title: Whole-Brain DTI Assessment of White Matter Damage in Children with Bilateral Cerebral Palsy: Evidence of Involvement beyond the Primary Target of the Anoxic Insult.
abstract: Cerebral palsy is frequently associated with both motor and nonmotor symptoms. DTI can characterize the damage at the level of motor tracts but provides less consistent results in nonmotor areas. We used a standardized pipeline of analysis to describe and quantify the pattern of DTI white matter abnormalities of the whole brain in a group of children with chronic bilateral cerebral palsy and periventricular leukomalacia. We also explored potential correlations between DTI and clinical scale metrics.
  
  
  
  Twenty-five patients (mean age, 11.8 years) and 25 healthy children (mean age, 11.8 years) were studied at 3T with a 2-mm isotropic DTI sequence. Differences between patients and controls were assessed both voxelwise and in ROIs obtained from an existing DTI atlas. Clinical metrics included the Gross Motor Function Classification System, the Manual Ability Classification System, and intelligence quotient.
  
  
  
  The voxel-level and ROI-level analyses demonstrated highly significant (P < .001) modifications of DTI measurements in patients at several levels: cerebellar peduncles, corticospinal tracts and posterior thalamic radiations, posterior corpus callosum, external capsule, anterior thalamic radiation, superior longitudinal fasciculi and corona radiata, optic nerves, and chiasm. The reduction of fractional anisotropy values in significant tracts was between 8% and 30%. Statistically significant correlations were found between motor impairment and fractional anisotropy in corticospinal tracts and commissural and associative tracts of the supratentorial brain.
  
  
  
  We demonstrated the involvement of several motor and nonmotor areas in the chronic damage associated with periventricular leukomalacia and showed new correlations between motor skills and DTI metrics.
authors.affiliation: From the Neuroimaging Lab (F.A., D.P.) filippo.arrigoni@bp.lnf.it.
authors.forename: F
authors.identifier: 0000-0002-5508-1149
authors.initials: F
authors.lastname: Arrigoni
authors.affiliation: From the Neuroimaging Lab (F.A., D.P.).
authors.forename: D
authors.identifier: 0000-0002-9480-379X
authors.initials: D
authors.lastname: Peruzzo
authors.affiliation: Functional Neurorehabilitation Unit (C.G., C.M., F.S.I., A.C.T.).
authors.forename: C
authors.identifier: 0000-0001-9931-9879
authors.initials: C
authors.lastname: Gagliardi
authors.affiliation: Functional Neurorehabilitation Unit (C.G., C.M., F.S.I., A.C.T.).
authors.forename: C
authors.identifier: 0000-0003-1668-7954
authors.initials: C
authors.lastname: Maghini
authors.affiliation: Child Psychopathology Unit (P.C.), Scientific Institute IRCCS Eugenio Medea, Bosisio Parini, Italy.
authors.forename: P
authors.identifier: 0000-0003-4687-5913
authors.initials: P
authors.lastname: Colombo
authors.affiliation: Functional Neurorehabilitation Unit (C.G., C.M., F.S.I., A.C.T.).
authors.forename: F Servodio
authors.identifier: 0000-0001-9141-6164
authors.initials: FS
authors.lastname: Iammarrone
authors.affiliation: National Institutes of Health (C.P.), Bethesda, Maryland.
authors.forename: C
authors.identifier: 0000-0001-8558-4428
authors.initials: C
authors.lastname: Pierpaoli
authors.affiliation: Department of Neuroradiology (F.T.), Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy.
authors.forename: F
authors.identifier: 0000-0002-5428-7217
authors.initials: F
authors.lastname: Triulzi
authors.affiliation: Functional Neurorehabilitation Unit (C.G., C.M., F.S.I., A.C.T.).
authors.forename: A C
authors.identifier: 0000-0002-5307-9053
authors.initials: AC
authors.lastname: Turconi
mesh_terms: D016880:Anisotropy; D001921:Brain / Q000000981:diagnostic imaging* / Q000473:pathology; D002547:Cerebral Palsy / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology; D002648:Child; D056324:Diffusion Tensor Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D007969:Leukomalacia, Periventricular / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D066127:White Matter / Q000000981:diagnostic imaging* / Q000473:pathology