Lessons from Cincinnati Children’s Hospital
By Marcel Warntjes. Published 20.11.2017
In early October the American Journal of NeuroRadiology released a study conducted by Dr. Aaron McAllister et al. from Cincinnati Children’s Hospital called ‘Quantitative Synthetic MRI in Children: Normative Intracranial Tissue Segmentation Values during Development’.
Cincinnati Children’s has worked with SyMRI since 2015 and has built up an extensive database of quantitative SyMRI scans on their pediatric population.
The published study was on a group which they selected retrospectively as being healthy. In children this is difficult to do since it is unusual to scan children as healthy volunteers. Instead, they selected a group which received a referral but where nothing was found. After a thorough selection process there were 122 children in the age 0.1 – 21.5 years old that were included.
The article shows normative curves of normal brain volumes on this group. Included is gray matter, white matter, CSF, whole brain and even myelin volume. Especially the latter is unique since myelin development is an extremely important marker for brain development and normative curves will help determining in what range myelin development can be regarded as normal.
The authors added a three example cases of pathology, of patients with microcephaly, developmental delay and Pelizaeus-Merzbacher disease (a primary hypomyelination disease).
This shows how the curves can be used in clinical practice: the measured brain volumes are compared to the 95% range of the normative curves at the same age, directly showing to what extent the patient deviates from normal.
Such objective decision support can make diagnose and patient follow-up far more accurate than using conventional imaging. Dr. McAllister et al. wrote an impressive article that sets the standard in quantitative pediatric imaging. It will be valuable as a reference in many studies to come.