Four-year longitudinal performance of a population-based sample of healthy children on a neuropsychological battery: the NIH MRI study of normal brain development.

The National Institutes of Health (NIH) Magnetic Resonance Imaging (MRI) Study of Normal Brain Development is a landmark study in which structural and metabolic brain development and behavior are followed longitudinally from birth to young adulthood in a population-based sample of healthy children. Cross-sectional findings from the neuropsychological test battery have been previously described (Waber et al., 2007). The present report details 4-year longitudinal neuropsychological outcomes for those children who were aged 6 to 18 years at baseline (N = 383), of whom 219 (57.2%) completed all 3 visits. Primary observations were (1) individual children displayed considerable variation in scores across visits on the same measures; (2) income-related differences were more prominent in the longitudinal than in the cross-sectional data; (3) no association between cognitive and behavioral measures and body mass index; and (4) several measures showed practice effects, despite the 2-year interval between visits. These data offer an unparalleled opportunity to observe normative performance and change over time on a set of standard and commonly used neuropsychological measures in a population-based sample of healthy children. They thus provide important background for the use and interpretation of these instruments in both research settings and clinical practice.

Neurodevelopmental MRI brain templates for children from 2 weeks to 4 years of age.

Spatial normalization and segmentation of pediatric brain magnetic resonance images (MRI) data with adult templates may impose biases and limitations in pediatric neuroimaging work. To remedy this issue, we created a single database made up of a series of pediatric, age-specific MRI average brain templates. These average, age-specific templates were constructed from brain scans of individual children obtained from two sources: (1) the NIH MRI Study of Normal Brain Development and (2) MRIs from University of South Carolina's McCausland Brain Imaging Center. Participants included young children enrolled at ages ranging from 8 days through 4.3 years of age. A total of 13 age group cohorts spanning the developmental progression from birth through 4.3 years of age were used to construct age-specific MRI brain templates (2 weeks, 3, 4.5, 6, 7.5, 9, 12, 15, 18 months, 2, 2.5, 3, 4 years). Widely used processing programs (FSL, SPM, and ANTS) extracted the brain and constructed average templates separately for 1.5T and 3T MRI volumes. The resulting age-specific, average templates showed clear changes in head and brain size across ages and between males and females, as well as changes in regional brain structural characteristics (e.g., myelin development). This average brain template database is available via our website (http://jerlab.psych.sc.edu/neurodevelopmentalmridatabase) for use by other researchers. Use of these age-specific, average pediatric brain templates by the research community will enhance our ability to gain a clearer understanding of the early postnatal development of the human brain in health and in disease.

Unbiased average age-appropriate atlases for pediatric studies.

Spatial normalization, registration, and segmentation techniques for Magnetic Resonance Imaging (MRI) often use a target or template volume to facilitate processing, take advantage of prior information, and define a common coordinate system for analysis. In the neuroimaging literature, the MNI305 Talairach-like coordinate system is often used as a standard template. However, when studying pediatric populations, variation from the adult brain makes the MNI305 suboptimal for processing brain images of children. Morphological changes occurring during development render the use of age-appropriate templates desirable to reduce potential errors and minimize bias during processing of pediatric data. This paper presents the methods used to create unbiased, age-appropriate MRI atlas templates for pediatric studies that represent the average anatomy for the age range of 4.5-18.5 years, while maintaining a high level of anatomical detail and contrast. The creation of anatomical T1-weighted, T2-weighted, and proton density-weighted templates for specific developmentally important age-ranges, used data derived from the largest epidemiological, representative (healthy and normal) sample of the U.S. population, where each subject was carefully screened for medical and psychiatric factors and characterized using established neuropsychological and behavioral assessments. Use of these age-specific templates was evaluated by computing average tissue maps for gray matter, white matter, and cerebrospinal fluid for each specific age range, and by conducting an exemplar voxel-wise deformation-based morphometry study using 66 young (4.5-6.9 years) participants to demonstrate the benefits of using the age-appropriate templates. The public availability of these atlases/templates will facilitate analysis of pediatric MRI data and enable comparison of results between studies in a common standardized space specific to pediatric research.

Erythropoietin sustains cognitive function and brain volume after neonatal stroke.

Neonatal stroke leads to mortality and severe morbidity, but there currently is no effective treatment. Erythropoietin (EPO) promotes cytoprotection and neurogenesis in the short term following brain injury; however, long-term cognitive outcomes and optimal dosing regimens have not been clarified. We performed middle cerebral artery occlusion in postnatal day 10 rats, which were treated with either a single dose of EPO (5 U/g, i.p.) immediately upon reperfusion, or 3 doses of EPO (1 U/g, i.p. each) at 0 h, 24 h, and 7 days after injury. At 3 months after injury, rats treated with 3 doses of EPO did not differ from shams in the Morris water maze, and generally performed better than either rats treated with a single dose or vehicle-treated injured rats. These multiple-dose-treated rats also had increases in hemispheric volume and its subregions. These results suggest that additional, later doses of EPO may be required for cell repair, proliferation, and long-term incorporation into neural networks after neonatal brain injury.

Age-specific MRI templates for pediatric neuroimaging.

