Advances in neuroimaging provide unique opportunities to evaluate brain structure, biochemistry, and function. Although a number of imaging techniques have been used in newborns, cranial ultrasonography in premature infants and nuclear magnetic resonance modalities, including magnetic resonance imaging and diffusion-weighted imaging, in high-risk term infants are of foremost benefit. Interpretation is based on knowledge of characteristic imaging findings in specific childhood neurologic disorders and an understanding of differential diagnosis in cerebral palsy syndromes, such as spastic diplegia and various subtypes of extrapyramidal cerebral palsy. This review focuses on imaging studies that can be effectively used in at-risk infants and in children with spasticity and movement disorders to refine diagnosis and guide therapeutic interventions. (J Child Neurol 2003:18:S25—S39).
Get full access to this article
View all access options for this article.
References
1.
Sarnat HB, Flores-Sarnat L.: Neuropathologic research strategies in holoprosencephaly. J Child Neurol2001;16:918—931.
2.
Cardoso C., Leventer RJ, Dowling JJ, et al: Clinical and molecular basis of classical lissencephaly: Mutations in the LIS1 gene (PAFAH1B1). Hum Mutat2002 ;19:4—15.
3.
Hoon AH, Melhem ER: Neuroimaging: Applications in disorders of early brain development. J Dev Behav Pediatr2000;21:291—302.
4.
Johnston MV, Nishimura A., Harum K., et al: Sculpting the developing brain. Adv Pediatr2001;48:1—38.
5.
Barkovich AJ : Magnetic resonance imaging: Role in the understanding of cerebral malformations. Brain Dev2002;24:2—12.
6.
Hoon AH, Lawrie WT, Melhem ER, et al: Diffusion tensor imaging of periventricular leukomalacia shows affected sensory cortex white matter pathways. Neurology2002;59:752—756.
7.
Barkovich JA: Techniques and methods in pediatric neuroimaging, in Pediatric Neuroimaging, 3rd ed. Philadelphia , Lippincott Williams and Wilkins, 2000, 1—12.
8.
Chugani HT: Metabolic imaging: A window on brain development and plasticity. Neuroscientist1999;5:29—40.
9.
Cornette L., Levene MI: Post-resuscitative management of the asphyxiated term and preterm infant. Semin Neonatol2001;6: 271—282.
10.
Volpe JJ: Neurobiology of periventricular leukomalacia in the premature infant. Pediatr Res2001;50:553—562.
11.
Hoon AH, Johnston MV: Cerebral palsy, in Asbury AK, McKhann GM, McDonald WI, et al (eds): Diseases of the Nervous System: Clinical Neuroscience and Therapeutic Principles. Cambridge, Cambridge University Press, 2002.
12.
Sharma N., Standaert DG: Inherited movement disorders. Neurol Clin2002;20:759—778.
13.
Huppi PS, Inder T.: Magnetic resonance techniques in the evaluation of the perinatal brain: Recent advances and future directions. Semin Neonatol2001;6:195—210.
14.
Bydder GM, Rutherford MA, Cowan FM: Diffusion-weighted imaging in neonates. Childs Nerv Syst2001;17:190—194.
15.
Schaefer PW , Grant PE, Gonzalez RG: Diffusion-weighted MR imaging of the brain . Radiology2000;217:331—345.
16.
Neil JJ, Shiran SI, McKinstry RC, et al: Normal brain in human newborns: Apparent diffusion coefficient and diffusion anisotropy measured by using diffusion tensor MR imaging. Radiology1998;209: 57—66.
17.
Mukherjee P. , Miller JH, Shimony JS, et al: Diffusion-tensor MR imaging of gray and white matter development during normal human brain maturation. AJNR Am J Neuroradiol2002;23: 1445—1456.
18.
Mori S., Kaufmann WE, Pearlson GD, et al: In vivo visualization of human neural pathways by magnetic resonance imaging. Ann Neurol2000;47:412—414.
19.
Shevell MI, Ashwal S., Novotny E.: Proton magnetic resonance spectroscopy: Clinical applications in children with nervous system diseases. SeminPediatr Neurol1999;6:68—77.
20.
Zarifi MK, Astrakas LG, Poussaint TY, et al: Prediction of adverse outcome with cerebral lactate level and apparent diffusion coefficient in infants with perinatal asphyxia. Radiology2002;225: 859—870.
21.
Robinson RO , Ferrie CD, Capra M., Maisey MN: Positron emission tomography and the central nervous system. Arch Dis Child1999;81:263—270.
