Related Experiment Video
Updated: Jun 4, 2025
Author Spotlight: Bridging Gaps in Anatomy and Establishing a Foundation for Algorithmic Studies
Published on: December 15, 2023
Assessment of Brain Development in Children With Congenital Diaphragmatic Hernia - an Automated Brain Segmentation
Sherif A Mohamed1, Larissa Götz2, Victor Saase2
1Department of Neuroradiology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; sherif.mohamed@umm.de.
Insights
Children with congenital diaphragmatic hernia (CDH) show altered brain development, with increased gray matter and cerebrospinal fluid volumes. ECMO treatment in CDH patients further impacts brain structure, suggesting neurodevelopmental challenges.
Area of Science:
- Pediatric Neurology
- Neonatal Surgery
- Neuroimaging
Background:
- Congenital diaphragmatic hernia (CDH) is a severe neonatal condition often leading to neurodevelopmental delays.
- Prenatal and postnatal factors like hypoxia and impaired lung development contribute to brain growth disruption.
- Improved survival rates from treatments like ECMO highlight the need to understand associated neurodevelopmental risks.
Purpose of the Study:
- To evaluate brain development in 2-year-old children with CDH, comparing those treated with and without ECMO to healthy controls.
- To utilize MRI-based automated segmentation for precise volumetric and cortical thickness measurements.
- To identify neurodevelopmental differences in CDH patients and the impact of ECMO therapy.
Main Methods:
- A cohort of 31 children with CDH (10 treated with ECMO) and 31 healthy controls underwent 3-T MRI.
- Automated MRI analysis using CerebroMatic and SPM12 software quantified cerebrospinal fluid (CSF), gray matter (GM), white matter (WM), and cortical thickness (CT).
- Statistical comparisons were made between CDH patients (with and without ECMO) and the control group.
Main Results:
- CDH patients exhibited significantly increased CSF, GM, and total intracranial volumes compared to controls.
- ECMO-treated CDH patients showed significantly higher GM and CSF volumes than healthy controls.
- Elevated cortical thickness in CDH patients, irrespective of ECMO, suggests potential maturational deficits.
Conclusions:
- Children with CDH display distinct neurodevelopmental patterns, evidenced by altered brain volumes.
- ECMO therapy in CDH patients is associated with specific volumetric brain changes.
- Increased cortical thickness, GM, and CSF volumes in CDH patients indicate complex neurodevelopmental challenges requiring further investigation.
Background/Aim:
Congenital diaphragmatic hernia (CDH) is a critical condition affecting newborns, which often results in long-term morbidities, including neurodevelopmental delays, which affect cognitive, motor, and behavioral functions. These delays are believed to stem from prenatal and postnatal factors, such as impaired lung development and chronic hypoxia, which disrupt normal brain growth. Understanding the underlying mechanisms of these neurodevelopmental impairments is crucial for improving prognosis and patient outcomes, particularly as advances in treatments like ECMO have increased survival rates but also pose additional risks for neurodevelopment. This study aimed to evaluate brain development in 2-year-old children who underwent CDH repair, with and without ECMO, compared to healthy controls using an MRI-based automated segmentation approach.
Patients And Methods:
The study included 31 children with CDH, of which 10 received ECMO therapy, and a control group of 31 healthy children. MRI-examinations were performed using a 3-T system. MRI data were processed using the CerebroMatic toolbox and SPM12 software to measure cerebrospinal fluid (CSF), gray matter (GM), white matter (WM), and cortical thickness (CT).
Results:
Patients with CDH showed significantly increased volumes of CSF (p=0.009), GM (p=0.02), and total intracranial volume (TIV) (p=0.01), compared to healthy controls. ECMO-treated patients had significantly increased GM (p=0.01) and CSF (p=0.005) volumes in comparison to healthy controls. CT was significantly higher in CDH patients regardless of ECMO therapy, indicating potential maturational deficits.
Conclusion:
The study reveals neurodevelopmental differences in children with CDH, particularly in those requiring ECMO therapy. Increased CT, GM, and CSF volumes suggest complex neurodevelopmental challenges.
