Cerebral Blood Flow and DTI metrics changes in children with cerebral palsy following therapy

It is known that patients with chronic hypoxia have regional changes in their cerebral blood flow (CBF). The purpose of this study was to observe the CBF and diffusion tensor imaging (DTI) metrics changes in children with cerebral palsy (CP) at baseline and after 6 months of treatment. Thirty-eight children with cerebral diplegia (mean age = 6.4 yr) and twenty-one age/sex matched controls (mean age = 7.5 yr) were evaluated by the Gross Motor Function Classification System (GMFCS) scoring of motor disability and modified Ashworth scoring of spasticity. All subjects underwent pseudo-continuous arterial spin labeling (PCASL) and DTI, in addition to conventional magnetic resonance imaging (MRI). Significant increase in CBF values was observed in several grey and white matter regions (including areas of abnormal T2 hyperintensity in the periventricular white matter) in CP children as compared to controls based upon voxel-wise analysis. Low fractional anisotropy (FA) and high apparent diffusion coefficient (ADC) values were observed in these areas of high CBF, using a region of interest (ROI) based analysis. On follow-up study, CBF values were found to be significantly higher in two grey matter areas and lower in three white matter regions in comparison to baseline; however no significant changes in DTI indices were observed in these regions. CBF values are high in CP children as compared to controls and show alteration following therapy even when the DTI metrics remain unchanged. Arterial spin labeling (ASL) may be added to the advanced imaging protocol for studying brain plasticity in such children in future.