Maternal Obesity during Pregnancy is Associated with Lower Cortical Thickness in the Neonate Brain.

BACKGROUND AND PURPOSE: Recent studies have suggested that maternal obesity during pregnancy is associated with differences in neurodevelopmental outcomes in children. In this study, we aimed to investigate the relationships between maternal obesity during pregnancy and neonatal brain cortical development. MATERIALS AND METHODS: Forty-four healthy women (28 normal-weight, 16 obese) were prospectively recruited at <10 weeks' gestation, and their healthy full-term neonates (23 boys, 21 girls) underwent brain MR imaging. All pregnant women had their body composition (fat mass percentage) measured at ∼12 weeks of pregnancy. All neonates were scanned at ∼2 weeks of age during natural sleep without sedation, and their 3D T1-weighted images were postprocessed by the new iBEAT2.0 software. Brain MR imaging segmentation and cortical surface reconstruction and parcellation were completed using age-appropriate templates. Mean cortical thickness for 34 regions in each brain hemisphere defined by the UNC Neonatal Cortical Surface Atlas was measured, compared between groups, and correlated with maternal body fat mass percentage, controlled for neonate sex and race, postmenstrual age at MR imaging, maternal age at pregnancy, and the maternal intelligence quotient and education. RESULTS: Neonates born to obese mothers showed significantly lower (P ≤ .05, false discovery rate-corrected) cortical thickness in the left pars opercularis gyrus, left pars triangularis gyrus, and left rostral middle frontal gyrus. Mean cortical thickness in these frontal lobe regions negatively correlated (R = -0.34, P = .04; R = -0.50, P = .001; and R = -0.42, P = .01; respectively) with the maternal body fat mass percentage measured at early pregnancy. CONCLUSIONS: Maternal obesity during pregnancy is associated with lower neonate brain cortical thickness in several frontal lobe regions important for language and executive functions.

Maternal Anxiety and Depression during Late Pregnancy and Newborn Brain White Matter Development.

BACKGROUND AND PURPOSE: Anxiety and depression during pregnancy have been associated with an increased risk of adverse neurodevelopmental outcomes in offspring. We aimed to study the in utero effects of maternal anxiety and depression on early brain development. MATERIALS AND METHODS: Pregnant women were recruited at ∼36 weeks of gestation for this prospective study. They were assessed for anxiety symptoms by the State-Trait Anxiety Inventory and for depression symptoms by the Beck Depression Inventory, 2nd Edition. After delivery, infant underwent an MR imaging examination of the brain without sedation, including DTI, for evaluation of white matter (WM) development. Infant fractional anisotropy values, a putative marker of WM integrity, were correlated with the mothers' State-Trait Anxiety Inventory and Beck Depression Inventory scores by using both tract-based spatial statistics and ROI methods. RESULTS: Thirty-four infants were included in this study. Both maternal State-Anxiety and Trait-Anxiety scores negatively correlated (P < .05, corrected) with fractional anisotropy values in widespread brain WM regions; Beck Depression Inventory scores also negatively correlated (P < .05) with fractional anisotropy values in one cluster in the brain. Further ROI analyses confirmed significant negative correlations between average fractional anisotropy values in ROIs including left and right prefrontal WM, left and right middle frontal gyrus WM, and the fornix, and State-Anxiety (R values, -0.47 to -0.67; P values, .008 to <.001), Trait-Anxiety (R, -0.37 to -0.59; P, .04 to <.001), and Beck Depression Inventory (R values, -0.36 to -0.55; P, .05 to .002) scores. CONCLUSIONS: Higher maternal anxiety and depression symptom scores during late pregnancy were associated with lower estimated infant brain WM development, which indicated in utero influences of maternal mental health during pregnancy on the developing brain.

Cesarean Delivery Impacts Infant Brain Development.

