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Reliability of fractional anisotropy measurement for children with cerebral palsy
Kyunghoon Min1, Su Jin Yu1, Ji Hyun Lee1
1Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University, Seongnam-si, Gyeonggi-do, Republic of Korea.
Insights
Diffusion tensor imaging (DTI) fractional anisotropy (FA) measurements are reliable for children with periventricular leukomalacia (PVL) and cerebral palsy (CP). This DTI metric shows good consistency for assessing white matter injury in pediatric CP patients.
Area of Science:
- Pediatric neurology
- Neuroimaging
- Biomedical engineering
Background:
- Periventricular leukomalacia (PVL) is a primary cause of disability in children with cerebral palsy (CP).
- Diffusion tensor imaging (DTI) detects white matter microstructural lesions.
- Fractional anisotropy (FA) is a key DTI metric for pediatric CP assessment.
Purpose of the Study:
- To evaluate the reliability of fractional anisotropy (FA) measurements in children diagnosed with periventricular leukomalacia (PVL).
- To assess the consistency of FA values derived from diffusion tensor imaging (DTI) in pediatric cerebral palsy (CP) patients.
Main Methods:
- Four observers measured FA values in 78 children with spastic CP and PVL.
- Regions of interest (ROIs) were defined in specific white matter tracts.
- Intra- and interobserver reliability were assessed using ICC, SRD%, and Bland-Altman analysis.
Main Results:
- High intraobserver (ICC ≥ 0.85) and interobserver (ICC > 0.90) reliability for FA measurements.
- Smallest Real Difference percentage (SRD%) ranged from 3.59% to 12.33% for intraobserver and under 10% for interobserver.
- Bland-Altman analysis confirmed good intra- and interobserver agreement; reliability was independent of impairment severity.
Conclusions:
- Diffusion tensor imaging (DTI)-derived fractional anisotropy (FA) values demonstrate satisfactory reliability in children with periventricular leukomalacia (PVL).
- The consistent FA measurements support its clinical utility in evaluating white matter integrity in pediatric cerebral palsy.
Objective:
Periventricular leukomalacia (PVL) is the leading cause of disability in children with cerebral palsy (CP). Diffusion tensor imaging (DTI) is a magnetic resonance imaging technique for detecting microstructural lesions of white matter. Fractional anisotropy (FA) is a widely used DTI index with clinical significance in children with CP. This study aims to estimate the reliability of FA for children with CP.
Design:
Four observers measured FA values in 78 children with spastic CP from PVL. Region of interests (ROIs) were placed in three anatomical loci at each side: medial and lateral portions of posterior limb of internal capsule and ascending sensory tract. Intra- and interobserver reliability indices including intraclass correlation coefficient (ICC), standard error of measurement, smallest real difference percentage (SRD%), and limit of agreement using Bland-Altman analysis were examined.
Results:
Intraobserver ICCs were 0.85 or greater in all ROIs, and SRD% ranged from 3.59 to 12.33%. Interobserver ICCs exceeded 0.90 in all ROIs, and the SRD% were less than 10%. The Bland-Altman analysis showed good intra- and interobserver agreements. The reliability was not affected by severity of impairment.
Conclusions:
Reliability of DTI-derived FA value using ROIs was satisfactory in children with PVL.
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