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Diffusion tensor imaging predicts motor outcome in children with acquired brain injury

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Abstract

Background: Rehabilitation in children with acquired brain injury is a challenging endeavour. There is a large variability in motor recovery between patients, and a need to optimize therapies by exploiting cerebral plasticity and recovery mechanisms. This retrospective study aims to identify tract-based markers that could serve as predictors of functional outcome following rehabilitation. Methods: Twenty-nine children with traumatic brain injury (n = 14) or stroke (n = 15) underwent a 3 T Magnetic Resonance Imaging (MRI) measurement, including Diffusion Tensor Imaging (DTI) between admission to the Hospital and onset of rehabilitation therapy at the Rehabilitation Centre. The Functional Independence Measure for Children (WeeFIM) was routinely applied at admission and discharge from the Rehabilitation Centre. Distinguishing between children with good versus poor functional independence was performed using ROC-analysis. A non-parametric partial correlation analysis between the DTI and WeeFIM motor scores was performed with age, time in rehabilitation, and time of MRI scan after injury as covariates. Results: Mean fractional anisotropy (FA) from the DTI in the ipsilesional corticospinal-tract provided the highest predictive accuracy (sensitivity = 95 %, specificity = 78 %, Youden Index = 0.73, Area under the curve = 0.9), in comparison to the lesion volume or other clinical variables. Mean FA of the ipsilesional corticospinal-tract correlated positively with the WeeFIM discharge motor scores (ρ = 0.547, p = 0.004). Prediction was poorer for the lesion volume or Glasgow Coma Scale. Conclusion: The results suggest that DTI data could improve the prediction of functional outcome after rehabilitation in children and adolescents with stroke or traumatic brain injury. Specifically, mean FA shows the highest predictive accuracy in comparison to lesion volume or clinical scales.

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Acknowledgments

The authors would like to thank the participants and their parents to provide the written consent for this retrospective study, Corinna Gerber to approach the participants and parents for their written consent, Nicole Iten for help with the Functional Independence Measure for Children (WeeFIM), Dr. med. Annette Hackenberg for the neuropediatric support, Dr. med. Vincenzo Cannizzaro for help in the intensive medicine and neonatology unit, and Prof. Dr. med. Barbara Plecko and PD Dr. Andreas Meyer-Heim for expert comments. We also acknowledge the Neuroscience Center Zurich (ZNZ). This work was funded by the Clinical Research Priority Programs Neurorehabilitation of the University of Zurich (Switzerland), the Mäxi-Foundation (Zurich, Switzerland), and the Anna Müller Grocholsky Foundation (Zurich, Switzerland). Last but not least, we would like to thank the anonymous reviewers for their helpful comments.

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Authors and Affiliations

  1. Rehabilitation Centre, University Children’s Hospital, CH-8910, Affoltern am Albis, Switzerland

    Volker Ressel & Hubertus J. A. van Hedel

  2. Centre MR-Research, University Children’s Hospital, Zurich, CH-8032, Switzerland

    Volker Ressel & Ruth O’Gorman Tuura

  3. Diagnostic Imaging, University Children’s Hospital, Zurich, CH-8032, Switzerland

    Ianina Scheer

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  1. Volker Ressel
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Correspondence to Volker Ressel.

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Volker Ressel, Ruth O’Gorman Tuura, Ianina Scheer and Hubertus J.A. van Hedel declare that they have no conflict of interest.

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All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, and the applicable revisions at the time of the investigation. Informed consent was obtained from all patients for being included in the study.

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Ressel, V., O’Gorman Tuura, R., Scheer, I. et al. Diffusion tensor imaging predicts motor outcome in children with acquired brain injury. Brain Imaging and Behavior 11, 1373–1384 (2017). https://doi.org/10.1007/s11682-016-9637-z

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