Diffusion Tensor Imaging Shows Value for Investigating White Matter Abnormalities

Published Online May 20, 2016
Journal of Neurosurgery: Pediatrics

The tiny microstructures of white matter in the brain can hold important clues to post-surgery development of children with hydrocephalus.

Diffusion tensor imaging (DTI)—a more detailed form of MRI—plays an increasingly important role in capturing these clues. The technique also might help predict future outcomes, according to authors of revealing research into the landscape of the brain.

The prospective study included Cincinnati Children’s researchers from the divisions of Neurosurgery, Biostatistics and Epidemiology, Neurology, Radiology and Developmental and Behavioral Pediatrics. It was led by Weihong Yuan, PhD, Radiology, and Francesco Mangano, DO, chief of Neurosurgery.

“The study is significant in that it further establishes DTI as a non-invasive objective biomarker with predictive prognostic value in the study of congenital hydrocephalus,” Mangano says.

“The authors,” he adds, “plan to build on this knowledge to translate research into an everyday clinical tool that may be used by many different pediatric subspecialists caring for complex neurologic conditions.”

The team analyzed data from 54 patients with congenital hydrocephalus, caused when cerebrospinal fluid abnormally accumulates in the brain. The condition occurs in three of 1,000 live births.

It can raise intracranial pressure at birth, resulting in severe brain damage. It can be fatal if left untreated, but often is not diagnosed until signs emerge, such as swelling of the head.

Researchers looked at data at three intervals: prior to surgery, and at three and 12 months after surgery.

DTI showed significant white matter abnormality in two major areas. But in the posterior limb of the internal capsule, these abnormalities did not persist at the 12-month mark indicating a prognostic predictive value of DTI.

Fig A:  These scatter plots show four types of diffusion tensor imaging (DTI) measures conducted after patients received surgery for congenital hydrocephalus: (A) fractional anisotropy, (B) mean diffusivity, (C) axial diffusivity and (D)  radial diffusivity. Each symbol represents the DTI value extracted from a single participant.  The solid black line and two dashed lines show results of regression analysis based on the control group. The study suggests that DTI can serve as a sensitive imaging biomarker for underlying neuroanatomical changes and post-surgical developmental outcome, and even as a predictor for future outcomes.
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Mangano FT, Altaye M, McKinstry RC, Shimony JS, Powell SK, Phillips JM, Barnard H, Limbrick DD, Jr., Holland SK, Jones BV, Dodd J, Simpson S, Mercer D, Rajagopal A, Bidwell S, Yuan W. Diffusion tensor imaging study of pediatric patients with congenital hydrocephalus: 1-year postsurgical outcomes. J Neurosurg Pediatr. 2016 Sep;18(3):306-19.