title: Automated, quantitative measures of grey and white matter lesion burden correlates with motor and cognitive function in children with unilateral cerebral palsy.
abstract: White and grey matter lesions are the most prevalent type of injury observable in the Magnetic Resonance Images (MRIs) of children with cerebral palsy (CP). Previous studies investigating the impact of lesions in children with CP have been qualitative, limited by the lack of automated segmentation approaches in this setting. As a result, the quantitative relationship between lesion burden has yet to be established. In this study, we perform automatic lesion segmentation on a large cohort of data (107 children with unilateral CP and 18 healthy children) with a new, validated method for segmenting both white matter (WM) and grey matter (GM) lesions. The method has better accuracy (94%) than the best current methods (73%), and only requires standard structural MRI sequences. Anatomical lesion burdens most predictive of clinical scores of motor, cognitive, visual and communicative function were identified using the Least Absolute Shrinkage and Selection operator (LASSO). The improved segmentations enabled identification of significant correlations between regional lesion burden and clinical performance, which conform to known structure-function relationships. Model performance was validated in an independent test set, with significant correlations observed for both WM and GM regional lesion burden with motor function (p < 0.008), and between WM and GM lesions alone with cognitive and visual function respectively (p < 0.008). The significant correlation of GM lesions with functional outcome highlights the serious implications GM lesions, in addition to WM lesions, have for prognosis, and the utility of structural MRI alone for quantifying lesion burden and planning therapy interventions.
authors.affiliation: CSIRO Health and Biosecurity, The Australian e-Health Research Centre, Brisbane, Australia; The University of Queensland, School of Information, Technology and Electrical Engineering, St Lucia, Brisbane, Australia. Electronic address: Alex.Pagnozzi@csiro.au.
authors.forename: Alex M
authors.initials: AM
authors.lastname: Pagnozzi
authors.affiliation: CSIRO Health and Biosecurity, The Australian e-Health Research Centre, Brisbane, Australia.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Dowson
authors.affiliation: CSIRO Health and Biosecurity, The Australian e-Health Research Centre, Brisbane, Australia.
authors.forename: James
authors.initials: J
authors.lastname: Doecke
authors.affiliation: IRCCS Stella Maris Foundation, Pisa, Italy.
authors.forename: Simona
authors.initials: S
authors.lastname: Fiori
authors.affiliation: The University of Queensland, School of Information, Technology and Electrical Engineering, St Lucia, Brisbane, Australia.
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Bradley
authors.affiliation: The University of Queensland, Queensland Cerebral Palsy and Rehabilitation Research Centre, Centre for Children's Health Research, Faculty of Medicine and Science, Brisbane, Australia.
authors.forename: Roslyn N
authors.initials: RN
authors.lastname: Boyd
authors.affiliation: CSIRO Health and Biosecurity, The Australian e-Health Research Centre, Brisbane, Australia.
authors.forename: Stephen
authors.initials: S
authors.lastname: Rose
mesh_terms: D000293:Adolescent; D000465:Algorithms; D001921:Brain / Q000000981:diagnostic imaging* / Q000473:pathology; D002547:Cerebral Palsy / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology; D002648:Child; D003072:Cognition Disorders / Q000000981:diagnostic imaging / Q000209:etiology*; D005260:Female; D007839:Functional Laterality / Q000502:physiology; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D009069:Movement Disorders / Q000000981:diagnostic imaging / Q000209:etiology*; D009483:Neuropsychological Tests; D012044:Regression Analysis; D012720:Severity of Illness Index
keywords: Brain lesion; Cerebral palsy; Magnetic resonance imaging