Assessment of myelination progression in subcortical white matter of children aged 6–48 months using T2-weighted imaging
This study aims to provide a screening scoring method by assessing the age-related change of subcortical white matter (WM) myelination via T2-weighted imaging (T2WI).
This study retrospectively recruited 109 children aged 6–48 months without abnormalities on MRI. Based on Parazzini’s study, we developed a modified T2WI-based method to assess subcortical WM myelination (frontal, temporal, parietal, occipital lobes, and insula) by scoring WM’s signal changes. Inter- and intra-observer agreements were evaluated by Bland-Altman plot. Age-related changes of myelination score were explored by locally weighted scatterplot smoothing (LOESS), linear regression, and Spearman correlation coefficients (r). Relationships between diffusion tensor imaging (DTI) metrics and total myelination score were investigated to further validate practicability of the scoring method by tract-based spatial statistics (TBSS).
This method showed good intra-observer (mean difference = 0.18, SD = 0.95) and inter-observer agreements (mean difference = − 0.06, SD = 1.01). The LOESS and linear regression results indicated that myelination proceeded in two phases: a period of rapid growth (6–20 months; slope = 0.561) and one of slower growth (21–48 months; slope = 0.097). Significant correlations between myelination score and age were observed in whole subcortical WM (r = 0.945; P < 0.001) and all regional subcortical WM (r_mean = 0.819, range, 0.664–0.928; P < 0.001). TBSS found significant correlations of WM-DTI metrics with myelination score during the range of 6–20 months, while no significant correlation was observed in 21–48 months.
The modified T2WI-based screening scoring method is easily feasible to assess myelination progression of subcortical WM, especially suitable for children aged 6–20 months. It may show potential in identifying individual developmental abnormalities by scoring assessment in the future clinical practice.
KeywordsChildren Subcortical white matter Myelination T2WI DTI
Diffusion tensor imaging
Functional MRI of the brain
FMRIB software library
Fast spin echo
Fluid-attenuated inversion recovery
Field of view
Locally weighted scatterplot smoothing model
Susceptibility weighted imaging
Tract-based spatial statistics
Compliance with ethical standards
This study was funded by the National Key Research and Development Program of China (2016YFC0100300), the National Natural Science Foundation of China (Nos. 81171317, 81471631, 81771810 and 51706178), the 2011 New Century Excellent Talent Support Plan of the Ministry of Education, China (NCET-11-0438), the China Postdoctoral Science Foundation (No. 2017M613145), the Shaanxi Provincial Natural Science Foundation for Youths of China (No. 2017JQ8005) and the Clinical Research Award of the First Affiliated Hospital of Xi’an Jiaotong University (No. XJTU1AF-CRF-2015-004).
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
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