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Using diffusion tensor imaging to identify corticospinal tract projection patterns in children with unilateral spastic cerebral palsy
Author(s) -
Kuo HsingChing,
Ferre Claudio L,
Carmel Jason B,
Gowatsky Jaimie L,
Stanford Arielle D,
Rowny Stefan B,
Lisanby Sarah H,
Gordon Andrew M,
Friel Kathleen M
Publication year - 2017
Publication title -
developmental medicine and child neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.658
H-Index - 143
eISSN - 1469-8749
pISSN - 0012-1622
DOI - 10.1111/dmcn.13192
Subject(s) - corticospinal tract , transcranial magnetic stimulation , diffusion mri , pyramidal tracts , tractography , cerebral palsy , motor cortex , medicine , spastic , spastic hemiplegia , primary motor cortex , psychology , neuroscience , physical medicine and rehabilitation , magnetic resonance imaging , radiology , stimulation
Aim To determine whether diffusion tensor imaging ( DTI ) can be an independent assessment for identifying the corticospinal tract ( CST ) projecting from the more‐affected motor cortex in children with unilateral spastic cerebral palsy ( CP ). Method Twenty children with unilateral spastic CP participated in this study (16 males, four females; mean age 9y 2mo [standard deviation ( SD ) 3y 2mo], Manual Ability Classification System [ MACS ] level I– III ). We used DTI tractography to reconstruct the CST projecting from the more‐affected motor cortex. We mapped the motor representation of the more‐affected hand by stimulating the more‐ and the less‐affected motor cortex measured with single‐pulse transcranial magnetic stimulation ( TMS ). We then verified the presence or absence of the contralateral CST by comparing the TMS map and DTI tractography. Fisher's exact test was used to determine the association between findings of TMS and DTI . Results DTI tractography successfully identified the CST controlling the more‐affected hand (sensitivity=82%, specificity=78%). Interpretation Contralateral CST projecting from the lesioned motor cortex assessed by DTI is consistent with findings of TMS mapping. Since CST connectivity may be predictive of response to certain upper extremity treatments, DTI ‐identified CST connectivity may potentially be valuable for determining such connectivity where TMS is unavailable or inadvisable for children with seizures.