Sereno MI, Dale AM, Reppas JB, et al: Borders of multiple visual areas in humans revealed by functional magnetic resonance imaging. Science1995;268:889—893.
29.
Gaillard WD , Balsamo LM, Ibrahim BA: fMRI identifies regional specialization of neural networks for reading in young children. Neurology2003;60:94—100.
30.
Cabeza R., Nyberg L.: Imaging Cognition II: An empirical review of 275 PET and fMRI studies. J Cogn Neurosci2000;12:1—47.
31.
Bookheimer S., Dapretto M., Karmarkar U.: Functional MRI in children with epilepsy . Dev Neurosci1999;21:191—9.
32.
Matthews PM , Clare S., Adcock J.: Functional magnetic resonance imaging: Clinical applications and potential. J Inherit Metab Dis1999;22:337—352.
33.
Leviton A., Paneth N., Reuss ML, et al: Maternal infection, fetal inflammatory response, and brain damage in very low birth weight infants. Developmental Epidemiology Network Investigators . Pediatr Res1999;46:566—575.
34.
Kumazaki K. , Nakayama M., Sumida Y., et al: Placental features in preterm infants with periventricular leukomalacia. Pediatrics2002;109:650—655.
35.
Miller SP, Shevell MI, Patenaude Y., et al: Neuromotor spectrum of periventricular leukomalacia in children born at term. Pediatr Neurol2000;23:155—159.
36.
Mitchell W. : Neurological and developmental effects of HIV and AIDS in children and adolescents. Ment Retard Dev Disabil Res Rev2001;7:211—216.
37.
Kobayashi H. , Garcia CA, Alfonso G., et al: Molecular genetics of familial spastic paraplegia: A multitude of responsible genes. J Neurol Sci1996;137:131—138.
38.
Egelhoff JC : MR imaging of congenital anomalies of the pediatric spine. Magn Reson Imaging Clin N Am1999;7:459—479.
39.
Willemsen MA , Ijlst L., Steijlen PM, et al: Clinical, biochemical and molecular genetic characteristics of 19 patients with the Sjögren-Larsson syndrome. Brain2001;124:1426—1437.
40.
Prasad AN, Breen JC, Ampola MG, et al: Argininemia: A treatable genetic cause of progressive spastic diplegia simulating cerebral palsy: Case reports and literature review. J Child Neurol1997; 12:301—309.
41.
Stewart AL, Rifkin L., Amess PN, et al: Brain structure and neurocognitive and behavioural function in adolescents who were born very preterm. Lancet1999;353:1653—1657.
42.
Perlman JM: White matter injury in the preterm infant: An important determination of abnormal neurodevelopment outcome. Early Hum Dev1998 ;53:99—120.
43.
Skranes JS, Nilsen G., Smevik O., et al: Cerebral MRI of very low birth weight children at 6 years of age compared with the findings at 1 year. Pediatr Radiol1998; 28: 471—475.
44.
Lin Y., Okumura A., Hayakawa F., et al: Quantitative evaluation of thalami and basal ganglia in infants with periventricular leukomalacia. Dev Med Child Neurol2001;43:481—485.
45.
Hoon AH, Freese PO, Reinhardt EM, et al: Age-dependent effects of trihexyphenidyl in extrapyramidal cerebral palsy. Pediatr Neurol2001;25:55—58.
46.
Melhem ER, Hoon AH Jr, Ferrucci JT Jr, Quinn CB: Periventricular leukomalacia: relationship between lateral ventricular volume on brain MR images and severity of cognitive and motor impairment. Radiology2000;214:199—204.
47.
Panigrahy A. , Barnes PD, Robertson RL, et al: Volumetric brain differences in children with periventricular T2-signal hyperintensities: A grouping by gestational age at birth. AJR Am J Roentgenol2001;177:695—702.
48.
Inder TE, Huppi PS, Warfield S., et al: Periventricular white matter injury in the premature infant is followed by reduced cerebral cortical gray matter volume at term. Ann Neurol1999;46:755—760.
49.
Murphy BP, Inder TE, Huppi PS, et al: Impaired cerebral cortical gray matter growth after treatment with dexamethasone for neonatal chronic lung disease. Pediatrics2001;107:217—221.
50.
Nosarti C., Al-Asady MH, Frangou S., et al: Adolescents who were born very preterm have decreased brain volumes. Brain2002;125: 1616—1623.
51.
Ment LR, Bada HS, Barnes P., et al: Practice parameter: Neuroimaging of the neonate (Report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society). Neurology2002; 58: 1726—1738.
