoogle Scholar
  • 33 Koerte I, Pelavin P, Kirmess Bet al.. Anisotropy of transcallosal motor fibres indicates functional impairment in children with periventricular leukomalacia. Dev Med Child Neurol 2011;53(2):179–186. Crossref, MedlineGoogle Scholar
  • 34 Vojta V. Die zerebralen Bewegungsstoerungen im Saeuglingsalter: Fruehdiagnose und Fruehtherapie. Stuttgart, Germany: Enke, 1988. Google Scholar
  • 35 Oishi K, Faria A, van Zijl PCM, Mori S. MRI atlas of human white matter. 2nd ed. London, England: Academic Press, 2010. Google Scholar
  • 36 Marín-Pallida M. Developmental neuropathology and impact of perinatal brain damage. III. Gray matter lesions of the neocortex. J Neuropathol Exp 1999;58(5):407–429. Crossref, MedlineGoogle Scholar
  • 37 Lin Y, Okumura A, Hayakawa F, Kato K, Kuno T, Watanabe K. Quantitative evaluation of thalami and basal ganglia in infants with periventricular leukomalacia. Dev Med Child Neurol 2001;43(7):481–485. Crossref, MedlineGoogle Scholar
  • 38 Inder TE, Warfield SK, Wang H, Hüppi PS, Volpe JJ. Abnormal cerebral structure is present at term in premature infants. Pediatrics 2005;115(2):286–294. Crossref, MedlineGoogle Scholar
  • 39 Boardman JP, Craven C, Valappil Set al.. A common neonatal image phenotype predicts adverse neurodevelopmental outcome in children born preterm. Neuroimage 2010;52(2):409–414. Crossref, MedlineGoogle Scholar
  • 40 Counsell SJ, Dyet LE, Larkman DJet al.. Thalamo-cortical connectivity in children born preterm mapped using probabilistic magnetic resonance tractography. Neuroimage 2007;34(3):896–904. Crossref, MedlineGoogle Scholar
  • 41 Anjari M, Srinivasan L, Allsop JMet al.. Diffusion tensor imaging with tract-based spatial statistics reveals local white matter abnormalities in preterm infants. Neuroimage 2007;35(3):1021–1027. Crossref, MedlineGoogle Scholar
  • 42 Skiöld B, Horsch S, Hallberg Bet al.. White matter changes in extremely preterm infants, a population-based diffusion tensor imaging study. Acta Paediatr 2010;99(6):842–849. Crossref, MedlineGoogle Scholar
  • 43 Rose J, Butler EE, Lamont LE, Barnes PD, Atlas SW, Stevenson DK. Neonatal brain structure on MRI and diffusion tensor imaging, sex, and neurodevelopment in very-low-birthweight preterm children. Dev Med Child Neurol 2009;51(7):526–535. Crossref, MedlineGoogle Scholar
  • 44 Rose J, Mirmiran M, Butler EEet al.. Neonatal microstructural development of the internal capsule on diffusion tensor imaging correlates with severity of gait and motor deficits. Dev Med Child Neurol 2007;49(10):745–750. Crossref, MedlineGoogle Scholar
  • 45 Dammann O, Hagberg H, Leviton A. Is periventricular leukomalacia an axonopathy as well as an oligopathy? Pediatr Res 2001;49(4):453–457. Crossref, MedlineGoogle Scholar
  • 46 Meng SZ, Arai Y, Deguchi K, Takashima S. Early detection of axonal and neuronal lesions in prenatal-onset periventricular leukomalacia. Brain Dev 1997;19(7):480–484. Crossref, MedlineGoogle Scholar
  • 47 Eyre JA. Corticospinal tract development and its plasticity after perinatal injury. Neurosci Biobehav Rev 2007;31(8):1136–1149. Crossref, MedlineGoogle Scholar
  • 48 Martin JH, Friel KM, Salimi I, Chakrabarty S. Activity- and use-dependent plasticity of the developing corticospinal system. Neurosci Biobehav Rev 2007;31(8):1125–1135. Crossref, MedlineGoogle Scholar
  • 49 Guzzetta A, Bonanni P, Biagi Let al.. Reorganisation of the somatosensory system after early brain damage. Clin Neurophysiol 2007;118(5):1110–1121. Crossref, MedlineGoogle Scholar
  • 50 Oishi K, Mori S, Donohue PKet al.. Multi-contrast human neonatal brain atlas: application to normal neonate development analysis. Neuroimage 2011 Jan 26. [Epub ahead of print]. CrossrefGoogle Scholar

Article History

Received September 14, 2010; revision requested October 29; revision received January 31, 2011; accepted March 1; final version accepted March 10.
Published online: Aug 2011
Published in print: Aug 2011