BACKGROUND AND PURPOSE: The cesarean delivery rate has increased globally in the past few decades. Neurodevelopmental outcomes associated with cesarean delivery are still unclear. This study investigated whether cesarean delivery has any effect on the brain development of offspring. MATERIALS AND METHODS: A total of 306 healthy children were studied retrospectively. We included 3 cohorts: 2-week-old neonates (cohort 1, n = 32/11 for vaginal delivery/cesarean delivery) and 8-year-old children (cohort 2, n = 37/23 for vaginal delivery/cesarean delivery) studied at Arkansas Children's Hospital, and a longitudinal cohort of 3-month to 5-year-old children (cohort 3, n = 164/39 for vaginal delivery/cesarean delivery) studied independently at Brown University. Diffusion tensor imaging, myelin water fraction imaging, voxel-based morphometry, and/or resting-state fMRI data were analyzed to evaluate white matter integrity, myelination, gray matter volume, and/or functional connectivity, respectively. RESULTS: While not all MR imaging techniques were shared across the institutions/cohorts, post hoc analyses showed similar results of potential effects of cesarean delivery. The cesarean delivery group in cohort 1 showed significantly lower white matter development in widespread brain regions and significantly lower functional connectivity in the brain default mode network, controlled for a number of potential confounders. No group differences were found in cohort 2 in white matter integrity or gray matter volume. Cohort 3 had significantly different trajectories of white matter myelination between groups, with those born by cesarean delivery having reduced myelin in infancy but normalizing with age. CONCLUSIONS: Cesarean delivery may influence infant brain development. The impact may be transient because similar effects were not observed in older children. Further prospective and longitudinal studies may be needed to confirm these novel findings.

Gestational Age at Birth and Brain White Matter Development in Term-Born Infants and Children.

BACKGROUND AND PURPOSE: Studies on infants and children born preterm have shown that adequate gestational length is critical for brain white matter development. Less is known regarding how variations in gestational age at birth in term infants and children affect white matter development, which was evaluated in this study. MATERIALS AND METHODS: Using DTI tract-based spatial statistics methods, we evaluated white matter microstructures in 2 groups of term-born (≥37 weeks of gestation) healthy subjects: 2-week-old infants (n = 44) and 8-year-old children (n = 63). DTI parameters including fractional anisotropy, mean diffusivity, axial diffusivity, and radial diffusivity were calculated by voxelwise and ROI methods and were correlated with gestational age at birth, with potential confounding factors such as postnatal age and sex controlled. RESULTS: Fractional anisotropy values, which are markers for white matter microstructural integrity, positively correlated (P < .05, corrected) with gestational age at birth in most major white matter tracts/regions for the term infants. Mean diffusivity values, which are measures of water diffusivities in the brain, and axial and radial diffusivity values, which are markers for axonal growth and myelination, respectively, negatively correlated (P < .05, corrected) with gestational age at birth in all major white matter tracts/regions excluding the body and splenium of the corpus callosum for the term infants. No significant correlations with gestational age were observed for any tracts/regions for the term-born 8-year-old children. CONCLUSIONS: Our results indicate that longer gestation during the normal term period is associated with significantly greater infant white matter development (as reflected by higher fractional anisotropy and lower mean diffusivity, axial diffusivity, and radial diffusivity values); however, similar associations were not observable in later childhood.

Differences in brain functional connectivity at resting state in neonates born to healthy obese or normal-weight mothers.