52.
Paneth N., Kazam E., Monte W.: Brain Damage in the Preterm Infant. London: Cambridge University Press, 1995.
53.
Merrill JD, Piecuch RE, Fell SC, et al: A new pattern of cerebellar hemorrhages in preterm infants. Pediatrics1998;102:E62.
54.
Mercuri E., He J., Curati WL, et al: Cerebellar infarction and atrophy in infants and children with a history of premature birth. Pediatr Radiol1997;27:139—143.
55.
Allin M., Matsumoto H., Santhouse AM, et al: Cognitive and motor function and the size of the cerebellum in adolescents born very pre-term. Brain2001 ;124:60—66.
56.
Maalouf EF, Duggan PJ, Counsell SJ, et al: Comparison of findings on cranial ultrasound and magnetic resonance imaging in preterm infants. Pediatrics2001 ;107:719—727.
57.
Felderhoff-Mueser U., Rutherford MA, Squier WV, et al: Relationship between MR imaging and histopathologic findings of the brain in extremely sick preterm infants. AJNR Am J Neuroradiol1999;20:1349—1357.
58.
Inder T., Huppi PS, Zientara GP, et al: Early detection of periventricular leukomalacia by diffusion-weighted magnetic resonance imaging techniques. J Pediatr1999; 134:631-634.
59.
Bydder GM, Rutherford MA: Diffusion-weighted imaging of the brain in neonates and infants. Magn Reson Imaging Clin N Am2001;9:viii, 83—98.
60.
Huppi PS, Murphy B., Maier SE, et al: Microstructural brain development after perinatal cerebral white matter injury assessed by diffusion tensor magnetic resonance imaging. Pediatrics2001;107: 455—460.
61.
Inder TE, Buckland L., Williams CE, et al: Lowered electroencephalographic spectral edge frequency predicts the presence of cerebral white matter injury in premature infants. Pediatrics2003;111:27—33.
62.
Baldoli C., Righini A., Parazzini C., et al: Demonstration of acute ischemic lesions in the fetal brain by diffusion magnetic resonance imaging. Ann Neurol2002;52:243—246.
63.
Johnston MV, Hoon AH: Excitotoxicity and patterns of brain injury from fetal or perinatal asphyxia , in Maulik D (ed): Asphyxia and Fetal Brain Damage. Hoboken, NJ, John Wiley and Sons, 1998.
64.
Shalak LF, Laptook AR, Jafri HS, et al: Clinical chorioamnionitis, elevated cytokines, and brain injury in term infants. Pediatrics2002;110:673—680.
65.
Yokochi K., Fujimoto S.: Magnetic resonance imaging in children with neonatal asphyxia: Correlation with developmental sequelae. Acta Paediatr1996;85:88—95.
66.
Jeng LB, Tarvin R., Robin NH: Genetic advances in central nervous system malformations in the fetus and neonate. SeminPediatr Neurol2001;8:89—99.
67.
Mercuri E., Cowan F., Gupte G., et al: Prothrombotic disorders and abnormal neurodevelopmental outcome in infants with neonatal cerebral infarction. Pediatrics2001;107:1400—1404.
68.
Thorarensen O., Ryan S., Hunter J., Younkin DP: Factor V Leiden mutation: An unrecognized cause of hemiplegic cerebral palsy, neonatal stroke, and placental thrombosis . Ann Neurol1997;42: 372—375.
69.
Smith RA, Skelton M., Howard M., Levene M.: Is thrombophilia a factor in the development of hemiplegic cerebral palsy?Dev Med Child Neurol2001;43:724—730.
70.
Vandermeeren Y., Olivier E., Sebire G., et al: Increased FDG uptake in the ipsilesional sensorimotor cortex in congenital hemiplegia. Neuroimage2002;15:949—960.
71.
Morioka T., Nishio S., Sasaki M., et al: Functional imaging in schizencephaly using [18F]fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) and single photon emission computed tomography with technetium-99m-hexamethyl-propyleneamine oxime (HMPAO-SPECT) . Neurosurg Rev1999;22:99—101.
72.
Cioni G., Sales B., Paolicelli PB, et al: MRI and clinical characteristics of children with hemiplegic cerebral palsy. Neuropediatrics1999;30:249—255.
73.
Denis D., Chateil JF, Brun M., et al: Schizencephaly: Clinical and imaging features in 30 infantile cases. Brain Dev2000;22:475—483.
74.
Pascual-Castroviejo I., Pascual-Pascual SI, Viano J., et al: Unilateral polymicrogyria: A common cause of hemiplegia of prenatal origin. Brain Dev2001;23:216—222.