This study created a database of pediatric age-specific magnetic resonance imaging (MRI) brain templates for normalization and segmentation. Participants included children from 4.5 through 19.5 years, totaling 823 scans from 494 subjects. Open-source processing programs (FMRIB Software Library, Statistical Parametric Mapping, Advanced Normalization Tools [ANTS]) constructed head, brain, and segmentation templates in 6-month intervals. The tissue classification (white matter [WM], gray matter [GM], cerebrospinal fluid) showed changes over age similar to previous reports. A volumetric analysis of age-related changes in WM and GM based on these templates showed expected increase/decrease pattern in GM and an increase in WM over the sampled ages. This database is available for use for neuroimaging studies (http://jerlab.psych.sc.edu/neurodevelopmentalmridatabase).

T(2) relaxometry of normal pediatric brain development.

PURPOSE: To establish normal age-related changes in the magnetic resonance (MR) T(2) relaxation time constants of brain using data collected as part of the National Institutes of Health (NIH) MRI Study of Normal Brain Development. MATERIALS AND METHODS: This multicenter study of normal brain and behavior development provides both longitudinal and cross-sectional data, and has enabled us to investigate T(2) evolution in several brain regions in healthy children within the age range of birth through 4 years 5 months. Due to the multicenter nature of the study and the extended period of data collection, periodically scanned inanimate and human phantoms were used to assess intra- and intersite variability. RESULTS: The main finding of this work, based on over 340 scans, is the identification and parameterization of the monoexponential evolution of T(2) from birth through 4 years 5 months of age in various brain structures. CONCLUSION: The exponentially decaying T(2) behavior is believed to reflect the rapid changes in water content as well as myelination during brain development. The data will become publicly available as part of a normative pediatric MRI and clinical/behavioral database, thereby providing a basis for comparison in studies assessing normal brain development, and studies of deviations due to various neurological, neuropsychiatric, and developmental disorders.

The NIH MRI study of normal brain development: performance of a population based sample of healthy children aged 6 to 18 years on a neuropsychological battery.

The National Institutes of Health (NIH) Magnetic Resonance Imaging (MRI) Study of Normal Brain Development is a landmark study in which structural and metabolic brain development and behavior are followed longitudinally from birth to young adulthood in a population-based sample of healthy children. The neuropsychological assessment protocol for children aged 6 to 18 years is described and normative data are presented for participants in that age range (N = 385). For many measures, raw score performance improved steeply from 6 to 10 years, decelerating during adolescence. Sex differences were documented for Block Design (male advantage), CVLT, Pegboard and Coding (female advantage). Household income predicted IQ and achievement, as well as externalizing problems and social competence, but not the other cognitive or behavioral measures. Performance of this healthy sample was generally better than published norms. This linked imaging-clinical/behavioral database will be an invaluable public resource for researchers for many years to come.

Hippocampal and visuospatial learning defects in mice with a deletion of frizzled 9, a gene in the Williams syndrome deletion interval.

Wnt signaling regulates hippocampal development but little is known about the functions of specific Wnt receptors in this structure. Frizzled 9 is selectively expressed in the hippocampus and is one of about 20 genes typically deleted in Williams syndrome. Since Williams syndrome is associated with severe visuospatial processing defects, we generated a targeted null allele for frizzled 9 to examine its role in hippocampal development. Frizzled 9-null mice had generally normal gross anatomical hippocampal organization but showed large increases in apoptotic cell death in the developing dentate gyrus. This increase in programmed cell death commenced with the onset of dentate gyrus development and persisted into the first postnatal week of life. There was also a perhaps compensatory increase in the number of dividing precursors in the dentate gyrus, which may have been a compensatory response to the increased cell death. These changes in the mutants resulted in a moderate decrease in the number of adult dentate granule cells in null mice and an increase in the number of hilar mossy cells. Heterozygous mice (the same frizzled 9 genotype as Williams syndrome patients) were intermediate between wild type and null mice for all developmental neuronanatomic defects. All mice with a mutant allele had diminished seizure thresholds, and frizzled 9 null mice had severe deficits on tests of visuospatial learning/memory. We conclude that frizzled 9 is a critical determinant of hippocampal development and is very likely to be a contributing factor to the neurodevelopmental and behavioral phenotype of patients with Williams syndrome.

Radial organization of developing preterm human cerebral cortex revealed by non-invasive water diffusion anisotropy MRI.

Cerebral cortical development involves a complex cascade of events which are difficult to visualize in intact, living subjects. In this study, we apply diffusion tensor imaging (DTI) to the evaluation of cortical development in human infants ranging from 26 to 41 weeks gestational age (GA). Apparent diffusion of water in cortex is maximally anisotropic at 26 weeks GA and anisotropy values approach zero by 36 weeks GA. During this period, the major eigenvector of the diffusion tensor in cerebral cortex is oriented radially across the cortical plate, in accord with a predominately radial deployment of its neuronal constituents. Values for the rotationally averaged water diffusion coefficient increase between 26 and 32 weeks GA, then decrease thereafter. These changes in DTI parameters are specific to cerebral cortex and reflect changes in underlying cortical architecture and formation of neuronal connections. Because of its correlation with tissue microstructure and non-invasive nature, DTI offers unique insight into cortical development in preterm human newborns and, potentially, detection of derangements of its basic cytoarchiteture.