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Updated: Jun 24, 2025
Diffusion Tensor Magnetic Resonance Imaging in the Analysis of Neurodegenerative Diseases
Published on: July 28, 2013
White matter characteristics in children with cerebral palsy prior to selective dorsal rhizotomy: a multicenter
Weihong Yuan1,2, Charles B Stevenson3,4, Paolo Moretti5
11Division of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Insights
Diffusion tensor imaging (DTI) revealed white matter (WM) abnormalities in children with cerebral palsy (CP) before selective dorsal rhizotomy (SDR). These DTI findings correlated with motor function and improved after SDR, demonstrating its efficacy.
Area of Science:
- Neuroscience
- Medical Imaging
- Pediatric Neurology
Background:
- Cerebral palsy (CP) is a condition affecting motor function due to brain damage.
- White matter (WM) microstructural integrity is crucial for motor development.
- Selective dorsal rhizotomy (SDR) is a surgical option for spastic CP.
Purpose of the Study:
- To quantify WM microstructural characteristics using DTI in children with CP before SDR.
- To explore associations between DTI-derived WM properties and motor function/spasticity in children with CP undergoing SDR.
Main Methods:
- Multisite study using pre-SDR DTI data and postoperative outcomes.
- Harmonization of DTI data from two sites using ComBat.
- Analysis of DTI abnormalities, correlation with Gross Motor Function Classification System (GMFCS) levels, and assessment of post-SDR improvements using GMFM-66, MTS, and MAS.
Main Results:
- Children with CP showed significant DTI alterations (lower FA, higher MD) in specific WM tracts (gCC, PLIC) compared to controls.
- Greater DTI alterations correlated with lower GMFCS levels.
- SDR significantly improved motor function (GMFM-66) and spasticity (MTS, MAS), with associations found between MTS improvement and DTI abnormalities.
Conclusions:
- This study provides quantitative evidence of WM microstructural characteristics in children with spastic CP before SDR.
- Baseline DTI characteristics are associated with pre-SDR mobility levels.
- SDR is effective in improving motor function and spasticity, and these improvements relate to DTI data.
Objective:
The aims of this study were to 1) assess and quantify white matter (WM) microstructural characteristics derived from diffusion tensor imaging (DTI) in children with cerebral palsy (CP) prior to selective dorsal rhizotomy (SDR), and 2) investigate potential associations between WM diffusion properties and gross motor function and spasticity in children with spastic CP who underwent SDR.
Methods:
This study is a multisite study based on DT images acquired prior to SDR as well as postoperative outcome data. DTI data collected from two sites were harmonized using the ComBat approach to minimize intersite scanner difference. The DTI abnormalities between children with spastic CP and controls were analyzed and correlated with the severity of impaired mobility based on the Gross Motor Function Classification System (GMFCS). The improvement in gross motor function and spasticity after SDR surgery was assessed utilizing the Gross Motor Function Measure-66 (GMFM-66), the Modified Tardieu Scale (MTS), and the modified Ashworth scale (MAS). Alterations in these outcome measures were quantified in association with DTI abnormalities.
Results:
Significant DTI alterations, including lower fractional anisotropy (FA) in the genu of the corpus callosum (gCC) and higher mean diffusivity (MD) in the gCC and posterior limb of the internal capsule (PLIC), were found in children in the SDR group when compared with the age-matched control group (all p < 0.05). Greater DTI alterations (FA in gCC and MD in gCC and PLIC) were associated with lower mobility levels as determined based on GMFCS level (p < 0.05). The pre- to post-SDR improvement in motor function based on GMFM-66 was statistically significant (p = 0.006 and 0.002 at 6-month and 12-month follow-ups, respectively). The SDR efficacy was also identified as improving spasticity in lower-extremity muscle groups assessed with the MTS and MAS. Partial correlation analysis presented a significant association between pre- to post-SDR MTS alteration and DTI abnormalities.
Conclusions:
The findings in the present study provided initial quantitative evidence to establish the WM microstructural characteristics in children with spastic CP prior to SDR surgery. The study generated data for the association between baseline DTI characteristics and mobility in children with CP prior to SDR surgery. The study also demonstrated SDR efficacy in improving motor function and spasticity based on the GMFM-66, MTS, and MAS, respectively, in association with DTI data.
