Magnetic resonance imaging outcomes from a comprehensive magnetic resonance study of children with fetal alcohol spectrum disorders.
BACKGROUND
Magnetic resonance (MR) technology offers noninvasive methods for in vivo assessment of neuroabnormalities.


METHODS
A comprehensive neuropsychological/psychiatric battery, coupled with MR imaging, (MRI), MR spectroscopy (MRS), and functional MRI (fMRI) assessments, were administered to children with fetal alcohol spectrum disorders (FASD) to determine if global and/or focal abnormalities could be identified, and distinguish diagnostic subclassifications across the spectrum. The 4 study groups included: (i) fetal alcohol syndrome (FAS)/partial FAS (PFAS); (ii) static encephalopathy/alcohol exposed (SE/AE); (iii) neurobehavioral disorder/alcohol exposed (ND/AE) as diagnosed with the FASD 4-Digit Code; and (iv) healthy peers with no prenatal alcohol exposure. Presented here are the MRI assessments that were used to compare the sizes of brain regions between the 4 groups. The neuropsychological/behavioral, MRS, and fMRI outcomes are reported separately.


RESULTS
Progressing across the 4 study groups from Controls to ND/AE to SE/AE to FAS/PFAS, the mean absolute size of the total brain, frontal lobe, caudate, putamen, hippocampus, cerebellar vermis, and corpus callosum length decreased incrementally and significantly. The FAS/PFAS group (the only group with the 4-Digit FAS facial phenotype) had disproportionately smaller frontal lobes relative to all other groups. The FAS/PFAS and SE/AE groups [the 2 groups with the most severe central nervous system (CNS) dysfunction] had disproportionately smaller caudate regions relative to the ND/AE and Control groups. The prevalence of subjects in the FAS/PFAS, SE/AE, and ND/AE groups that had 1 or more brain regions, 2 or more SDs below the mean size observed in the Control group was 78, 58, and 43%, respectively. Significant correlations were observed between size of brain regions and level of prenatal alcohol exposure, magnitude of FAS facial phenotype, and level of CNS dysfunction.


CONCLUSIONS
Magnetic resonance imaging provided further validation that ND/AE, SE/AE, and FAS/PFAS as defined by the FASD 4-Digit Code are 3 clinically distinct and increasingly more affected diagnostic subclassifications under the umbrella of FASD. Neurostructural abnormalities are present across the spectrum. MRI could importantly augment diagnosis of conditions under the umbrella of FASD, once population-based norms for structural development of the human brain are established.
Astley
Susan J
SJ
Department of Epidemiology, University of Washington, Seattle, Washington 98195-7920, USA. astley@u.washington.edu
Aylward
Elizabeth H
EH
Olson
Heather Carmichael
HC
Kerns
Kimberly
K
Brooks
Allison
A
Coggins
Truman E
TE
Davies
Julian
J
Dorn
Susan
S
Gendler
Beth
B
Jirikowic
Tracy
T
Kraegel
Paul
P
Maravilla
Kenneth
K
Richards
Todd
T
D000014:Abnormalities, Drug-Induced / Q000473:pathology; D000428:Alcohol Drinking; D000704:Analysis of Variance; D001479:Basal Ganglia / Q000473:pathology; D001921:Brain / Q000473:pathology*; D002531:Cerebellum / Q000473:pathology; D002648:Child; D003337:Corpus Callosum / Q000473:pathology; D005260:Female; D063647:Fetal Alcohol Spectrum Disorders / Q000175:diagnosis / Q000473:pathology*; D005625:Frontal Lobe / Q000473:pathology; D006624:Hippocampus / Q000473:pathology; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D009483:Neuropsychological Tests; D011247:Pregnancy; D011569:Psychiatric Status Rating Scales; D018401:Sample Size; D012959:Socioeconomic Factors