Recent studies have shown associations between maternal obesity at pre- or early pregnancy and long-term neurodevelopment in children, suggesting in utero effects of maternal obesity on offspring brain development. In this study, we examined whether brain functional connectivity to the prefrontal lobe network is different in newborns from normal-weight or obese mothers. Thirty-four full-term healthy infants from uncomplicated pregnancies were included, with 18 born to normal-weight and 16 born to obese mothers. Two weeks after delivery, the infants underwent an magnetic resonance imaging (MRI) examination during natural sleep, which included structural imaging and resting-state functional MRI (fMRI) scans. Independent component analysis was used to identify the prefrontal lobe network, and dual regression was used to compare functional connectivity between groups. Infants born to normal-weight mothers had higher recruiting (P<0.05, corrected) of dorsal anterior cingulate cortex regions to the prefrontal network after adjusting for maternal intelligence quotient, gestational weight gain and infant postmenstrual age, gender, birth weight/length, head circumference and neonatal diet. The functional connectivity strength in dorsal anterior cingulate cortex negatively correlated (P<0.05) with maternal fat mass percentage measured at early pregnancy. This preliminary study indicates that exposure to maternal obesity in utero may be associated with changes in resting-state functional connectivity in the newborn offspring's brain.

Impaired white matter development in extremely low-birth-weight infants with previous brain hemorrhage.

BACKGROUND AND PURPOSE: Brain hemorrhage is common in premature infants. The purpose of the study is to evaluate white matter development in extremely low-birth-weight infants with or without previous brain hemorrhage. MATERIALS AND METHODS: Thirty-three extremely low-birth-weight infants were prospectively enrolled and included in this institutional review board-approved study. Another 10 healthy term infants were included as controls. The medical records of the extremely low-birth-weight infants were reviewed for sonography diagnosis of intraventricular hemorrhage. All infants had an MR imaging examination at term-equivalent age for detection of previous hemorrhage, and their white matter was scored and compared among different groups. DTI measured fractional anisotropy values were also compared voxelwise by tract-based spatial statistics. RESULTS: Compared with controls, the white matter score was not significantly different in extremely low-birth-weight infants without blood deposition on MR imaging (P = .17), but was significantly worse in extremely low-birth-weight infants with blood deposition on MR imaging but no intraventricular hemorrhage diagnosis by sonography (P = .02), in extremely low-birth-weight infants with grade 1 or 2 intraventricular hemorrhage on sonography (P = .003), and in extremely low-birth-weight infants with grade 3 or 4 intraventricular hemorrhage on sonography (P = .0001). Extremely low-birth-weight infants without blood deposition on MR imaging did not show any white matter regions with significantly lower fractional anisotropy values than controls. Extremely low-birth-weight infants with blood deposition on MR imaging, but no intraventricular hemorrhage diagnosis, did show white matter regions with significantly lower fractional anisotropy values, and extremely low-birth-weight infants with intraventricular hemorrhage diagnosis had widespread white matter regions with lower fractional anisotropy values. CONCLUSIONS: Previous brain hemorrhage is associated with abnormal white matter in extremely low-birth-weight infants at term-equivalent age, and sonography is not sensitive to minor hemorrhages that are sufficient to cause white matter injury.

Congenital cerebral and cerebrovascular anomalies: magnetic resonance imaging.

Magnetic resonance is the imaging modality of choice for the evaluation of infants and children with known or suspected cerebral and cerebrovascular abnormalities. Entities described include cephaloceles, holoprosencephaly, dysgenesis of corpus callosum, and anomalies of neuronal migration. Congenital vascular lesions described include aneurysm, arteriovenous malformation, cavernous malformation, and Galenic malformations.

Pediatric imaging: sedation with an injection formulation modified for rectal administration.

PURPOSE: To determine if rectal sedation with thiopental sodium produced for intravenous administration provides safe and effective sedation for children undergoing diagnostic imaging. MATERIALS AND METHODS: Five hundred twenty-five consecutive children (mean age, 2.7 years +/- 2.2 [SD]) underwent magnetic resonance imaging (n = 425), computed tomography (n = 89), and nuclear medicine (n = 11) examinations after rectal administration of thiopental sodium injection solution. The solution was prepared from thiopental sodium powder mixed with sterile water to create a concentration of 100 mg/mL. The dose ranged from 25 to 40 mg per kilogram of body weight, with a total dose limit of 1.5 g. The percentages of successful sedations and adverse reactions were evaluated on the basis of data collected at the time of the sedation. RESULTS: Sedation was successful in 504 (96%) children. Ten (2%) children experienced desaturation, but only three of the 10 experienced sedation failure. All cases of desaturation were treated successfully with head repositioning, administration of supplemental oxygen, or both. No children experienced vomiting, acute rectal irritation, paradoxical hyperactivity, or prolonged sedation. CONCLUSION: Thiopental sodium sedation for pediatric imaging, with use of a rectal solution prepared from thiopental sodium preparation for intravenous injection, is safe and effective.

