Brain lesion scores obtained using a simple semi-quantitative scale from MR imaging are associated with motor function, communication and cognition in dyskinetic cerebral palsy

Olga Laporta-Hoyos, Simona Fiori, Kerstin Pannek, Júlia Ballester-Plané, David Leiva, Lee B Reid, Alex M Pagnozzi, Élida Vázquez, Ignacio Delgado, Alfons Macaya, Roser Pueyo, Roslyn N Boyd, Olga Laporta-Hoyos, Simona Fiori, Kerstin Pannek, Júlia Ballester-Plané, David Leiva, Lee B Reid, Alex M Pagnozzi, Élida Vázquez, Ignacio Delgado, Alfons Macaya, Roser Pueyo, Roslyn N Boyd

Abstract

Purpose: To characterise brain lesions in dyskinetic cerebral palsy (DCP) using the semi-quantitative scale for structural MRI (sqMRI) and to investigate their relationship with motor, communication and cognitive function.

Materials and methods: Thirty-nine participants (19 females, median age 21y) with DCP were assessed in terms of motor function, communication and a variety of cognitive domains. Whole-head magnetic resonance imaging (MRI) was performed including T1-MPRAGE, T2 turbo spin echo (axial plane), and fluid attenuated inversion recovery images (FLAIR). A child neurologist visually assessed images for brain lesions and scored these using the sqMRI. Ordinal, Poisson and binomial negative regression models identified which brain lesions accounted for clinical outcomes.

Results: Brain lesions were most frequently located in the ventral posterior lateral thalamus and the frontal lobe. Gross (B = 0.180, p < .001; B = 0.658, p < .001) and fine (B = 0.136, p = .003; B = 0.540, p < .001) motor function were associated with global sqMRI score and parietal involvement. Communication functioning was associated with putamen involvement (B = 0.747, p < .028). Intellectual functioning was associated with global sqMRI score and posterior thalamus involvement (B = -0.018, p < .001; B = -0.192, p < .001). Selective attention was associated with global sqMRI score (B = -0.035, p < .001), parietal (B = -0.063, p = .023), and corpus callosum involvement (B = -0.448, p < .001). Visuospatial and visuoperceptive abilities were associated with global sqMRI score (B = -0.078, p = .007) and medial dorsal thalamus involvement (B = -0.139, p < .012), respectively.

Conclusions: Key clinical outcomes in DCP are associated with specific observable brain lesions as indexed by a simple lesion scoring system that relies only on standard clinical MRI.

Keywords: Cerebral palsy, (CP); Communication; Dyskinetic cerebral palsy; Dyskinetic cerebral palsy, (DCP); Fluid attenuated inversion recovery images, (FLAIR); Frontal lobe; Gross motor function classification system, (GMFCS); Intellectual functioning; Magnetic resonance images, (MRI); Semi-quantitative scale for brain structural MRI, (sqMRI); Ventral posterior lateral thalamus; Visuoperception.

Figures

Fig. 1
Fig. 1
Flowchart showing requitement process for participants.
Fig. 2
Fig. 2
Percentage of cases presenting different lesion severity according sqMRI scores a) global score (maximum score of 40) to b) ranging from 0 to 6 for each lobar score (including right and left side) c) ranging from no lesion, middle and posterior lesion for corpus callosum and d) ranging from none, unilateral and bilateral lesion for basal ganglia, thalamus, brainstem and cerebellum. PLIC: posterior limb of internal capsule; VPLT: ventral posterior lateral thalamus.
Fig. 3
Fig. 3
Axial FLAIR images of a 14 year old male, showing an example of the most common involvement observed, including ventral posterior lateral thalamus (A, arrowheads) and frontal perirolandic cortex (B, arrowheads). In this subject also putamina are involved (arrows).
Fig. 4
Fig. 4
An illustration of the results of the regression models obtained for the subscores regression models presented in Table 2. F: frontal, O: occipital, P: parietal, T: temporal. The colour bar indicates a) the percentage of odds change in each clinical outcome when the sqMRI score in this region increases by one unit b) the percentage change in clinical outcome when the sqMRI score in this region increases by one unit.
Fig. 5
Fig. 5
Top row: Axial FLAIR images showing an example of the regions which showed an association with clinical measures. (A) Axial FLAIR: parietal white matter involvement (arrowheads); (B) Axial FLAIR: posterior putamina involvement (arrowheads); here with ventral posterior lateral thalamus involvement (arrows); (C) Axial FLAIR: posterior thalamic involvement (arrowheads); (D) Sagittal T1: thinning of middle and posterior corpus callosum (arrowheads); (E) Axial FLAIR: medial dorsal thalamus involvement (arrowheads). Images correspond to a (A) 50 year old male; (B) 21 year old female; (C) 42 year old male (D) 41 year old female and a (E) 17 year old male.

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