Objectives: Using diffusion tensor imaging (DTI), we investigated the state of medial lemniscus (ML), corticospinal tract (CST), and posterior thalamic radiation (PTR), which were expected as probable reasons for clinical hemiplegia in pediatric patients, especially those who showed impaired fine motor control and proprioception, but no definite motor weakness or spasticity. Methods: We recruited 13 hemiplegic patients and 8 age-matched healthy control subjects. Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) for the bilateral ML, CST, and PTR were calculated and compared between the affected hemisphere of the patient (AP), the unaffected hemisphere of the patient (UP), and the mean value of the bilateral hemispheres in control subjects (MC). Results: FA and ADC values for the CST and PTR did not differ significantly between the AP, UP, and MC subgroups (p > 0.05). However, the FA value for the ML in AP showed a significant decrease, compared with that in UP (p = 0.012) and MC (p = 0.047). DTT for the CST and PTR showed preserved integrity and ML in the UP also had continuity to the cortex; however, ML in AP showed disruption. Conclusions: Using DTI, we demonstrated that the ML lesion might be related to clinical hemiplegia in pediatric patients.

1.
Kulak W, Sobaniec W: Comparisons of right and left hemiparetic cerebral palsy. Pediatr Neurol 2004;31:101–108.
2.
Hoon AH Jr, Lawrie WT Jr, Melhem ER, et al: Diffusion tensor imaging of periventricular leukomalacia shows affected sensory cortex white matter pathways. Neurology 2002;59:752–756.
3.
Nagae LM, Hoon AH Jr, Stashinko E, et al: Diffusion tensor imaging in children with periventricular leukomalacia: variability of injuries to white matter tracts. AJNR Am J Neuroradiol 2007;28:1213–1222.
4.
Hoon AH Jr, Stashinko E, Nagae LM, et al: Sensory and motor deficits in children with cerebral palsy born preterm correlate with diffusion tensor imaging abnormalities in thalamocortical pathways. Dev Med Child Neurol 2009;51:697–704.
5.
Son SM, Ahn YH, Sakong J, et al: Diffusion tensor imaging demonstrates focal lesions of the corticospinal tract in hemiparetic patients with cerebral palsy. Neurosci Lett 2007;420:34–38.
6.
Son SM, Park SH, Moon HK, et al: Diffusion tensor tractography can predict hemiparesis in infants with high risk factors. Neurosci Lett 2009;451:94–97.
7.
Uvebrant P: Hemiplegic cerebral palsy. Aetiology and outcome. Acta Paediatr Scand 1988;345(suppl):1–100.
8.
Oeffinger D, Conaway M, Stevenson R, Hall J, Shapiro R, Tylkowski C: Tibial length growth curves for ambulatory children and adolescents with cerebral palsy. Dev Med Child Neurol 2010;52:e195–201.
9.
Ohata K, Tsuboyama T, Haruta T, Ichihashi N, Nakamura T: Longitudinal change in muscle and fat thickness in children and adolescents with cerebral palsy. Dev Med Child Neurol 2009;51:943–948.
10.
Malaiya R, McNee AE, Fry NR, Eve LC, Gough M, Shortland AP: The morphology of the medial gastrocnemius in typically developing children and children with spastic hemiplegic cerebral palsy. J Electromyogr Kinesiol 2007;17:657–663.
11.
Moreau NG, Teefey SA, Damiano DL: In vivo muscle architecture and size of the rectus femoris and vastus lateralis in children and adolescents with cerebral palsy. Dev Med Child Neurol 2009;51:800–806.
12.
Gorter JW, Rosenbaum PL, Hanna SE, et al: Limb distribution, motor impairment, and functional classification of cerebral palsy. Dev Med Child Neurol 2004;46:461–467.
13.
Thomas B, Eyssen M, Peeters R, et al: Quantitative diffusion tensor imaging in cerebral palsy due to periventricular white matter injury. Brain 2005;128:2562–2577.
14.
Eyre JA, Smith M, Dabydeen L, et al: Is hemiplegic cerebral palsy equivalent to amblyopia of the corticospinal system? Ann Neurol 2007;62:493–503.
15.
Eyre JA: Corticospinal tract development and its plasticity after perinatal injury. Neurosci Biobehav Rev 2007;31:1136–1149.
16.
Eyre JA: Development and plasticity of the corticospinal system in man. Neural Plast 2003;10:93–106.
17.
Forssberg H: Neural control of human motor development. Curr Opin Neurobiol 1999;9:676–682.
18.
Carr LJ, Harrison LM, Evans AL, Stephens JA: Patterns of central motor reorganization in hemiplegic cerebral palsy. Brain 1993;116:1223–1247.
19.
Farmer SF, Harrison LM, Ingram DA, Stephens JA: Plasticity of central motor pathways in children with hemiplegic cerebral palsy. Neurology 1991;41:1505–1510.
20.
Brouwer B, Ashby P: Do injuries to the developing human brain alter corticospinal projections? Neurosci Lett 1990;108:225–230.
21.
Binkofski F, Seitz RJ, Amold S, Classen J, Benecke R, Freund HJ: Thalamic metabolism and corticospinal tract integrity determine motor recovery in stroke. Ann Neurol 1996;39:460–470.
