Relationship between characteristics on magnetic resonance imaging and motor outcomes in children with cerebral palsy and white matter injury.
In a population cohort of children with white matter injury (WMI) and cerebral palsy (CP), we aimed to describe the magnetic resonance imaging (MRI) characteristics, identify key structure-function relationships, and classify the severity of WMI in a clinically relevant way. Stratified on MRI laterality/symmetry, variables indicating the extent and location of cerebral abnormalities for 272 children with CP and WMI on chronic-phase MRI were related to gross motor function and motor topography using univariable and multivariable approaches. We found that symmetrical involvement, severe WM loss in the hemispheres and corpus callosum, and cerebellar involvement were the strongest predictors of poor gross motor function, but the final model explained only a small proportion of the variability. Bilateral, extensive WM loss was more likely to result in quadriplegia, whereas volume loss in the posterior-mid WM more frequently resulted in diplegia. The extent and location of MRI abnormalities differed according to laterality/symmetry; asymmetry was associated with less extensive hemispheric involvement than symmetrical WMI, and unilateral lesions were more focal and located more anteriorly. In summary, laterality/symmetry of WMI, possibly reflecting different pathogenic mechanisms, together with extent of WM loss and cerebellar abnormality predicted gross motor function in CP, but to a limited extent.
Developmental Disability and Rehabilitation Research, Murdoch Childrens Research Institute, 50 Flemington Road, Parkville 3052, VIC, Australia; Department of Paediatrics, University of Melbourne, Parkville 3052, VIC, Australia. Electronic address: sue.reid@mcri.edu.au.
Susan M
SM
Reid
Department of Diagnostic Imaging, Monash Children's Hospital, 246 Clayton Road, Clayton 3168, VIC, Australia.
Michael R
MR
Ditchfield
Medical Imaging Department, Royal Children's Hospital, 50 Flemington Road, Parkville 3052, VIC, Australia.
Jenny
J
Bracken
Developmental Disability and Rehabilitation Research, Murdoch Childrens Research Institute, 50 Flemington Road, Parkville 3052, VIC, Australia; Department of Paediatrics, University of Melbourne, Parkville 3052, VIC, Australia.
Dinah S
DS
Reddihough
D001921:Brain / Q000473:pathology*; D002547:Cerebral Palsy / Q000150:complications / Q000473:pathology* / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D005260:Female; D007839:Functional Laterality; D006429:Hemiplegia / Q000209:etiology / Q000473:pathology* / Q000503:physiopathology; D006801:Humans; D007223:Infant; D062071:Infant, Extremely Premature; D007234:Infant, Premature; D056784:Leukoencephalopathies / Q000150:complications / Q000473:pathology* / Q000503:physiopathology; D007969:Leukomalacia, Periventricular / Q000150:complications / Q000473:pathology* / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008297:Male; D010243:Paralysis / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D011782:Quadriplegia / Q000209:etiology / Q000473:pathology* / Q000503:physiopathology
Cerebral palsy; Intraventricular haemorrhage; Magnetic resonance imaging; Periventricular leukomalacia; White matter injury