title: Using diffusion tensor imaging to identify corticospinal tract projection patterns in children with unilateral spastic cerebral palsy.
abstract: To determine whether diffusion tensor imaging (DTI) can be an independent assessment for identifying the corticospinal tract (CST) projecting from the more-affected motor cortex in children with unilateral spastic cerebral palsy (CP).
  
  
  
  Twenty children with unilateral spastic CP participated in this study (16 males, four females; mean age 9y 2mo [standard deviation (SD) 3y 2mo], Manual Ability Classification System [MACS] level I-III). We used DTI tractography to reconstruct the CST projecting from the more-affected motor cortex. We mapped the motor representation of the more-affected hand by stimulating the more- and the less-affected motor cortex measured with single-pulse transcranial magnetic stimulation (TMS). We then verified the presence or absence of the contralateral CST by comparing the TMS map and DTI tractography. Fisher's exact test was used to determine the association between findings of TMS and DTI.
  
  
  
  DTI tractography successfully identified the CST controlling the more-affected hand (sensitivity=82%, specificity=78%).
  
  
  
  Contralateral CST projecting from the lesioned motor cortex assessed by DTI is consistent with findings of TMS mapping. Since CST connectivity may be predictive of response to certain upper extremity treatments, DTI-identified CST connectivity may potentially be valuable for determining such connectivity where TMS is unavailable or inadvisable for children with seizures.
authors.affiliation: Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, USA.
authors.forename: Hsing-Ching
authors.initials: HC
authors.lastname: Kuo
authors.affiliation: Burke-Cornell Medical Research Institute, White Plains, NY, USA.
authors.forename: Claudio L
authors.initials: CL
authors.lastname: Ferre
authors.affiliation: Burke-Cornell Medical Research Institute, White Plains, NY, USA.|Brain Mind Research Institute and Department of Neurology, Weill Cornell Medical College, New York, NY, USA.|Department of Pediatrics, Weill Cornell Medical College, New York, NY, USA.
authors.forename: Jason B
authors.initials: JB
authors.lastname: Carmel
authors.affiliation: New York State Psychiatric Institute, Columbia University, New York, NY, USA.
authors.forename: Jaimie L
authors.initials: JL
authors.lastname: Gowatsky
authors.affiliation: Clinical Science, Alkermes Inc., Waltham, MA, USA.
authors.forename: Arielle D
authors.initials: AD
authors.lastname: Stanford
authors.affiliation: New York State Psychiatric Institute, Columbia University, New York, NY, USA.
authors.forename: Stefan B
authors.initials: SB
authors.lastname: Rowny
authors.affiliation: Division of Translational Research, National Institutes of Health, Rockville, MD, USA.
authors.forename: Sarah H
authors.initials: SH
authors.lastname: Lisanby
authors.affiliation: Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, USA.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Gordon
authors.affiliation: Burke-Cornell Medical Research Institute, White Plains, NY, USA.|Brain Mind Research Institute and Department of Neurology, Weill Cornell Medical College, New York, NY, USA.
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Friel
mesh_terms: D000293:Adolescent; D001931:Brain Mapping; D002547:Cerebral Palsy / Q000000981:diagnostic imaging* / Q000503:physiopathology; D002648:Child; D056324:Diffusion Tensor Imaging; D004576:Electromyography; D005260:Female; D007839:Functional Laterality / Q000502:physiology*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D011712:Pyramidal Tracts / Q000000981:diagnostic imaging*; D050781:Transcranial Magnetic Stimulation