title: White Matter Tract Pathology in Pediatric Anoxic Brain Injury from Drowning.
abstract: Although drowning is a leading cause of mortality and morbidity in young children, the neuropathologic consequences have not been fully determined. The purpose of this article was to quantitatively characterize white matter microstructural abnormalities in pediatric anoxic brain injury from nonfatal drowning and investigate the correlation with motor function.
  
  
  
  Whole-brain T1-weighted and diffusion-weighted MR imaging datasets were acquired in 11 children with chronic anoxic brain injury and 11 age- and sex-matched neurotypical controls (4-12 years of age). A systematic evaluation form and scoring system were created to assess motor function. Tract-Based Spatial Statistics was used to quantify between-group alterations in the diffusion tensor imaging indices of fractional anisotropy and mean diffusivity and to correlate with per-subject functional motor scores.
  
  
  
  Group-wise Tract-Based Spatial Statistics analyses demonstrated reduced fractional anisotropy in the bilateral posterior limbs of the internal capsule and the splenium of the corpus callosum (P< .001). Mean diffusivity was more diffusely increased, affecting the bilateral superior corona radiata, anterior and posterior limbs of the internal capsule, and external capsules (P< .001). Individual-subject fractional anisotropy and mean diffusivity values derived from the ROIs of the bilateral posterior limbs of the internal capsule strongly correlated with motor scores and demonstrated more potent between-group effects than with ROIs of the entire corticospinal tract.
  
  
  
  These data particularly implicate the deep white matter, predominantly the posterior limbs of the internal capsule, as targets of damage in pediatric anoxic brain injury with drowning. The substantial involvement of motor-system tracts with relative sparing elsewhere is notable. These results localize white matter pathology and inform future diagnostic and prognostic markers.
authors.affiliation: From the Research Imaging Institute (M.I., M.D.W., C.G.F., F.S.S., P.T.F.) Ishaque@livemail.uthscsa.edu Fox@uthscsa.edu.|Department of Radiological Sciences (M.I., P.T.F.), University of Texas Health Science Center at San Antonio, San Antonio, Texas.
authors.forename: M
authors.identifier: 0000-0002-9488-936X
authors.initials: M
authors.lastname: Ishaque
authors.affiliation: Merrill Palmer Skillman Institute (J.H.M.), Wayne State University, Detroit, Michigan.
authors.forename: J H
authors.identifier: 0000-0002-8781-9072
authors.initials: JH
authors.lastname: Manning
authors.affiliation: From the Research Imaging Institute (M.I., M.D.W., C.G.F., F.S.S., P.T.F.).
authors.forename: M D
authors.identifier: 0000-0002-0132-9102
authors.initials: MD
authors.lastname: Woolsey
authors.affiliation: From the Research Imaging Institute (M.I., M.D.W., C.G.F., F.S.S., P.T.F.).
authors.forename: C G
authors.identifier: 0000-0002-7382-1315
authors.initials: CG
authors.lastname: Franklin
authors.affiliation: From the Research Imaging Institute (M.I., M.D.W., C.G.F., F.S.S., P.T.F.).
authors.forename: F S
authors.identifier: 0000-0003-3591-186X
authors.initials: FS
authors.lastname: Salinas
authors.affiliation: From the Research Imaging Institute (M.I., M.D.W., C.G.F., F.S.S., P.T.F.) Ishaque@livemail.uthscsa.edu Fox@uthscsa.edu.|Department of Radiological Sciences (M.I., P.T.F.), University of Texas Health Science Center at San Antonio, San Antonio, Texas.|South Texas Veterans Healthcare System (P.T.F.), San Antonio, Texas.|Shenzhen University School of Medicine (P.T.F.), Shenzhen, People's Republic of China.
authors.forename: P T
authors.identifier: 0000-0002-0465-2028
authors.initials: PT
authors.lastname: Fox
mesh_terms: D016880:Anisotropy; D001921:Brain / Q000000981:diagnostic imaging; D002648:Child; D002675:Child, Preschool; D003337:Corpus Callosum / Q000000981:diagnostic imaging; D056324:Diffusion Tensor Imaging; D004332:Drowning / Q000000981:diagnostic imaging*; D004525:Efferent Pathways / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D002534:Hypoxia, Brain / Q000000981:diagnostic imaging*; D020772:Internal Capsule / Q000000981:diagnostic imaging; D008297:Male; D009068:Movement; D066127:White Matter / Q000000981:diagnostic imaging*