- Email: [email protected]
DTI findings
S42
E U R O P E A N JO U R N A L O F PAEDIATRIC N E U R O L O G Y
ence of shaken baby syndrome (SBS). Many authors state that presence of RH is a pathognomic finding to diagnose SBS. According to our experience, this assumption is incorrect. We performed a retrospective study on children admitted to our university hospital with RH. Material and methods: Our study included 29 children with RH, aged 1–18 months old, admitted to our hospital from the year 2000 to 2013. Story and physical examination during presentation, medical course, coagulation tests, metabolic investigations, skeletal survey and head circumference of the infant and his parents were collected. Retinal findings as well as central imaging (CT and MRI) were reassessed to obtain a standardized description. Evaluation reports by social services or civil/criminal courts were collected. (Preliminary) results: Of the 29 children, 23 were found suspect of SBS by the medical team and/or social services. In 5 of the 23 cases shaking was admitted. Three cases showed intraparenchymal hematomas, 4 interhemispheric blood, 4 cerebral edema, 6 compression of a ventricle, and 3 papilledema. In 15 of the 23 cases diffusionweighted MRI was performed: 6 showed diffuse lesions, 4 showed bilateral lesions. In 2 of the 6 non-suspect cases a clear etiology was found (accidental trauma or cerebral aneurysm). None of the 4 remaining cases showed intraparenchymal or interhemispheric blood, cerebral edema, compression of a ventricle, diffuse lesions on diffusion-weighted MRI or papilledema. Three of the 4 cases showed an accelerated growth of the head circumference months before presentation. Conclusion: According to our study infants can present RH and/or SDH without SBS. Infants with a large head circumference could be predisposed to retinal or subdural hemorrhages with or without a minor trauma.
PP5.1 - 1846 Pediatric TBI: acute and 1-year MRs/DTI findings Holshouser BA, Ghosh N, Tong KA, Pivonka-Jones J, Rundquist M, Ashwal S. Departments of Radiology and Pediatrics, Loma Linda University School of Medicine, USA – [email protected] Objective: We present longitudinal MR spectroscopic and DTI findings in children with complicated mild/severe TBI. Methods: Studies were done (7–15 days & 1 year) with MRI (3D-T1W, 3D-T2W, FLAIR, SWI, DTI-mean FA, ADC, AD, RD) and with 3D MRSI (10 mm slabs-corpus callosum–brain stem). MRSI voxel data were overlaid onto DTI white matter (WM) data to compare DTI parameters to metabolite ratios (NAA/Cr, NAA/Cho, Cho/Cr) for each voxel and region. Neuropsychological evaluations were done (3, 12 months). Results: We studied 17 TBI (13.2yrs; GCS: 3–15) and 15 controls (11.5 yrs). Initial MRI found decreased NAA/Cr and NAA/Cho ratios in all regions in TBI patients compared to controls. Mean FA values were decreased in corpus callosum (CC), basal ganglia (BG), parieto-occipital and temporal white matter. The mixed model analysis which accounts for age effects, showed a significant recovery of NAA/Cr only in 3 regions - BG (p=0.01), temporal gray (p=0.03) and thalami (p=0.01) and showed no significant longitudinal recovery of DTI metrics compared to controls. The initial NAA ratios and mean FA measurements correlated significantly with IQ and memory deficits evaluated at 12 months after injury. Conclusions: Early decreases in NAA represent neuronal loss or dysfunction and early FA reductions represent structural white matter injury. At 12 months, MRS showed significant recovery of metabolite ratios only in 3 regions, whereas, no regional DTI metrics recovered. This suggests incomplete metabolic and axonal recovery as the source of cognitive impairment.
17s (2013) S1 – S149
PP5.2 - 1844 Advanced MR and spectroscopic imaging in adolescents with chronic post-concussive symptoms following sports-related concussion Bartnik-Olson BL, Grube M, Wang H, Wong V, Holshouser BA, Ashwal S. Departments of Radiology and Pediatrics, Loma Linda University Medical Center, USA – [email protected] Objective: There is growing interest in using advanced MRI techniques (diffusion tensor imaging, DTI; perfusion weighted imaging, PWI) to identify and quantify microstructural axonal injury and perfusion abnormalities in adolescents with sports related concussion (SRC). We investigated these changes in a group of post-concussive symptomatic adolescents. Methods: We studied 13 adolescents (16±4 years) who sustained a SRC (1–24 months before imaging) and 14 controls (15±4 years). Symptoms included headache (persistent or intermittent, n=13), dizziness (n=3), and cognitive (n=6) or behavioral changes (including depression, n=4). DTI and PWI data were acquired on a Siemens Tim Trio 3T scanner. Region of interest DTI (FA, MD, RD) and PWI (CBF, CBV, MTT) analysis was performed. Results: FA and RD were reduced in the genu of the corpus callosum in SRC subjects compared to controls (p=0.05 and p=0.04). SRC subjects also showed reduced rCBF (p=0.03) and rCBV (p=0.05) in the right thalamus and a trend (p=0.06) towards reduced rCBF and rCBV in the left thalamus. Conclusions: Lower callosal FA values have been reported after mild TBI and indicate axonal injury. Elevated RD in this region suggests the presence of myelin damage along with axonal injury. rCBF and rCBV also were reduced in the thalami of SRC subjects and may be due to post-injury vascular disruption or impairment of microvascular responsiveness. Our findings suggest that DTI and PWI reflect different components of the complex injury that occurs after SRC and that both are sensitive indicators of lasting injury in chronically symptomatic athletes.
