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Author Spotlight: Noninvasive Cerebral Blood Flow Determination in Human Functional Brain Region for Diagnosis of Neurological Disorders
Published on: May 31, 2024
Cerebral blood flow in children with syndromic craniosynostosis: cohort arterial spin labeling studies
Priya N Doerga1, Maarten H Lequin2, Marjolein H G Dremmen3
11Department of Plastic and Reconstructive Surgery and Hand Surgery, Dutch Craniofacial Center.
Insights
Children with syndromic craniosynostosis (sCS) have lower cerebral blood flow (CBF) in infancy. CBF normalizes with age and treatment, but the childhood peak occurs later than in healthy children.
Area of Science:
- Pediatric Neurology
- Neurosurgery
- Medical Imaging
Background:
- Children with syndromic craniosynostosis (sCS) exhibit altered cerebral venous anatomy and a higher risk of intracranial hypertension.
- Postnatal development of cerebral blood flow (CBF) in sCS remains poorly understood.
Purpose of the Study:
- To investigate and compare regional CBF patterns in patients with sCS against control subjects.
- To analyze the impact of age and surgical intervention on CBF in sCS.
Main Methods:
- A prospective cohort study utilized MRI and arterial spin labeling (ASL) to assess regional CBF.
- Patients with sCS and controls were stratified by age and compared across brain regions.
- Longitudinal pre- to postoperative CBF changes were analyzed in a subgroup of sCS patients.
Main Results:
- Infants with sCS (<1 year) showed significantly lower CBF compared to controls.
- CBF normalized in older sCS patients, aligning with control values.
- The typical childhood peak in CBF occurred later (5-6 years) in sCS patients compared to controls (4 years).
- Surgery led to significant increases in CBF in sCS patients.
Conclusions:
- Infants with sCS have reduced CBF, which normalizes with age and treatment.
- While CBF normalizes, the timing of the physiological childhood peak is delayed in sCS.
- Surgical intervention positively impacts CBF in patients with sCS.
Objective:
In comparison with the general population, children with syndromic craniosynostosis (sCS) have abnormal cerebral venous anatomy and are more likely to develop intracranial hypertension. To date, little is known about the postnatal development change in cerebral blood flow (CBF) in sCS. The aim of this study was to determine CBF in patients with sCS, and compare findings with control subjects.
Methods:
A prospective cohort study of patients with sCS using MRI and arterial spin labeling (ASL) determined regional CBF patterns in comparison with a convenience sample of control subjects with identical MRI/ASL assessments in whom the imaging showed no cerebral/neurological pathology. Patients with SCS and control subjects were stratified into four age categories and compared using CBF measurements from four brain lobes, the cerebellum, supratentorial cortex, and white matter. In a subgroup of patients with sCS the authors also compared longitudinal pre- to postoperative CBF changes.
Results:
Seventy-six patients with sCS (35 female [46.1%] and 41 male [53.9%]), with a mean age of 4.5 years (range 0.2-19.2 years), were compared with 86 control subjects (38 female [44.2%] and 48 male [55.8%]), with a mean age of 6.4 years (range 0.1-17.8 years). Untreated sCS patients < 1 year old had lower CBF than control subjects. In older age categories, CBF normalized to values observed in controls. Graphical analyses of CBF by age showed that the normally expected peak in CBF during childhood, noted at 4 years of age in control subjects, occurred at 5-6 years of age in patients with sCS. Patients with longitudinal pre- to postoperative CBF measurements showed significant increases in CBF after surgery.
Conclusions:
Untreated patients with sCS < 1 year old have lower CBF than control subjects. Following vault expansion, and with age, CBF in these patients normalizes to that of control subjects, but the usual physiological peak in CBF in childhood occurs later than expected.
