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Abnormal anisotropic diffusion properties in pediatric myelomeningocele patients treated with fetal surgery: an

Francesco T Mangano1,2, Charles B Stevenson1,2, Usha Nagaraj2,3

  • 1Division of Pediatric Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.

Child'S Nervous System : Chns : Official Journal of the International Society for Pediatric Neurosurgery
|August 11, 2019
PubMed

Insights

Diffusion tensor imaging (DTI) revealed white matter abnormalities in pediatric patients who underwent fetal repair for myelomeningocele (MMC). These DTI findings may serve as biomarkers for hydrocephalus assessment in this population.

Area of Science:

  • Neuroimaging
  • Pediatric Neurology
  • Developmental Biology

Background:

  • Myelomeningocele (MMC) repair in utero aims to improve outcomes but may impact brain development.
  • Understanding white matter microstructural changes post-fetal MMC repair is crucial for long-term patient management.

Purpose of the Study:

  • To investigate white matter microstructural abnormalities using diffusion tensor imaging (DTI) in pediatric patients following fetal repair for myelomeningocele (MMC).

Main Methods:

  • Retrospective analysis of DTI data from 8 pediatric patients with prenatal MMC repair and 8 age-matched controls.
  • Calculated fractional anisotropy (FA) and mean diffusivity (MD) in the genu of corpus callosum (gCC) and posterior limb of internal capsule (PLIC).
  • Assessed ventricle size using the fronto-occipital horn ratio (FOHR) and compared DTI values between groups using paired t-tests.

Main Results:

  • Patients with prenatal MMC repair exhibited significantly larger ventricles (FOHR) compared to controls (p < 0.001).
  • Significant differences in DTI measures were observed in the gCC, with lower FA and higher MD in the patient group (p = 0.007 and 0.003, respectively).
  • A trend towards increased MD was noted in the PLIC of patients compared to controls (p = 0.065).

Conclusions:

  • Diffusion tensor imaging (DTI) demonstrates white matter microstructural abnormalities in pediatric patients after fetal MMC repair.
  • DTI's sensitivity in detecting these abnormalities suggests its potential as an imaging biomarker for hydrocephalus assessment.
  • These findings can aid in optimizing treatment decisions for hydrocephalus in this patient population.
Abstract

Keywords:
DTIFetal repairMyelomeningoceleWhite matter injury

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