Violeta Tenorio

Fetal Brain MRI Texture Analysis Identifies Different Microstructural Patterns in Adequate and Small for Gestational Age Fetuses at Term

Objectives: We tested the hypothesis whether a texture analysis (TA) algorithm applied to MRI brain images identified different patterns in small for gestational age (SGA) fetuses as compared with adequate for gestational age (AGA). Study Design: MRI was performed on 83 SGA and 70 AGA at 37 weeks GA. Texture features were quantified in the frontal lobe, basal ganglia, mesencephalon, cerebellum and cingulum. A classification algorithm based on discriminative models was used to correlate texture features with clinical diagnosis. Results: Region of interest delineation in all areas was achieved in 61 SGA (12 vasodilated) and 52 AGA; this was the sample for TA feature extraction which allowed classifying SGA from AGA with accuracies ranging from 90.9 to 98.9% in SGA versus AGA comparison and from 93.6 to 100% in vasodilated SGA versus AGA comparison. Conclusions: This study demonstrates that TA can detect brain differences in SGA fetuses. This supports the existence of brain microstructural changes in SGA fetuses.

Correlation Between a Semiautomated Method Based on Ultrasound Texture Analysis and Standard Ultrasound Diagnosis Using White Matter Damage in Preterm Neonates as a Model

Diagnosis of white matter damage by cranial ultrasound imaging is still subject to interobserver variability and has limited sensitivity for predicting abnormal neurodevelopment later in life. In this study, we evaluated the ability of a semiautomated method based on ultrasound texture analysis to identify patterns that correlate with the ultrasound diagnosis of white matter damage.

Measuring intellectual ability in cerebral palsy: The comparison of three tests and their neuroimaging correlates.

Standard intelligence scales require both verbal and manipulative responses, making it difficult to use in cerebral palsy and leading to underestimate their actual performance. This study aims to compare three intelligence tests suitable for the heterogeneity of cerebral palsy in order to identify which one(s) could be more appropriate to use. Forty-four subjects with bilateral dyskinetic cerebral palsy (26 male, mean age 23 years) conducted the Ravens Coloured Progressive Matrices (RCPM), the Peabody Picture Vocabulary Test-3rd (PPVT-III) and the Wechsler Nonverbal Scale of Ability (WNV). Furthermore, a comprehensive neuropsychological battery and magnetic resonance imaging were assessed. The results show that PPVT-III gives limited information on cognitive performance and brain correlates, getting lower intelligence quotient scores. The WNV provides similar outcomes as RCPM, but cases with severe motor impairment were unable to perform it. Finally, the RCPM gives more comprehensive information on cognitive performance, comprising not only visual but also verbal functions. It is also sensitive to the structural state of the brain, being related to basal ganglia, thalamus and white matter areas such as superior longitudinal fasciculus. So, the RCPM may be considered a standardized easy-to-administer tool with great potential in both clinical and research fields of bilateral cerebral palsy.

Risk of ultrasound‐detected neonatal brain abnormalities in intrauterine growth‐restricted fetuses born between 28 and 34 weeks' gestation: relationship with gestational age at birth and fetal Doppler parameters

To estimate the value of gestational age at birth and fetal Doppler parameters in predicting the risk of neonatal cranial abnormalities in intrauterine growth‐restricted (IUGR) fetuses born between 28 and 34 weeks gestation.

CORRELATION OF QUANTITATIVE TEXTURE ANALYSIS OF CRANIAL ULTRASOUND WITH LATER NEUROBEHAVIOR IN PRETERM INFANTS

The purpose of the study was to evaluate the association between a quantitative texture analysis of early neonatal brain ultrasound images and later neurobehavior in preterm infants. A prospective cohort study including 120 preterm (<33 wk of gestational age) infants was performed. Cranial ultrasound images taken early after birth were analyzed in six regions of interest using software based on texture analysis. The resulting texture scores were correlated with the Neonatal Behavioural Assessment Scale (NBAS) at term-equivalent age. The ability of texture scores, in combination with clinical data and standard ultrasound findings, to predict the NBAS results was evaluated. Texture scores were significantly associated with all but one NBAS domain and better predicted NBAS results than clinical data and standard ultrasound findings. The best predictive value was obtained by combining texture scores with clinical information and ultrasound standard findings (area under the curve = 0.94). We conclude that texture analysis of neonatal cranial ultrasound-extracted quantitative features that correlate with later neurobehavior has a higher predictive value than the combination of clinical data with abnormalities in conventional cranial ultrasound.

Evaluation of semiautomated quantification of cranial ultrasound images in newborns as a predictor of Neonatal Behavioral Assessment Scale

Diagnosis of white matter damage by neonatal cranial ultrasound (CrUS) is subject to inter-observer variability and has a low sensitivity to detect late abnormal neurodevelopment in life. In the last decades there have been a significant effort reporting that statistical features of ultrasound images carry important information associated with changes of tissue microstructure. In this work we explored the ability of a semi-automated image processing method to associate ultrasound texture patterns with Neonatal Behavioral Assessment Scale (NBAS) performance in premature neonates. A total of ninety infants born at a median gestational age of 29 weeks were included. The infants underwent one CrUS scan performed at the same day that NBAS test. In this work, we developed a feature selection algorithm to identify combination of features that correlated to NBAS clusters. Our algorithm was then able to predict individual underscored NBAS clusters with accuracy higher than 80% in a “blind” sample.

