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Journal of Pediatric Neuroradiology 2014; 03(02): 063-073
DOI: 10.3233/PNR-14088
Georg Thieme Verlag KG Stuttgart – New York

Cerebral Blood Flow and DTI metrics changes in children with cerebral palsy following therapy

Krishan K. Jain
a   Department of Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
g   Departments of Radiology & Imaging, Fortis Memorial Research Institute, Gurgaon.
,
Vimal K. Paliwal
b   Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
,
Abhinav Yadav
c   Department of Biological Sciences, Indian Institute of Science Education and Research, Kolkata, India
,
Bhaswati Roy
a   Department of Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
g   Departments of Radiology & Imaging, Fortis Memorial Research Institute, Gurgaon.
,
Puneet Goel
d   Department of Anaesthesiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
,
Saurabh Chaturvedi
a   Department of Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
,
Ankita Chaurasia
a   Department of Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
,
Ravindra K. Garg
e   Department of Neurology, King George Medical University, Lucknow, India
,
Ram K.S. Rathore
f   Department of Mathematics and Statistics, Indian Institute of Technology, Kanpur, India
,
Rakesh K. Gupta
a   Department of Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
g   Departments of Radiology & Imaging, Fortis Memorial Research Institute, Gurgaon.
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Publication History

24 May 2013

29 December 2013

Publication Date:
29 July 2015 (online)

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Abstract

It is known that patients with chronic hypoxia have regional changes in their cerebral blood flow (CBF). The purpose of this study was to observe the CBF and diffusion tensor imaging (DTI) metrics changes in children with cerebral palsy (CP) at baseline and after 6 months of treatment. Thirty-eight children with cerebral diplegia (mean age = 6.4 yr) and twenty-one age/sex matched controls (mean age = 7.5 yr) were evaluated by the Gross Motor Function Classification System (GMFCS) scoring of motor disability and modified Ashworth scoring of spasticity. All subjects underwent pseudo-continuous arterial spin labeling (PCASL) and DTI, in addition to conventional magnetic resonance imaging (MRI). Significant increase in CBF values was observed in several grey and white matter regions (including areas of abnormal T2 hyperintensity in the periventricular white matter) in CP children as compared to controls based upon voxel-wise analysis. Low fractional anisotropy (FA) and high apparent diffusion coefficient (ADC) values were observed in these areas of high CBF, using a region of interest (ROI) based analysis. On follow-up study, CBF values were found to be significantly higher in two grey matter areas and lower in three white matter regions in comparison to baseline; however no significant changes in DTI indices were observed in these regions. CBF values are high in CP children as compared to controls and show alteration following therapy even when the DTI metrics remain unchanged. Arterial spin labeling (ASL) may be added to the advanced imaging protocol for studying brain plasticity in such children in future.

Keywords

Cerebral palsy - cerebral blood flow - voxel wise analysis - diffusion tensor imaging - arterial spin labeling - brain