Ophthalmologic disease in children.

MR imaging has become essential in the evaluation of a spectrum of ophthalmologic diseases in children. Orbit, globe, optic nerve, and optic tract disease processes that are frequently evaluated by MR imaging include congenital malformations, and inflammatory, neoplastic, and traumatic lesions. MR imaging evaluation aids in differentiating these lesions for diagnosis, the extent of disease, treatment planning, follow-up, and prognosis.

Intracranial resistive index (RI) values in normal term infants during the first day of life.

PURPOSE: The purpose of this study was to determine normal resistive index (RI) values for term neonates during the first day of life as part of an ongoing prospective study of RI values in term infants with perinatal asphyxia. MATERIALS AND METHODS: Forty normal term neonates underwent cranial sonography and Doppler during the first 24 h after birth. Transfontanelle Doppler was performed of the internal carotid, anterior cerebral, and middle cerebral arteries bilaterally. In addition, transtemporal Doppler was performed of the middle cerebral arteries bilaterally. Mean and median RI values were calculated in all vessels interrogated. The transfontanelle and transtemporal middle cerebral artery measurements were compared using paired t-tests. RESULTS: The overall mean RI of all interrogated vessels was 0.726 with a standard deviation of 0.057. The mean RI value in the middle cerebral arteries was not significantly different with the two different measurement techniques. CONCLUSION: Normal intracranial RI values for a term infant in the first day of life were calculated for comparison with RI values in term infants with perinatal asphyxia.

Intracranial aneurysms in infants and children.

BACKGROUND: The diagnosis and imaging of pediatric aneurysms has changed since the advent of MR and MRA. OBJECTIVE: To update the literature on pediatric aneurysms and better define the appropriate work-up of childhood aneurysms in 1997. MATERIALS AND METHODS: Retrospective review of 21 children (12 boys, 9 girls) with 25 aneurysms from three institutions over a 20-year period was performed. Imaging studies were mixed and included CT (19 patients), MR (11 patients), MRA (6 patients) and angiography (18 patients). RESULTS: Eighteen of 25 aneurysms were congenital saccular, 6 were mycotic, and 1 was post-traumatic. Of these, 44 % were in the posterior circulation. Nine aneurysms arose from distal arterial branches. Forty percent were large (between 1-2.5 cm) and 16 % were giant (> 2.5 cm). CT and MR showed hemorrhage, and frequently revealed the aneurysms as a focal mass with or without enhancement and flow void. Six children had MRA which revealed aneurysms in four patients. All patients with MRA had corresponding conventional angiography. CONCLUSION: Characteristics of pediatric aneurysms include diversity of type, increased incidence in the posterior fossa, peripheral location, and large size. CT, MR and MRA are useful in the diagnosis with conventional angiography essential for preoperative planning.

Segmental spinal dysgenesis: a report of three cases.

