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Updated: Jan 12, 2026
Diffusion Tensor Magnetic Resonance Imaging in the Analysis of Neurodegenerative Diseases
Published on: July 28, 2013
Characterization of brain microstructural changes in children with infantile vitamin B12 deficiency using diffusion
Sameer Vyas1, Pawan Kumar2, Teddy Salan3
1Post Graduate Institute of Medical Education and Research, Chandigarh, India. sameer574@yahoo.co.in.
Insights
Infantile Vitamin B12 deficiency causes brain microstructural issues. Treatment with B12 improves these abnormalities and neurodevelopmental outcomes, as shown by DTI scans.
Area of Science:
- Pediatric Neurology
- Neuroimaging
- Nutritional Neuroscience
Background:
- Infantile Vitamin B12 deficiency, or Infantile Tremor Syndrome (ITS), affects exclusively breastfed infants of vegetarian mothers.
- Known structural neuroimaging findings include cerebral and corpus callosal atrophy.
- Microstructural brain changes in ITS are not well understood.
Purpose of the Study:
- To investigate brain microstructural changes in Infantile Vitamin B12 deficiency using Diffusion Tensor Imaging (DTI).
- To correlate these microstructural changes with neurodevelopmental outcomes after Vitamin B12 supplementation.
Main Methods:
- Thirty infants with Infantile Vitamin B12 deficiency underwent clinical, neurodevelopmental, and DTI assessments.
- DTI metrics (FA, MD, RD, AD) were analyzed using region-of-interest and voxel-based methods.
- Correlations between DTI metrics and developmental scores were evaluated post-treatment.
Main Results:
- Vitamin B12 supplementation improved serum B12, hemoglobin, neurodevelopmental scores, and normalized homocysteine.
- DTI revealed increased FA and reduced diffusivity, indicating remyelination and axonal recovery.
- Significant improvements were observed in the corpus callosum, corona radiata, internal capsule, thalamus, and pre-central gyrus.
Conclusions:
- Infantile Vitamin B12 deficiency presents with global brain microstructural abnormalities.
- These abnormalities significantly improve with Vitamin B12 therapy.
- DTI metrics correlate with neurodevelopmental recovery, highlighting B12's role in brain myelination.
Background And Objective:
Infantile Vitamin B12 deficiency commonly called Infantile tremor syndrome (ITS) is a neurocutaneous disorder primarily affecting exclusively breastfed infants of vegetarian mothers. Few reports of structural neuroimaging in this condition highlight cerebral and corpus callosal atrophy, while microstructural brain changes remain underexplored. This study investigates brain microstructural changes in Infantile Vitamin B12 deficiency using diffusion tensor imaging (DTI) and their correlation with neurodevelopmental outcomes following B12 supplementation.
Methods:
Thirty children with Infantile vitamin B12 deficiency underwent clinical, neurodevelopmental, and DTI assessments at baseline and post-B12 treatment (3 months or later). MRI scans were analysed for fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD), and axial diffusivity (AD) using both region-of-interest (ROI) and voxel-based approaches. Correlations between DTI metrics and developmental scores were evaluated.
Results:
Vitamin B12 supplementation significantly improved serum B12, hemoglobin, neurodevelopmental scores and normalized homocysteine levels. DTI revealed increased FA and reduced MD, RD, and AD, indicating remyelination and axonal recovery. Corpus callosum, corona radiata, and internal capsule showed maximal improvement, aligning with recovery remyelination. Grey matter areas, including the thalamus and pre-central gyrus, also demonstrated recovery. Developmental scores positively correlated with DTI metrics, particularly in regions associated with language and motor function.
Conclusion:
Infantile vitamin B12 deficiency is characterized by global brain microstructural abnormalities that improve significantly with B12 therapy. DTI metrics correlate with neurodevelopmental recovery, underscoring the role of B12 in brain myelination.
