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Combined diffusion tensor and MR spectroscopic imaging methodology for automated regional brain analysis: Application in a normal pediatric population
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e u r o p e a n j o u r n a l o f p a e d i a t r i c n e u r o l o g y 2 1 ( 2 0 1 7 ) e 1 9 7 ee 2 1 3
with presence of nystagmus, foot deformities, upper limb areflexia, dysarthria and ECG abnormality. Conclusion: We need a further studies with a larger number of patients to find out the most important factors that could influence in the expression of the disease.
http://dx.doi.org/10.1016/j.ejpn.2017.04.1083 P3-67 Unique presentation of a ruptured arachnoid cyst with subdural hygroma formation and midline shift in a 10-year-old girl M. Sergentanis, A. Spungina, S. Raina. Department of Paediatrics, The Princess Alexandra Hospital, Harlow, UK Objective: The majority of intracranial arachnoid cysts are asymptomatic and are detected incidentally. They are benign congenital cavities arising in the subarachnoid space. Rupture may result in symptomatic presentation, the most common symptom being headache. Raised intracranial pressure is a rare complication requiring surgical treatment. Methods: Information was collected from the patient, parents, notes and hospital databases. Results: A 10-year-old girl presented to a district general hospital with a 2-month history of a strange sensation in her head during any physical activity. A week prior to admission she heard a “pop” in her head while performing a cartwheel, developed nausea and headache that was eased when standing up or tilting her head to the right. On examination, the patient was neurologically intact with no signs of raised intracranial pressure. However, MRI brain showed a ruptured 3.8 2.9 x 2.3 cm left middle cranial fossa arachnoid cyst with extensive subdural hygroma and mass effect (Image 1, 2). She was managed with burr hole drainage. Conclusion: It is essential to pay attention to the history, which may appear to be trivial on presentation (a sensation of “pop” while doing cartwheel) to avoid missing burst arachnoid cysts that may have disastrous consequences.
http://dx.doi.org/10.1016/j.ejpn.2017.04.1084 P3-68 Combined diffusion tensor and MR spectroscopic imaging methodology for automated regional brain analysis: Application in a normal pediatric population S. Ashwal, N. Ghosh, S. Barnes, U. Oyoyo, K. Tong, B. Holshouser. Loma Linda University School of Medicine, USA Objective: During brain development, anatomic regions mature at different rates. Quantitative anatomy-specific analysis of longitudinal diffusion tensor imaging (DTI) and magnetic resonance spectroscopic imaging (MRSI) data may improve our ability to quantify and categorize these maturational changes. Computational tools designed to fuse and analyze imaging information from multiple, data sets would facilitate research during normal maturation and for comparison to disease states. Methods: We developed a complete battery of computational tools to execute such data analyses that included data preprocessing, DTI tractbased statistical analysis, automated brain-anatomy parsing from T1-weighted MR images, assignment of metabolite information from MRSI data, and co-alignment of these multimodality data streams for reporting of region-specific indices. Results: We present regional DTI and MRSI data in a cohort of normal pediatric subjects (n ¼ 72; range: 5-18 years; mean age 12.7 ± 3.3 years) to establish normative data, evaluate maturational trends and
provide examples of how these methods could be applied to pediatric patients with traumatic brain injury. Several regions showed significant DTI and MRSI maturational changes however, the percent change over the age range tended to be small. In the subcortical region (combined basal ganglia (BG), thalami (TH) and corpus callosum (CC)), the largest combined percent change was a 10% increase of fractional anisotropy (FA) primarily due to increases in the BG (12.7%) and TH (9%). The largest significant percent increase in N- acetylaspartate/creatine (NAA/Cr) was seen in the brain stem (BS) (18.8%) followed by the subcortical regions in the BG (11.9%), CC (8.9%) and the TH (6.0%).We found consistent, significant (p < 0.01) but weak positive correlations (r ¼ 0.2280.329) between NAA ratios and mean FA in the BS, BG and CC regions. Conclusion: Age- and region- specific normative MR diffusion and spectroscopic metabolite ranges show brain maturation changes and are requisite for detecting abnormalities in an injured or diseased population.
