Magnetic Resonance Imaging of Brain Patterns in Children with Cerebral Palsy- A Hospital Based Indian Study

Abstract

Introduction: Magnetic Resonance Imaging (MRI) of brain is recommended as a standard evaluation in children with Cerebral Palsy (CP). Aim: To investigate the MRI brain abnormality patterns and its frequency in children with CP and to find the association between the gestational ages, CP clinical types, and the MRI findings. Materials and Methods: The retrospective observational study was done in a clinically diagnosed cohort of CP with MRI scans performed between November 2016 to July 2019 at Vydehi Hospital, Vydehi Institute of Medical Sciences and Research Centre, Whitefield, Bangalore, India. MRI brain scans of 63 children with the clinical diagnosis of CP (term 41, preterm 22), aged between 1 month to 15 years were studied. Births with unknown gestational age and postnatally acquired CP cases were excluded from the study. MRI scans were performed on a Philips Achieva 1.5 T Scanner. MR images of all cases were comprehensively evaluated by a single senior MRI radiologist and split into normal and abnormal categories. Statistical analysis was done by using SPSS version 22 software. A Chi-square test was used as a test of significance for qualitative data and to find the association between the gestational ages, clinical type of CP and MRI findings. p-value of <0.05 was considered as statistically significant. Results: MRI brain abnormalities were documented in 74.6% of cases. White Matter Injury (WMI) was the most common type (50.8%) followed by gray matter (9.5% superficial + deep), focal vascular insults (6.3%), cerebral malformations (6.3%) and intra cranial haemorrhage (1.6%). Normal MRI findings were observed in 25.4% of cases. The study group consisted of 88.8% of spastic motor type CP of which 31.7% had quadriplegic and hemiplegic CP and 25.4% had diplegic, respectively. The nonspastic type consisted of ataxia or hypotonia (6.3%) and dyskinesia or athetosis (4.8%). MRI abnormal findings were most likely to be identified in children with spastic hemiplegia (90%) and less likely to be in nonspastic motor (50%) types. Deep gray matter injury was more common in dyskinetic type and cerebral malformations were more associated with spastic diplegic CP (p-value -0.014*). In both the term and preterm births, White Matter (WM) abnormality was the most common type (58.5% in term and 36.4% in preterm) but Focal vascular insults were significantly associated with preterm compared to term births (13.6% vs 2.4%, p=0.028). Conclusion: MRI was useful in revealing underlying brain abnormalities in children with CP. Specific MRI findings in children with CP were found to be associated with neurological subtype and gestational age at birth.

Keywords

• grey matter injury
• intra cranial hemorrhage
• white matter injury