75.
Barkovich AJ , Chuang SH: Unilateral megalencephaly: Correlation of MR imaging and pathologic characteristics. AJNR Am J Neuroradiol1990;11:523—531.
76.
Niemann G., Wakat JP, Krageloh-Mann I., et al: Congenital hemiparesis and periventricular leukomalacia: Pathogenetic aspects on magnetic resonance imaging. Dev Med Child Neurol1994; 36:943—950.
77.
Montenegro MA, Guerreiro MM, Lopes-Cendes I., et al: Interrelationship of genetics and prenatal injury in the genesis of malformations of cortical development. Arch Neurol2002;59:1147—1153.
78.
Iannetti P. , Nigro G., Spalice A., et al: Cytomegalovirus infection and schizencephaly: Case reports. Ann Neurol1998;43:123—127.
79.
Mercuri E., Rutherford M., Cowan F., et al: Early prognostic indicators of outcome in infants with neonatal cerebral infarction: A clinical, electroencephalogram, and magnetic resonance imaging study. Pediatrics1999;103:39—46.
80.
deVeber G.: Risk factors for childhood stroke: Little folks have different strokes, editorial . Ann Neurol2003;53:149—150.
81.
Poldrack R. : Imaging brain plasticity: Conceptual and methodological issues—A theoretical review. Neuroimage2000;12:1—13.
82.
Briellmann RS, Abbott DF, Caflisch U., et al: Brain reorganisation in cerebral palsy: A high-field functional MRI study. Neuropediatrics2002;33:162—165.
83.
Staudt M., Pieper T., Grodd W., et al: Functional MRI in a 6 year old boy with unilateral cortical malformation: Concordant representation of both hands in the unaffected hemisphere . Neuropediatrics2001;32:159—160.
84.
Staudt M., Lidzba K., Grodd W., et al: Right-hemispheric organization of language following early left-sided brain lesions: Functional MRI topography. Neuroimage2002;16:954—967.
85.
Hoon AH, Reinhardt EM, Kelley RI, et al: Brain magnetic resonance imaging in suspected extrapyramidal cerebral palsy: Observations in distinguishing genetic-metabolic from acquired causes. J Pediatr1997;131:240—245.
86.
Vitek JL, Chockkan V., Zhang JY, et al: Neuronal activity in the basal ganglia in patients with generalized dystonia and hemiballismus. Ann Neurol1999 ;46:22—35.
87.
Saint Hilaire MH, Burke RE, Bressman SB, et al: Delayed-onset dystonia due to perinatal or early childhood asphyxia. Neurology1991 ;41:216—222.
88.
American Academy for Cerebral Palsy and Developmental Medicine 11th Annual Conference: Kernicterus and its importance in cerebral palsy. Springfield, IL, Charles C. Thomas, 1961.
89.
Karbe H., Holthoff VA, Rudolf J., et al: Positron emission tomography demonstrates frontal cortex and basal ganglia hypometabolism in dystonia. Neurology1992;42:1540—1544.
Nygaard TG, Takahashi H., Heiman GA: Long-term treatment response and fluorodopa positron emission tomographic scanning of parkinsonism in a family with dopa-responsive dystonia. Ann Neurol1992;32:603—608.
92.
O'Sullivan JD, Costa DC, Gacinovic S., Lees AJ: SPECT imaging of the dopamine transporter in juvenile-onset dystonia. Neurology2001 ;56:266—267.
93.
De Volder A., Bol A., Michel C., et al: Brain glucose utilization in childhood Huntington's disease studied with positron emission tomography (PET). Brain Dev1988; 10:47-50.
94.
Barsottini OG, Ferraz HB, Seviliano MM, Barbieri A.: Brain SPECT imaging in Sydenham's chorea . Braz J Med Biol Res2002;35: 431—436.
95.
Jeon B., Kim JM, Jeong JM, et al: Dopamine transporter imaging with [123I]-beta-CIT demonstrates presynaptic nigrostriatal dopaminergic damage in Wilson's disease. J Neurol Neurosurg Psychiatry1998;65:60—64.
96.
Hermann W., Reuter M., Barthel H., et al: Diagnosis of Hallervorden-Spatz disease using MRI, (123)I-beta-CIT-SPECT and (123)I-IBZM-SPECT. Eur Neurol2000;43:187—188.
97.