PP5.3 - 1676 The risk factors of severe brain injury by head trauma under 6 years old children Na YH, Cha BH. Wonju Severance Christian Hospital, Korea – [email protected] Objectives: The head trauma is common type of injury coming to emergency room during childhood period, especially under 6 years old children. We would like to evaluate the risk factors of severe brain injuries associated with the head trauma occurring under 6 years old children. Material and methods: We retrospectively reviewed the medical records of 392 children, who came to emergency room of Wonju Severance Christian Hospital from March, 2011 to February, 2012 due to head trauma. We evaluated the clinical characteristics of these children for risk factors of severe brain injuries. Results: The 1981 children under 15 years old came to emergency room due to traumatic injuries. Among them, 554 children (28.0%) had head trauma and 392 children (70.8%) were under 6 years old; under 3 years old, 244 (62.2%) and between 3 and 6 years old, 148 (37.8%). the male and female ratio was 1.65:1. The causes of head trauma were falling down (77.6%), strucken by objects (8.2%), car accident (7.9%) and unknown (6.3%). The most of children (77.1%) were no neurologic symptoms and signs, but there were noted that intracranial hemorrhage was 24 (6.1%); male 58%, skull fracture, 10 (2.6%); male 80%, seizure, 8 (2.0%); male 75%, intracranial hemorrhage with skull fracture, 14 (3.6%); male 71%, and soft neurologic symptoms, 10 (2.6%); male 67%. The younger aged and male children were more prone to severe brain injuries. Conclusions: The head trauma is common during childhood period, especially under 6 years old children. The most of head trauma children are no severe neurological damages but the severe brain injuries such as intracranial hemorrhage are more common to younger and
E U R O P E A N JO U R N A L O F PAEDIATRIC N E U R O L O G Y
ence of shaken baby syndrome (SBS). Many authors state that presence of RH is a pathognomic finding to diagnose SBS. According to our experience, this assumption is incorrect. We performed a retrospective study on children admitted to our university hospital with RH. Material and methods: Our study included 29 children with RH, aged 1–18 months old, admitted to our hospital from the year 2000 to 2013. Story and physical examination during presentation, medical course, coagulation tests, metabolic investigations, skeletal survey and head circumference of the infant and his parents were collected. Retinal findings as well as central imaging (CT and MRI) were reassessed to obtain a standardized description. Evaluation reports by social services or civil/criminal courts were collected. (Preliminary) results: Of the 29 children, 23 were found suspect of SBS by the medical team and/or social services. In 5 of the 23 cases shaking was admitted. Three cases showed intraparenchymal hematomas, 4 interhemispheric blood, 4 cerebral edema, 6 compression of a ventricle, and 3 papilledema. In 15 of the 23 cases diffusionweighted MRI was performed: 6 showed diffuse lesions, 4 showed bilateral lesions. In 2 of the 6 non-suspect cases a clear etiology was found (accidental trauma or cerebral aneurysm). None of the 4 remaining cases showed intraparenchymal or interhemispheric blood, cerebral edema, compression of a ventricle, diffuse lesions on diffusion-weighted MRI or papilledema. Three of the 4 cases showed an accelerated growth of the head circumference months before presentation. Conclusion: According to our study infants can present RH and/or SDH without SBS. Infants with a large head circumference could be predisposed to retinal or subdural hemorrhages with or without a minor trauma.