Segmental spinal dysgenesis is an uncommon congenital spinal defect characterized by localized segmental agenesis of the upper lumbar or thoracolumbar spine. Bony defects include significant focal canal stenosis, hypoplastic or absent vertebrae, subluxation of the spinal column, and instability. The distal bony architecture is usually normal but may be bifid. There is significant narrowing of the thecal sac and absence of adjacent nerve roots at the level of the lesion. Distal neurologic deficits are variable in severity, the prevalence of neurogenic bladder is high, and associated anomalies are common. Progressive kyphosis is inevitable. The cause is unknown, but an association with maternal diabetes and with various medications and toxins has been noted. Other authors suggested a relation to an aberrant segmental vascular supply. Treatment should be directed at the establishment and maintenance of spinal stability and arrest of the progressive kyphosis. It should consist of early anterior and posterior arthrodesis, with or without anterior decompression of the cord. Accurate visualization of this unusual deformity is difficult with conventional radiographic techniques. Three-dimensional computerized tomographic reconstruction can therefore be invaluable in preoperative planning. We report three cases of segmental spinal dysgenesis, all of which have been uniquely detailed by striking three-dimensional imaging studies.

Transcranial Doppler, MRA, and MRI as a screening examination for cerebrovascular disease in patients with sickle cell anemia: an 8-year study.

OBJECTIVE: The authors previously reported five transcranial Doppler ultrasonography (TCD) findings as significant in detecting clinical cerebrovascular disease in a 4-year study in patients with sickle cell disease. This is a follow-up to evaluate the validity of the original findings over another 4-year period during which the study population doubled. A clinical follow-up of the original asymptomatic sickle cell patients with positive TCD, MRA, and MRI was also made. MATERIALS AND METHODS: Over an 8-year period TCD, MRI, and MRA were prospectively performed in 90 sickle cell patients who were clinically asymptomatic for stroke and in 27 sickle cell patients with clinical stroke. RESULTS: Of the 4 out of original 46 control patients in 1992 who had positive MRA and TCD, 3 have subsequently had clinical stroke. None of the 9 original patients with positive TCD and positive MRI but negative MRA have developed stroke. All five original TCD indicators of disease were still significant (P < 0.05) for detecting clinical disease: maximum velocity in ophthalmic artery (OA) > 35 cm/s, mean velocity in middle cerebral artery (MCA) > 170 cm/s, resistive index (RI) in OA < 50, velocity in OA greater than in MCA, and velocity in posterior cerebral (PCA), vertebral, or basilar arteries greater than in MCA. An RI of < 60 in the DA was also now found to be significant [corrected]. Four additional factors were also significant: turbulence, PCA or ACA without MCA, RI < 30, and maximum velocity in MCA > 200 cm/s. CONCLUSION: Positive MRA with a positive TCD in an asymptomatic patient in long-term follow-up suggests a trend for developing clinical stroke. A 4- to 8-year follow-up of nine patients with positive TCD, positive MRI, but not positive MRA did not show development of clinical stroke. Nine Doppler findings are significant in screening for clinically symptomatic vascular disease in sickle cell patients. It is recommended that children with sickle cell disease be screened for cerebrovascular disease with TCD. If one or two indicators of abnormality are present, MRA is recommended. If the MRA is positive, the patient may be considered for transfusion therapy or other treatment for prevention of stroke.

Fatal cerebral edema and intracranial hemorrhage associated with hypernatremic dehydration.

We report neuroimaging findings of intracranial hemorrhage and cerebral edema in an infant with obtundation and seizures, initially suspected to be secondary to non-accidental trauma but finally attributed to hypernatremic dehydration. Neuroimaging findings due to hypernatremic dehydration have not been previously described in the radiologic literature. Hypernatremia should be included in the differential diagnosis of intracranial hemorrhage in the infant without evidence of nonaccidental trauma.

Subarachnoid fluid of the optic nerve in normal adults.