http://dx.doi.org/10.1016/j.ejpn.2017.04.1085 P3-69 Susceptibility weighted imaging identifies iron-oxide labeled human neural stem cells: Automated computational detection S. Ashwal, M. Baghchechi, A. Plaia, M. Hamer, N. Ghosh, A. Obenaus. Loma Linda University School of Medicine, USA Objective: Neonatal hypoxic ischemic brain injury (HII) can lead to devastating neurological outcomes and human neural stem cell (hNSCs) transplantation may provide treatment of this condition. Multipotent hNSCs can activate multiple reparative mechanisms including secretion of neurotrophic factors that enhance brain repair and plasticity. For clinical use of implanted hNSCs, methods are required to identify, quantify, track and visualize migration and replication in an automated and reproducible fashion. Methods: In the current study, we used a model of unilateral HII in 10d old rat pups implanted with 250K Feridex-labeled hNSCs into the contralateral ventricle 3d after HII. In addition to standard non-invasively acquired serial MRI (11.7 and 4.7T) sequences that included diffusion-weighted imaging, T2 weighted imaging and we also acquired Susceptibility Weighted Imaging (SWI) at 1-90d post hNSC implantation. SWI is an advanced MRI method that enhances the visualization of iron oxide labeled hNSCs within affected regions of the injured neonatal brain. hNSC contrast was further enhanced by creating minimal intensity projections (MIP’s) from the raw SWI magnitude images combined with phase information. Automated computational analysis using Hierarchical Region Splitting (HRS) was applied for semi-automatic detection of hNSCs from SWI images. Results: We found hNSCs in the ipsilateral HII lesion within the striatum and cortex adjacent to the lesion that corresponded to histological staining for iron. Quantitative phase values (radians) obtained from SWI revealed temporally evolving increased phase which reflects decreased iron oxide content that is possibly related to cell division and the replicative capacity of the implanted hNSCs. SWI images also revealed hNSC migration from the contralateral injection site towards the ipsilateral HII lesion. Conclusion: Our results demonstrate that SWI can monitor iron-labeled hNSCs in a clinically relevant manner and that automated computational methods can rapidly identify iron-oxide labeled hNSCs.
http://dx.doi.org/10.1016/j.ejpn.2017.04.1086
e u r o p e a n j o u r n a l o f p a e d i a t r i c n e u r o l o g y 2 1 ( 2 0 1 7 ) e 1 9 7 ee 2 1 3
with presence of nystagmus, foot deformities, upper limb areflexia, dysarthria and ECG abnormality. Conclusion: We need a further studies with a larger number of patients to find out the most important factors that could influence in the expression of the disease.
http://dx.doi.org/10.1016/j.ejpn.2017.04.1083 P3-67 Unique presentation of a ruptured arachnoid cyst with subdural hygroma formation and midline shift in a 10-year-old girl M. Sergentanis, A. Spungina, S. Raina. Department of Paediatrics, The Princess Alexandra Hospital, Harlow, UK Objective: The majority of intracranial arachnoid cysts are asymptomatic and are detected incidentally. They are benign congenital cavities arising in the subarachnoid space. Rupture may result in symptomatic presentation, the most common symptom being headache. Raised intracranial pressure is a rare complication requiring surgical treatment. Methods: Information was collected from the patient, parents, notes and hospital databases. Results: A 10-year-old girl presented to a district general hospital with a 2-month history of a strange sensation in her head during any physical activity. A week prior to admission she heard a “pop” in her head while performing a cartwheel, developed nausea and headache that was eased when standing up or tilting her head to the right. On examination, the patient was neurologically intact with no signs of raised intracranial pressure. However, MRI brain showed a ruptured 3.8 2.9 x 2.3 cm left middle cranial fossa arachnoid cyst with extensive subdural hygroma and mass effect (Image 1, 2). She was managed with burr hole drainage. Conclusion: It is essential to pay attention to the history, which may appear to be trivial on presentation (a sensation of “pop” while doing cartwheel) to avoid missing burst arachnoid cysts that may have disastrous consequences.
