title: Diffusion tensor imaging predicts motor outcome in children with acquired brain injury.
abstract: BACKGROUND
  Rehabilitation in children with acquired brain injury is a challenging endeavour. There is a large variability in motor recovery between patients, and a need to optimize therapies by exploiting cerebral plasticity and recovery mechanisms. This retrospective study aims to identify tract-based markers that could serve as predictors of functional outcome following rehabilitation.
  
  
  METHODS
  Twenty-nine children with traumatic brain injury (n = 14) or stroke (n = 15) underwent a 3 T Magnetic Resonance Imaging (MRI) measurement, including Diffusion Tensor Imaging (DTI) between admission to the Hospital and onset of rehabilitation therapy at the Rehabilitation Centre. The Functional Independence Measure for Children (WeeFIM) was routinely applied at admission and discharge from the Rehabilitation Centre. Distinguishing between children with good versus poor functional independence was performed using ROC-analysis. A non-parametric partial correlation analysis between the DTI and WeeFIM motor scores was performed with age, time in rehabilitation, and time of MRI scan after injury as covariates.
  
  
  RESULTS
  Mean fractional anisotropy (FA) from the DTI in the ipsilesional corticospinal-tract provided the highest predictive accuracy (sensitivity = 95 %, specificity = 78 %, Youden Index = 0.73, Area under the curve = 0.9), in comparison to the lesion volume or other clinical variables. Mean FA of the ipsilesional corticospinal-tract correlated positively with the WeeFIM discharge motor scores (ρ = 0.547, p = 0.004). Prediction was poorer for the lesion volume or Glasgow Coma Scale.
  
  
  CONCLUSIONS
  The results suggest that DTI data could improve the prediction of functional outcome after rehabilitation in children and adolescents with stroke or traumatic brain injury. Specifically, mean FA shows the highest predictive accuracy in comparison to lesion volume or clinical scales.
authors.affiliation: Rehabilitation Centre, University Children's Hospital, CH-8910, Affoltern am Albis, Switzerland. volker.ressel@kispi.uzh.ch.|Centre MR-Research, University Children's Hospital, Zurich, CH-8032, Switzerland. volker.ressel@kispi.uzh.ch.
authors.forename: Volker
authors.identifier: http://orcid.org/0000-0002-2378-830X
authors.initials: V
authors.lastname: Ressel
authors.affiliation: Centre MR-Research, University Children's Hospital, Zurich, CH-8032, Switzerland.
authors.forename: Ruth
authors.initials: R
authors.lastname: O'Gorman Tuura
authors.affiliation: Diagnostic Imaging, University Children's Hospital, Zurich, CH-8032, Switzerland.
authors.forename: Ianina
authors.initials: I
authors.lastname: Scheer
authors.affiliation: Rehabilitation Centre, University Children's Hospital, CH-8910, Affoltern am Albis, Switzerland.
authors.forename: Hubertus J A
authors.initials: HJA
authors.lastname: van Hedel
mesh_terms: D000293:Adolescent; D001921:Brain / Q000000981:diagnostic imaging*; D001930:Brain Injuries / Q000150:complications / Q000000981:diagnostic imaging* / Q000534:rehabilitation*; D002648:Child; D002675:Child, Preschool; D056324:Diffusion Tensor Imaging; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D009043:Motor Activity; D009069:Movement Disorders / Q000000981:diagnostic imaging / Q000209:etiology / Q000534:rehabilitation; D011379:Prognosis; D011712:Pyramidal Tracts / Q000000981:diagnostic imaging; D012372:ROC Curve; D020127:Recovery of Function; D012189:Retrospective Studies; D020521:Stroke / Q000150:complications / Q000000981:diagnostic imaging; D000071939:Stroke Rehabilitation; D055815:Young Adult
keywords: Corticospinal-tracts; DTI; Paediatric; Stroke and TBI; WeeFIM