Infant Corpus Callosum Size After Surgery and Critical Care for Long-Gap Esophageal Atresia: Qualitative and Quantitative MRI

Abstract

previous studies in preterm infants report white matter abnormalities of the corpus callosum (cc) as an important predictor of neurodevelopmental outcomes. our cross-sectional study aimed to describe qualitative and quantitative cc size in critically ill infants following surgical and critical care for longgap esophageal atresia (LGeA)-in comparison to healthy infants-using MRi. non-sedated brain MRi was acquired for full-term (n = 13) and premature (n = 13) patients following treatment for LGEA, and controls (n = 20) <1 year corrected age. A neuroradiologist performed qualitative evaluation of T1weighted images. ITK-SNAP was used for linear, 2-D and 3-D manual CC measures and segmentations as part of CC size quantification. Qualitative MRI analysis indicated underdeveloped CC in both patient groups in comparison to controls. We show no group differences in mid-sagittal CC length. Although 2-D results were inconclusive, volumetric analysis showed smaller absolute (F(2,42) = 20.40, p < 0.001) and normalized (F(2,42) = 16.61, p < 0.001) CC volumes following complex perioperative treatment for LGeA in both full-term and premature patients, suggesting delayed or diminished cc growth in comparison to controls, with no difference between patient groups. Future research should look into etiology of described differences, neurodevelopmental outcomes, and role of the CC as an early marker of neurodevelopment in this unique infant population.

Longitudinal Evaluation of Cerebellar Signs of H-ABC Tubulinopathy in a Patient and in the taiep Model

“…In the case of the patient, imaging analysis is based on the changes in brain structures related to skull volume. Recently, Mongerson et al reported changes in the CC employing a method similar to the one we used here to evaluate degenerative processes in the brain (27). They normalized the quantitative differences in the CC (in %) using total brain tissue.…”

Infant study of hemispheric asymmetry after long‐gap esophageal atresia repair

“…This pilot MRI study builds on our previous reports 13 , 17 , 19 using data from the same infant study cohort. Our study received ethical approval from Boston Children’s Hospital Institutional Review Board as a “no more than minimal risk” study and recruitment was possible thanks to The Esophageal and Airway Treatment Center at Boston Children’s Hospital ‐ a premier program designed to treat infants born with thoracic noncardiac and gastrointestinal congenital anomalies, especially LGEA.…”

“…A representative timeline illustrating the sequence of perioperative critical care for Foker process 20 was previously presented, 18,23 while associations between individual MRI end‐point measures (e.g., number of cranial MRI findings and brain volumes) and the clinical measures of care as to assess the severity of underlying disease in cohort subjects will be presented elsewhere. Methodological approach for recruitment criteria and MRI scanning were previously described 13,17,19 . Briefly, informed written parental consent was obtained for non‐sedated research brain MRI participation, in accordance with the Declaration of Helsinki and Good Clinical Practice guidelines.…”

“…Brain volume masks underwent additional (d) minor manual editing using ITK‐SNAP (v.3.6.0; http://www.itksnap.org), 29 to draw‐in any missing brain tissue. T1‐weighted data were used previously to report qualitative and quantitative findings regarding total brain and corpus callosum volumes 19 …”

“… 23 , 24 We hypothesized that when compared to healthy infants, both critically ill term‐born and premature patients following critical care for LGEA with Foker process would exhibit alteration in the expected left‐larger‐than‐right hemispheric asymmetry of infancy. Therefore, this report addresses the possible (mal)adaptation in hemispheric asymmetry in the same, aforementioned cohort using structural T1‐ 19 and T2‐weighted 17 brain magnetic resonance imaging (MRI).…”