ORIGINAL RESEARCH PEDIATRICS Advanced Fiber Tracking in Early Acquired Brain Injury Causing Cerebral Palsy

BACKGROUND AND PURPOSE: Diffusion-weighted MR imaging and fiber tractography can be used to investigate alterations in white matter tracts in patients with early acquired brain lesions and cerebral palsy.Most existing studies have used diffusion tensor tractography, which is limited in areas of complex fiber structures or pathologic processes. We explored a combined normalization and probabilistic fiber-tracking method for more realistic fiber tractography in this patient group. MATERIALS AND METHODS: This cross-sectional study included 17 children with unilateral cerebral palsy and 24 typically developing controls. DWI data were collected at 1.5T (45 directions, b1000 s/mm2). Regions of interest were defined on a study-specific fractional anisotropy template and mapped onto subjects for fiber tracking. Probabilistic fiber tracking of the corticospinal tract and thalamic projections to the somatosensory cortexwas performed by using constrained spherical deconvolution. Tracts were qualitatively assessed, and DTI parameters were extracted close to and distant from lesions and compared between groups. RESULTS: The corticospinal tract and thalamic projections to the somatosensory cortex were realistically reconstructed in both groups. Structural changes to tracts were seen in the cerebral palsy group and included splits, dislocations, compaction of the tracts, or failure to delineate the tract and were associated with underlying pathology seen on conventional MR imaging. Comparisons of DTI parameters indicated primary and secondary neurodegeneration along the corticospinal tract. Corticospinal tract and thalamic projections to the somatosensory cortex showed dissimilarities in both structural changes and DTI parameters. CONCLUSIONS: Our proposed method offers a sensitive means to explore alterations in WM tracts to further understand pathophys-iologic changes following early acquired brain injury. ABBREVIATIONS: CerPed cerebral peduncle; CP cerebral palsy; CSD constrained spherical deconvolution; CST corticospinal tract; FA fractional anisotropy; FTA fiber-tract assessment;M1 primarymotor cortex;MDmean diffusivity; PLIC posterior limb of the internal capsule; TRS1 thalamic projection