OC22.02: Combination of the aortic isthmus with ductus venosus improves the prediction of neurological damage in early-onset intrauterine growth restricted fetuses

Objectives: To evaluate the neurobehavioral outcome of earlyonset intrauterine growth restricted (IUGR) fetuses with abnormal umbilical artery (UA) Doppler and to compare the groups with and without brain sparing. Methods: A cohort of consecutive IUGR fetuses (birth weight < 10th centile) with abnormal UA Doppler (pulsatility index > 95th centile) and requiring delivery before 34 weeks was created and compared to a group of appropriate-for-gestational age (AGA) infants matched with cases by gestational age at delivery. Middle cerebral artery (MCA) was assessed by Doppler in all cases within 72 hours of delivery. Neonatal behavior was evaluated at 40-week corrected age with the Neonatal Behavioral Assessment Scale (NBAS). The effects of the study group and brain sparing (MCA pulsatility index < 5th centile) on each NBAS area were adjusted by multiple analysis of covariance or logistic regression for smoking during pregnancy, socioeconomic level, mode of delivery and gender. Results: A total of 126 fetuses (64 IUGR and 62 AGA) were included. Among IUGR fetuses, the proportion with abnormal MCA was 55%. All the neurobehavioral areas studied were poorer in the IUGR group, significantly in habituation, motor and socialinteractive. Abnormal habituation (36.2 vs. 16.3%; P = 0.027), motor (40.3 vs. 15.6%; P = 0.002) and social-interactive (25.8 vs. 8.2%; P = 0.009) scores were more frequent in IUGR than in AGA newborns. All the neurobehavioral areas studied were poorer in IUGR fetuses with brain sparing, significantly in habituation, motor, social-interactive and attention. Abnormal MCA identified IUGR fetuses with the highest risks of abnormal NBAS in motor (odds ratio 3.6; P = 0.011), social-interactive (odds ratio 4.1; P = 0.019) and attention (odds ratio 3.7; P = 0.011) areas. Conclusions: Early-onset IUGR with abnormal umbilical artery Doppler have poorer neurobehavioral competencies, which suggest a delayed neurological maturation. Abnormal MCA Doppler discriminates those cases at highest risk for abnormal neurobehavior.

PS-193 Quantitative Cranial Ultrasound (crus) Analysis In Relation To Outcome At 2 Years Of Age In Preterm Infants

Introduction CrUS is an important prognostic variable in prematurity, although with some limitations. Quantitative CrUS techniques might have the potential to overcome some of those limitations. Objectives To investigate whether a semi-quantitative method of CrUS analysis correlated with developmental outcome at 2 years in a cohort of preterm infants, and to compare this method with clinical variables and CrUS qualitative evaluation. Methods Cohort of 88 <33 weeks gestational aged (GA) infants underwent several CrUS scans from birth to term. This last scan was analysed using a quantitative texture method (LBR), eventually obtaining 3 Quantitative Scores (QS). Outcome variables included abnormal Bayley Scales of Infant Development (3rd edition): Motor, Cognitive, and Language composite scores (<1SD); and Any Developmental Impairment (any abnormal previous result or a vision or hearing impairment). Results Mean GA was 29,0 (SD 2,2). Hearing and vision deficits were present in 3 patients. Abnormal scores occurred 9.1% in cognitive, 11.4% motor, 18.2% language and 23.9% NDI. QS significantly correlated to all outcome variables (p values: cognitive = 0.003, motor = 0.011, language = 0.015, NDI = 0.036). ROC analysis is shown in table. When clinical information and CrUS abnormalities were added in logistic regression analysis, QS added significant information (R2 Nagelkerke) in all but motor outcome (Figure). Conclusions Quantitative analysis of CrUS may add significant information to standard qualitative evaluation with regards to outcome at 2 years in preterm infants. Abstract PS-193 Table 1 AUC Significance Sensitivity Specificity Cognitive 0.81 0.005 0.62 0.85 Motor 0.68 0.064 0.40 0.80 Language 0.68 0.021 0.50 0.83 NDI 0.65 0.044 0.35 0.76 Abstract PS-193 Figure 1

O-073 Total And Regional Corpus Callosum Volumes Are Related To Intelligence And Motor Function In Dyskinetic Cerebral Palsy

Background The relationship between corpus callosum (CC) morphology and mainly motor outcomes has been studied in spastic cerebral palsy (CP) but not yet in dyskinetic CP, which has been recently related to a diffuse brain injury pattern. This study aims to analyse the relationship of total and regional CC volumes with intelligence and motor impairment severity in dyskinetic CP. Methods 15 subjects (age range, 12–34) with dyskinetic CP and signs of perinatal asphyxia underwent a MRI. CC total, anterior, central and posterior volumes were calculated (Figure 1). The intelligence and motor scales most commonly used in CP were administered. Abstract O-073 Figure 1 CC subdivisions generated by Freesurfer (in colour) Results The CC total volume and most of its parts were related to intelligence and motor measures (Table 1). Abstract O-073 Table 1 Partial correlation controlling for age Intelligence Motor Verbal1 Non-verbal2 GMFCS BFMF MACS TOTAL CC 0.773*** 0.775*** -0.641** -0.542* -0.634** ANTERIOR 0.612** 0.681** no significative CENTRAL 0.659** 0.637 ** -0.619** -0.587* -0.641** POSTERIOR 0.812*** 0.779*** -0.684** -0.517* -0.656** * <.05; ** <. 01; *** <. 001; GMFCS: Gross Motor Function Classification System; BFMF: Bimanual Fine Motor Function; MACS: Manual Ability Classification System; 1Peabody Picture Vocabulary Test-3rd; 2Raven’s Progressive Matrices. Conclusions Total CC volume may be indicative of intelligence and motor status in dyskinetic CP. Regionally, the posterior part is the most related to intelligence, in agreement with recent theories of intelligence. The anterior part of the CC is not found to be related to motor function. This result agrees with the fact that premotor and sensorimotor fibres are located more posteriorly than previously thought.