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Diffusion tensor imaging of the pyramidal tracts in infants with motor dysfunction

From the Department of Radiology (N.A.L., J.I.B., J.K., A.J.B., R.G.H., O.A.G.), Departments of Neurology and Pediatrics (Y.W.W., A.I.B., D.M.F.), and Pediatric Clinical Research Center (R.J.), Department of Pediatrics, University of California San Francisco.

Address correspondence and reprint requests to Dr. Orit A. Glenn, UCSF Department of Radiology, Neuroradiology Section, 505 Parnassus Avenue, Box #0628, San Francisco, CA 94143-0628 Orit.Glenn{at}radiology.ucsf.edu

Objective: To determine if diffusion tensor imaging (DTI) metrics of the pyramidal tracts correlate with motor outcome in infants presenting with motor dysfunction.

Methods: DTI tractography of the pyramidal tracts was performed in 21 patients with clinical motor dysfunction who were less than 30 months of age and in 22 age-matched controls. We plotted tract-specific DTI metrics (fractional anisotropy, parallel diffusivity, transverse diffusivity, and mean diffusivity) against age for the controls and generated normative curves. For each patient, we calculated the deviation from the normative curves. Patients returned for a neurodevelopmental evaluation when they were over 36 months of age, and motor outcome measures were performed. We analyzed the association between normative deviation in DTI metrics and motor outcome measures using linear and logistic regression models.

Results: Normative deviation in fractional anisotropy and transverse diffusivity were significantly correlated with all measures of motor outcome. Lower fractional anisotropy and higher transverse diffusivity compared to controls were associated with worse motor outcome. Furthermore, children who were eventually diagnosed with permanent motor dysfunction had lower fractional anisotropy and higher transverse diffusivity compared with those whose motor dysfunction normalized.

Conclusions: Diffusion tensor imaging metrics correlate with motor outcome in infants presenting with motor dysfunction. The identification of a quantitative imaging marker that can be applied to infants at the time of clinical presentation has implications for the evaluation of early motor dysfunction.

Abbreviations: DTI= diffusion tensor imaging; FA= fractional anisotropy; NMS = neuromotor score; VMI-4 = Visual-Motor Integration, 4th Edition, Revised.

Supplemental data at www.neurology.org

e-Pub ahead of print on April 30, 2008, at www.neurology.org.

Supported by the Charles A. Dana Clinical Hypotheses Program in Imaging, Radiological Society of North America Fellowship, and Grant Number UL RR024131-02 from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH) and NIH Roadmap for Medical Research.

Disclosure: The authors report no disclosures.

Received July 6, 2007. Accepted in final form November 5, 2007.

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