Diffusion Tensor Analysis of Pediatric Multiple Sclerosis and Clinically Isolated Syndromes

Abstract

BACKGROUND AND PURPOSE: DTI has shown focal and diffuse white matter abnormalities in adults and children with MS. Here we explore whether DTI abnormalities are present at the time of a first attack or CIS in children and whether early DTI features can predict the development of MS.

Early White Matter Changes in Childhood Multiple Sclerosis: A Diffusion Tensor Imaging Study

“…However, no changes were observed in 27 patients with a single demyelinating event, 15 from which the authors concluded that there might be a window of opportunity to prevent further damage between the period of a single demyelination and the diagnosis of MS. This is in accordance with the significant negative correlation between mean FA of the white matter skeleton and disease duration that we observed in our study.…”

“…Our findings are in accordance with previously published data on the microstructure of white matter in childhood MS. 12,13 Two recent studies of Vishwas et al 14,15 demonstrated higher MD and lower mean FA values in all white matter pathways in pediatric patients with MS compared with controls. However, no changes were observed in 27 patients with a single demyelinating event, 15 from which the authors concluded that there might be a window of opportunity to prevent further damage between the period of a single demyelination and the diagnosis of MS.…”

“…Most recently, a study assessing major white matter tracts in children with MS compared with children with a single demyelinating event showed a decrease in FA with a concomitant increase in MD in patients with MS only. 14,15 Tract-based spatial statistics (TBSS) allows a coregistration of likely white matter tracts to analyze multisubject diffusion tensor data. For this purpose, subject data are projected on a mean FA skeleton, which refers to the center of all tracts common to both groups, before applying voxelwise between-group comparisons.…”

Disease-Modifying Therapy of Pediatric Multiple Sclerosis

“…Three Tesla MRI studies suggest that pediatric patients have a lower number of cortical lesions than adults [30]. However, diffusion tensor imaging (DTI) studies in children with MS demonstrated damage in the normal appearing white matter (NAWM) of the interhemispheric, projection and intrahemispheric white matter tracts [31,32]. Brain atrophy appears to be slower in children who have MS compared with adults who have MS, despite equal or higher T2 lesion load [29].…”

Clinical associations of white matter damage in cART-treated HIV-positive children in South Africa

“…DTI is able to examine the microstructural integrity and directionality of the white matter, and therefore capable of providing information on the location of white matter microstructural changes correlated with clinical variables in vertically infected HIVpositive children. DTI has been used successfully in pediatric populations to document injury to white matter tracts after prematurity (Feldman et al 2010), in multiple sclerosis (Vishwas et al 2013), and as a consequence of moderate-tosevere traumatic brain injury (Wu et al 2009). Reported neuroimaging findings in pediatric HIV include calcifying microangiopathy, atrophy, and ventricular dilatation on CT scan and white matter lesions and atrophy on MRI (Mitchell 2001).…”