Innovative New Imaging Technique "Maps" Brain Injury

September 10, 2002
Technology is leading to discoveries about how disorders of the developing brain lead to Cerebral Palsy

BALTIMORE - Physicians at Kennedy Krieger Institute and neuro-imaging experts at the Institute's F.M. Kirby Research Center for Functional Brain Imaging have developed a new way to see the white matter pathways, or "cables," that carry messages from one part of the brain to another in children with cerebral palsy. Already, the new technique has led to a better understanding of how disorders of the developing brain lead to cerebral palsy - which holds promise for better diagnosis and more effective treatment. The preliminary results of the study were published in the September 10 issue of the journal Neurology. The research team at Kennedy Krieger included Alec Hoon, M.D.; Tom Lawrie, AB; Elias Melhem, M.D.; Elsie Reinhardt, MSN; Peter van Zijl, Ph.D.; Meiyappan Solaiyappan, BE; H. Jiang, Ph.D.; Michael Johnston, MD; and Susumu Mori, Ph.D.

This new technique, a form of magnetic resonance imaging (MRI) called Diffusion Tensor Imaging (DTI), shows white matter pathways in three dimensions, with color codes that identify the individual bundles. Injury to these pathways is an important cause for the motor disabilities seen in children with CP. Previous imaging techniques have not been able to visualize white matter in much detail.

In two children born prematurely who have been studied so far, the research team was surprised to find injury to white matter pathways in unexpected areas of the brain. Although they expected to find injury to the pathways that carry messages to the arms and legs from motor control areas in the front of the brain, these children had abnormal pathways in the back of the brain where sensory information is processed. This suggests that sensory processing may be very important for controlling tone and movement in children.

"While further investigation will be required to validate the findings, we believe that DTI will become a powerful tool to understand motor function in children with cerebral palsy and improve treatment," says Dr. Hoon, director of the Phelps Center for Cerebral Palsy and Neurodevelopmental Medicine at Kennedy Krieger Institute. For example, if sensory pathways in the brain are abnormal, therapies that activate them, such as gait training or therapeutic horseback riding (hippotherapy), might be beneficial.

"This project underscores the strength of research at Kennedy Krieger, where clinicians and scientists with differing backgrounds and interests can work together to improve the care for children with developmental disorders," Dr. Hoon adds.

This new imaging technique is safe for most children and adults with CP since it uses magnetism, not radiation or X-rays. The procedure usually is completed in under an hour.

"This result shows the relevance of developing new and non-invasive MRI technologies to gain a better understanding of the mechanism underlying CP and other disorders," says Dr. van Zijl, director of the F. M. Kirby Center for Functional Brain Imaging. "The availability of new technologies that can assess brain function instead of just brain anatomy is of tremendous importance for the study of developmental disorders".

Kennedy Krieger Institute is dedicated to helping children and adolescents with disabilities, resulting from disorders of the brain, achieve their potential and participate as fully as possible in family, community and school life. For more information about Kennedy Krieger Institute, visit www.kennedykrieger.org.

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