Neonatal Functional and Structural Connectivity Are Associated with Cerebral Palsy at Two Years of Age

Stephanie L. Merhar; Elveda Gozdas; Jean A. Tkach; Nehal A. Parikh; Beth M. Kline-Fath; Lili He; Weihong Yuan; Mekibib Altaye; James L. Leach; Scott K. Holland

doi:10.1055/s-0039-1683874

American Journal of Perinatology, Table of Contents

Am J Perinatol 2020; 37(02): 137-145
DOI: 10.1055/s-0039-1683874

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Neonatal Functional and Structural Connectivity Are Associated with Cerebral Palsy at Two Years of Age

Authors

Stephanie L. Merhar

¹Division of Neonatology, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio

²Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio
Elveda Gozdas

³Psychiatry and Behavioral Sciences, Stanford University, Stanford, California
Jean A. Tkach

⁴Imaging Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio

⁵Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
Nehal A. Parikh

¹Division of Neonatology, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio

²Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio
Beth M. Kline-Fath

⁵Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
Lili He

¹Division of Neonatology, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
Weihong Yuan

⁵Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio

⁶Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
Mekibib Altaye

⁷Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
James L. Leach

⁵Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
Scott K. Holland

⁸Medpace Imaging Core Laboratory, Medpace Inc., Cincinnati, Ohio

Abstract

Objective The accuracy of structural magnetic resonance imaging (MRI) to predict later cerebral palsy (CP) in newborns with perinatal brain injury is variable. Diffusion tensor imaging (DTI) and task-based functional MRI (fMRI) show promise as predictive tools. We hypothesized that infants who later developed CP would have reduced structural and functional connectivity as compared with those without CP.

Study Design We performed DTI and fMRI using a passive motor task at 40 to 48 weeks' postmenstrual age in 12 infants with perinatal brain injury. CP was diagnosed at age 2 using a standardized examination.

Results Five infants had CP at 2 years of age, and seven did not have CP. Tract-based spatial statistics showed a widespread reduction of fractional anisotropy (FA) in almost all white matter tracts in the CP group. Using the median FA value in the corticospinal tracts as a cutoff, FA was 100% sensitive and 86% specific to predict CP compared with a sensitivity of 60 to 80% and a specificity of 71% for structural MRI. During fMRI, the CP group had reduced functional connectivity from the right supplemental motor area as compared with the non-CP group.

Conclusion DTI and fMRI obtained soon after birth are potential biomarkers to predict CP in newborns with perinatal brain injury.

Keywords

functional MRI - diffusion tensor imaging - cerebral palsy - hypoxic–ischemic encephalopathy

Full Text

References

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