PP5.1 - 1846 Pediatric TBI: acute and 1-year MRs/DTI findings Holshouser BA, Ghosh N, Tong KA, Pivonka-Jones J, Rundquist M, Ashwal S. Departments of Radiology and Pediatrics, Loma Linda University School of Medicine, USA – [email protected] Objective: We present longitudinal MR spectroscopic and DTI findings in children with complicated mild/severe TBI. Methods: Studies were done (7–15 days & 1 year) with MRI (3D-T1W, 3D-T2W, FLAIR, SWI, DTI-mean FA, ADC, AD, RD) and with 3D MRSI (10 mm slabs-corpus callosum–brain stem). MRSI voxel data were overlaid onto DTI white matter (WM) data to compare DTI parameters to metabolite ratios (NAA/Cr, NAA/Cho, Cho/Cr) for each voxel and region. Neuropsychological evaluations were done (3, 12 months). Results: We studied 17 TBI (13.2yrs; GCS: 3–15) and 15 controls (11.5 yrs). Initial MRI found decreased NAA/Cr and NAA/Cho ratios in all regions in TBI patients compared to controls. Mean FA values were decreased in corpus callosum (CC), basal ganglia (BG), parieto-occipital and temporal white matter. The mixed model analysis which accounts for age effects, showed a significant recovery of NAA/Cr only in 3 regions - BG (p=0.01), temporal gray (p=0.03) and thalami (p=0.01) and showed no significant longitudinal recovery of DTI metrics compared to controls. The initial NAA ratios and mean FA measurements correlated significantly with IQ and memory deficits evaluated at 12 months after injury. Conclusions: Early decreases in NAA represent neuronal loss or dysfunction and early FA reductions represent structural white matter injury. At 12 months, MRS showed significant recovery of metabolite ratios only in 3 regions, whereas, no regional DTI metrics recovered. This suggests incomplete metabolic and axonal recovery as the source of cognitive impairment.
17s (2013) S1 – S149
PP5.2 - 1844 Advanced MR and spectroscopic imaging in adolescents with chronic post-concussive symptoms following sports-related concussion Bartnik-Olson BL, Grube M, Wang H, Wong V, Holshouser BA, Ashwal S. Departments of Radiology and Pediatrics, Loma Linda University Medical Center, USA – [email protected] Objective: There is growing interest in using advanced MRI techniques (diffusion tensor imaging, DTI; perfusion weighted imaging, PWI) to identify and quantify microstructural axonal injury and perfusion abnormalities in adolescents with sports related concussion (SRC). We investigated these changes in a group of post-concussive symptomatic adolescents. Methods: We studied 13 adolescents (16±4 years) who sustained a SRC (1–24 months before imaging) and 14 controls (15±4 years). Symptoms included headache (persistent or intermittent, n=13), dizziness (n=3), and cognitive (n=6) or behavioral changes (including depression, n=4). DTI and PWI data were acquired on a Siemens Tim Trio 3T scanner. Region of interest DTI (FA, MD, RD) and PWI (CBF, CBV, MTT) analysis was performed. Results: FA and RD were reduced in the genu of the corpus callosum in SRC subjects compared to controls (p=0.05 and p=0.04). SRC subjects also showed reduced rCBF (p=0.03) and rCBV (p=0.05) in the right thalamus and a trend (p=0.06) towards reduced rCBF and rCBV in the left thalamus. Conclusions: Lower callosal FA values have been reported after mild TBI and indicate axonal injury. Elevated RD in this region suggests the presence of myelin damage along with axonal injury. rCBF and rCBV also were reduced in the thalami of SRC subjects and may be due to post-injury vascular disruption or impairment of microvascular responsiveness. Our findings suggest that DTI and PWI reflect different components of the complex injury that occurs after SRC and that both are sensitive indicators of lasting injury in chronically symptomatic athletes.
PP5.3 - 1676 The risk factors of severe brain injury by head trauma under 6 years old children Na YH, Cha BH. Wonju Severance Christian Hospital, Korea – [email protected] Objectives: The head trauma is common type of injury coming to emergency room during childhood period, especially under 6 years old children. We would like to evaluate the risk factors of severe brain injuries associated with the head trauma occurring under 6 years old children. Material and methods: We retrospectively reviewed the medical records of 392 children, who came to emergency room of Wonju Severance Christian Hospital from March, 2011 to February, 2012 due to head trauma. We evaluated the clinical characteristics of these children for risk factors of severe brain injuries. Results: The 1981 children under 15 years old came to emergency room due to traumatic injuries. Among them, 554 children (28.0%) had head trauma and 392 children (70.8%) were under 6 years old; under 3 years old, 244 (62.2%) and between 3 and 6 years old, 148 (37.8%). the male and female ratio was 1.65:1. The causes of head trauma were falling down (77.6%), strucken by objects (8.2%), car accident (7.9%) and unknown (6.3%). The most of children (77.1%) were no neurologic symptoms and signs, but there were noted that intracranial hemorrhage was 24 (6.1%); male 58%, skull fracture, 10 (2.6%); male 80%, seizure, 8 (2.0%); male 75%, intracranial hemorrhage with skull fracture, 14 (3.6%); male 71%, and soft neurologic symptoms, 10 (2.6%); male 67%. The younger aged and male children were more prone to severe brain injuries. Conclusions: The head trauma is common during childhood period, especially under 6 years old children. The most of head trauma children are no severe neurological damages but the severe brain injuries such as intracranial hemorrhage are more common to younger and