Duncan DB, Herholz K., Kugel H., et al: Positron emission tomography and magnetic resonance spectroscopy of cerebral glycolysis in children with congenital lactic acidosis. Ann Neurol1995; 37:351—358.
98.
Johnston MV, Hoon AH: Possible mechanisms in infants for selective basal ganglia damage from asphyxia, kernicterus, or mitochondrial encephalopathies. J Child Neurol2000;15:588—591.
99.
Wolf RL, Zimmerman RA, Clancy RC, Haselgrove JL: Quantitative apparent diffusion coefficient measurement in term neonates for early detection of hypoxic-ischemic brain injury: Initial experience. Radiology2001;218:825—833.
100.
Johnson AJ , Lee BC, Lin W.: Echoplanar diffusion-weighted imaging in neonates and infants with suspected hypoxic-ischemic injury: Correlation with patient outcome. AJR Am J Roentgenol1999;172:219—226.
101.
Groenendaal F., Roelants-Van Rijn AM, van Der Grond J., et al: Glutamate in cerebral tissue of asphyxiated neonates during the first week of life demonstrated in vivo using proton magnetic resonance spectroscopy . Biol Neonate2001;79:254—257.
102.
Barkovich AJ, Baranski K., Vigneron D., et al: Proton MR spectroscopy for the evaluation of brain injury in asphyxiated, term neonates. AJNR Am J Neuroradiol1999;20:1399—1405.
103.
Yilmaz Y., Alper G., Kilicoglu G., et al: Magnetic resonance imaging findings in patients with severe neonatal indirect hyperbilirubinemia. J Child Neurol2001;16:452—455.
104.
Klein C., Breakefield XO, Ozelius LJ: Genetics of primary dystonia. Semin Neurol1999;19:271—280.
105.
Hayflick SJ , Westaway SK, Levinson B., et al: Genetic, clinical, and radiographic delineation of Hallervorden-Spatz syndrome. N Engl J Med2003;348:33—40.
106.
Saatci I., Topcu M., Baltaoglu FF, et al: Cranial MR findings in Wilson's disease. Acta Radiol1997;38:250—258.
107.
Ho VB, Chuang HS, Rovira MJ, Koo B.: Juvenile Huntington disease: CT and MR features. AJNR Am J Neuroradiol1995;16: 1405—1412.
108.
Brewer GJ, Fink JK, Hedera P.: Diagnosis and treatment of Wilson's disease. Semin Neurol1999;19:261—270.
109.
Monavari AA , Naughten ER: Prevention of cerebral palsy in glutaric aciduria type 1 by dietary management. Arch Dis Child2000;82:67—70.
110.
Brismar J. , Ozand PT: CT and MR of the brain in the diagnosis of organic acidemias. Experiences from 107 patients. Brain Dev1994;16(Suppl):104—124.
111.
Furukawa Y. : Genetics and biochemistry of dopa-responsive dystonia: Significance of striatal tyrosine hydroxylase protein loss. Adv Neurol2003;91:401—410.
112.
Bandmann O. , Wood NW: Dopa-responsive dystonia—The story so far. Neuropediatrics2002;33:1—5.
113.
Turk MA, Geremski CA, Rosenbaum PF, Weber RJ: The health status of women with cerebral palsy. Arch Phys Med Rehabil1997; 78:S10—S17
114.
Epstein NE : Circumferential cervical surgery for spondylostenosis with kyphosis in two patients with athetoid cerebral palsy. Surg Neurol1999;52:339—344.
115.
Mostofsky SH, Schafer Jgb, Abrams MT, et al: fMRI evidence that the neural basis of response inhibition is task-dependent. Cogn Brain Res2003;17:419—430.
116.
Naidu S., Kaufmann WE, Abrams MT, et al: Neuroimaging studies in Rett syndrome. Brain Dev2001;23:S62—S71.
117.
Pouwels PJ , Brockmann K., Kruse B., et al: Regional age dependence of human brain metabolites from infancy to adulthood as detected by quantitative localized proton MRS. Pediatr Res1999;46:474—485.
118.
Levy LM, Hallett M.Impaired brain GABA in focal dystonia. Ann Neurol2002;51:93—101.
119.
Wilichowski E., Pouwels PJ, Frahm J., Hanefeld F.: Quantitative proton magnetic resonance spectroscopy of cerebral metabolic disturbances in patients with MELAS. Neuropediatrics1999;30: 256—263.
120.
Albayram S. , Melhem ER, Mori S., et al: Holoprosencephaly in children: Diffusion tensor MR imaging of white matter tracts of the brainstem—Initial experience . Radiology2002;223:645—651.