OBJECTIVE: The purpose of the study is to determine the amount of subarachnoid fluid of the optic nerve in normal adults using magnetic resonance (MR) imaging and to investigate whether the subarachnoid fluid is displaced in abduction as assumed by the 30 degree echographic test. DESIGN: The design was a prospective observation study. PARTICIPANTS: Twenty-one healthy headache-free adults participated. Ten (48%) were men and 11 (52%) were women with a mean age of 34.3 +/- 7.9 years. INTERVENTION: Both optic nerves were examined in primary and 45 degrees right and left gazes with T2 fast-spin echo fat-suppressed coronal MR imaging in quadrature head coil. Four MR images, 4 mm apart, starting from 4 mm posterior to the globe were obtained for both nerves simultaneously with an imaging time of 2 minutes and 24 seconds per gaze. MAIN OUTCOME MEASURES: Optic nerve and sheath diameters were measured. RESULTS: Mean nerve diameters were 3.2 +/- 0.4 mm anteriorly to 2.6 +/- 0.4 mm posteriorly, and mean sheath diameters were 5.2 +/- 0.9 mm anteriorly to 3.9 +/- 0.4 mm posteriorly. Optic sheath diameters did not change significantly in abduction or adduction. CONCLUSIONS: Magnetic resonance imaging can be used effectively to determine the amount of subarachnoid fluid of the optic nerve. In normal adults, the amount of optic nerve subarachnoid fluid is variable and may be substantial. The authors' MR findings show that optic nerve subarachnoid fluid is not displaced significantly with abduction or adduction.

Disappearing enhancing brain lesion in a child with neurofibromatosis type I.

Neurofibromatosis type 1 (NF1) in children can produce a variety of parenchymal signal abnormalities on cranial MR. Areas of abnormal signal in these patients may represent regions of disordered myelination, "hamartomatous" change or frank neoplasia. The presence of contrast enhancement in intracranial lesions in patients with NF1 is usually strongly suggestive of tumor. We report the case of a child with NF1 and a focal enhancing brain parenchymal lesion which spontaneously resolved without specific therapy.

Magnetic resonance angiography in children.

MRA in children utilizes the same pulse sequences used in adults, but for investigation of the differing forms of vascular pathology found in the pediatric population. Because of the extreme sensitivity of MRA to motion artifact, sedation is an important adjunct to the performance of diagnostic MRI and MRA in children. Because of the noninvasive nature of MRA, strictly diagnostic conventional angiography in children is uncommonly performed and frequently directed toward investigation and therapy of intracranial vascular malformations. Common indications for MRA in children include sickle cell vasculopathy, cerebral and posterior fossa infarction, tumors, vascular malformations, and follow-up of patients recently on extra corporeal membrane oxygenation (ECMO). Non-invasive follow-up subsequent to surgical or medical therapy of intra or extra cranial vascular pathology is another important use for MRA in children.

Blindness, deafness, quadriparesis, and a retinal malformation: the ravages of neurofibromatosis 2.

Advances in molecular biology have established that the diseases once collectively referred to as neurofibromatosis are actually genetically distinct and clinically heterogenous conditions. This realization has led to separate definitions for neurofibromatosis (NF) type 1 and 2. Although ophthalmologic manifestations of NF1 have long been recognized, the distinguishing ocular features of NF2 have only recently received attention. We describe an inferior retinopapillary malformation with an overlying glial hamartoma in a deaf, quadriparetic patient with NF2. Magnetic resonance (MR) imaging initially showed bilateral vestibular schwannomas and a large cervical ependymoma. Over six years of follow-up, the patient developed multiple intracranial meningiomas.

Atlanto-axial subluxation and cervical osteomyelitis: two unusual complications of adenoidectomy.

Grisel's syndrome (atlanto-axial subluxation) and cervical osteomyelitis are two unusual complications of adenoidectomy. We present two patients; one with atlanto-axial subluxation following uncomplicated tonsillectomy and adenoidectomy, and one with cervical osteomyelitis following uncomplicated adenoidectomy. Both patients presented with persistent postoperative neck pain. Surgical intervention, as well as long-term intravenous antibiotics, was required. A high index of suspicion, as well as cervical spinal series with flexion-extension views, is necessary for diagnosis. Flexible nasopharyngoscopy and computed tomography of the cervical spine also aided in diagnosis and treatment planning. With early diagnosis and proper treatment, the prognosis is good. Neurologic sequelae were prevented in both of our patients.