22.
Ward NS, Newton JM, Swayne OB, et al: Motor system activation after subcortical stroke depends on corticospinal system integrity. Brain 2006;129:809–819.
23.
Jang SH: The role of the corticospinal tract in motor recovery in patients with a stroke: a review. NeuroRehabilitation 2009;24:285–290.
24.
Weiller C, Chollet F, Friston KJ, Wise RJ, Frackowiak RS: Functional reorganization of the brain in recovery from striatocapsular infarction in man. Ann Neurol 1992;31:463–472.
25.
Carey LM, Matyas TA, Oke LE: Sensory loss in stroke patients: effective training of tactile and proprioceptive discrimination. Arch Phys Med Rehabil 1993;74:602–611.
26.
Warren S, Capra NF, Yezierski RP: The somatosensory system. I. Tactile discrimination and position sense; in Haines DE (ed): Fundamental Neuroscience, ed 2. Philadelphia, Churchill Livingstone, 2002.
27.
De Weerdt W, Lincoln NB, Harrison MA: Prediction of arm and hand function recovery in stroke patients. Int J Rehabil Res 1987;10(suppl 5):110–112.
28.
Johansson RS, Cole KJ: Sensory-motor coordination during grasping and manipulative actions. Curr Opin Neurobiol 1992;2:815–823.
29.
Twitchell TE: Sensory factors in purposive movement. J Neurophysiol 1954;17:239–252.
30.
Yang DS, Hong JH, Byun WM, et al: Identification of the medial lemniscus in the human brain: combined study of functional MRI and diffusion tensor tractography. Neurosci Lett 2009;459:19–24.
31.
Habas C, Cabanis EA: Anatomical parcellation of the brainstem and cerebellar white matter: a preliminary probabilistic tractography study at 3 T. Neuroradiology 2007;49:849–863.
32.
Hagmann P, Thiran JP, Jonasson L, et al: DTI mapping of human brain connectivity: statistical fibre tracking and virtual dissection. Neuroimage 2003;19:545–554.
33.
Stieltjes B, Kaufmann WE, van Zijl PC, Fredericksen K, Pearlson GD, Solaiyappan M, Mori S: Diffusion tensor imaging and axonal tracking in the human brainstem. Neuroimage 2001;14:723–735.
34.
Wakana S, Jiang H, Nagae-Poetscher LM, van Zijl PC, Mori S: Fiber tract-based atlas of human white matter anatomy. Radiology 2004;230:77–87.
35.
Mori S, Crain BJ, Chacko VP, van Zijl PC: Three-dimensional tracking of axonal projections in the brain by magnetic resonance imaging. Ann Neurol 1999;45:265–269.
36.
Hong JH, Son SM, Jang SH: Somatotopic location of corticospinal tract at pons in human brain: a diffusion tensor tractography study. Neuroimage 2010;51:952–955.
37.
Jang SH: A review of corticospinal tract location at corona radiata and posterior limb of the internal capsule in human brain. NeuroRehabilitation 2009;24:279–283.
38.
Yoshida S, Hayakawa K, Yamamoto A, et al: Quantitative diffusion tensor tractography of the motor and sensory tract in children with cerebral palsy. Dev Med Child Neurol 2010;52:935–940.
39.
Jang SH, Park KA, Ahn SH, et al: Transcallosal fibers from corticospinal tract in patients with cerebral infarct. NeuroRehabilitation 2009;24:159–164.
40.
Lee SK, Kim DI, Kim J, et al: Diffusion-tensor MR imaging and fiber tractography: a new method of describing aberrant fiber connections in developmental CNS anomalies. Radiographics 2005;25:53–68.
41.
Nieuwenhuys R, Voogd J, van Huijzen C: The Human Central Nervous System: A Synopsis and Atlas, ed 4. New York, Springer, 2007, pp 190–210.
42.
Kunimatsu A, Aoki S, Masutani Y, et al: The optimal trackability threshold of fractional anisotropy for diffusion tensor tractography of the corticospinal tract. Magn Reson Med Sci 2004;3:11–17.
43.
Song SK, Sun SW, Ramsbottom MJ, Chang C, Russell J, Cross AH: Dysmyelination revealed through MRI as increased radial (but unchanged axial) diffusion of water. Neuroimage 2002;17:1429–1436.
44.
Arzoumanian Y, Mirmiran M, Barnes PD, et al: Diffusion tensor brain imaging findings at term-equivalent age may predict neurologic abnormalities in low birth weight preterm infants. AJNR Am J Neuroradiol 2003;24:1646–1653.
45.
Hüppi PS, Dubois J: Diffusion tensor imaging of brain development. Semin Fetal Neonatal Med 2006;11:489–497.
46.
Jang SH, Cho SH, Kim YH, et al: Diffusion anisotropy in the early stages of stroke can predict motor outcome. Restor Neurol Neurosci 2005;23:11–17.
47.
Trivedi R, Agarwal S, Shah V, et al: Correlation of quantitative sensorimotor tractography with clinical grade of cerebral palsy. Neuroradiology 2010;52:759–765.
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