http://dx.doi.org/10.1016/j.ejpn.2017.04.1084 P3-68 Combined diffusion tensor and MR spectroscopic imaging methodology for automated regional brain analysis: Application in a normal pediatric population S. Ashwal, N. Ghosh, S. Barnes, U. Oyoyo, K. Tong, B. Holshouser. Loma Linda University School of Medicine, USA Objective: During brain development, anatomic regions mature at different rates. Quantitative anatomy-specific analysis of longitudinal diffusion tensor imaging (DTI) and magnetic resonance spectroscopic imaging (MRSI) data may improve our ability to quantify and categorize these maturational changes. Computational tools designed to fuse and analyze imaging information from multiple, data sets would facilitate research during normal maturation and for comparison to disease states. Methods: We developed a complete battery of computational tools to execute such data analyses that included data preprocessing, DTI tractbased statistical analysis, automated brain-anatomy parsing from T1-weighted MR images, assignment of metabolite information from MRSI data, and co-alignment of these multimodality data streams for reporting of region-specific indices. Results: We present regional DTI and MRSI data in a cohort of normal pediatric subjects (n ¼ 72; range: 5-18 years; mean age 12.7 ± 3.3 years) to establish normative data, evaluate maturational trends and
provide examples of how these methods could be applied to pediatric patients with traumatic brain injury. Several regions showed significant DTI and MRSI maturational changes however, the percent change over the age range tended to be small. In the subcortical region (combined basal ganglia (BG), thalami (TH) and corpus callosum (CC)), the largest combined percent change was a 10% increase of fractional anisotropy (FA) primarily due to increases in the BG (12.7%) and TH (9%). The largest significant percent increase in N- acetylaspartate/creatine (NAA/Cr) was seen in the brain stem (BS) (18.8%) followed by the subcortical regions in the BG (11.9%), CC (8.9%) and the TH (6.0%).We found consistent, significant (p < 0.01) but weak positive correlations (r ¼ 0.2280.329) between NAA ratios and mean FA in the BS, BG and CC regions. Conclusion: Age- and region- specific normative MR diffusion and spectroscopic metabolite ranges show brain maturation changes and are requisite for detecting abnormalities in an injured or diseased population.
http://dx.doi.org/10.1016/j.ejpn.2017.04.1085 P3-69 Susceptibility weighted imaging identifies iron-oxide labeled human neural stem cells: Automated computational detection S. Ashwal, M. Baghchechi, A. Plaia, M. Hamer, N. Ghosh, A. Obenaus. Loma Linda University School of Medicine, USA Objective: Neonatal hypoxic ischemic brain injury (HII) can lead to devastating neurological outcomes and human neural stem cell (hNSCs) transplantation may provide treatment of this condition. Multipotent hNSCs can activate multiple reparative mechanisms including secretion of neurotrophic factors that enhance brain repair and plasticity. For clinical use of implanted hNSCs, methods are required to identify, quantify, track and visualize migration and replication in an automated and reproducible fashion. Methods: In the current study, we used a model of unilateral HII in 10d old rat pups implanted with 250K Feridex-labeled hNSCs into the contralateral ventricle 3d after HII. In addition to standard non-invasively acquired serial MRI (11.7 and 4.7T) sequences that included diffusion-weighted imaging, T2 weighted imaging and we also acquired Susceptibility Weighted Imaging (SWI) at 1-90d post hNSC implantation. SWI is an advanced MRI method that enhances the visualization of iron oxide labeled hNSCs within affected regions of the injured neonatal brain. hNSC contrast was further enhanced by creating minimal intensity projections (MIP’s) from the raw SWI magnitude images combined with phase information. Automated computational analysis using Hierarchical Region Splitting (HRS) was applied for semi-automatic detection of hNSCs from SWI images. Results: We found hNSCs in the ipsilateral HII lesion within the striatum and cortex adjacent to the lesion that corresponded to histological staining for iron. Quantitative phase values (radians) obtained from SWI revealed temporally evolving increased phase which reflects decreased iron oxide content that is possibly related to cell division and the replicative capacity of the implanted hNSCs. SWI images also revealed hNSC migration from the contralateral injection site towards the ipsilateral HII lesion. Conclusion: Our results demonstrate that SWI can monitor iron-labeled hNSCs in a clinically relevant manner and that automated computational methods can rapidly identify iron-oxide labeled hNSCs.
http://dx.doi.org/10.1016/j.ejpn.2017.04.1086