Validity of semi-quantitative scale for brain MRI in unilateral cerebral palsy due to periventricular white matter lesions: Relationship with hand sensorimotor function and structural connectivity

Neuroimage Clin. 2015 Apr 9;8:104-9. doi: 10.1016/j.nicl.2015.04.005. eCollection 2015.


Aim: To provide first evidence of construct validity of a semi-quantitative scale for brain structural MRI (sqMRI scale) in children with unilateral cerebral palsy (UCP) secondary to periventricular white matter (PWM) lesions, by examining the relationship with hand sensorimotor function and whole brain structural connectivity.

Methods: Cross-sectional study of 50 children with UCP due to PWM lesions using 3 T (MRI), diffusion MRI and assessment of hand sensorimotor function. We explored the relationship of lobar, hemispheric and global scores on the sqMRI scale, with fractional anisotropy (FA), as a measure of brain white matter microstructure, and with hand sensorimotor measures (Assisting Hand Assessment, AHA; Jebsen-Taylor Test for Hand Function, JTTHF; Melbourne Assessment of Unilateral Upper Limb Function, MUUL; stereognosis; 2-point discrimination).

Results: Lobar and hemispheric scores on the sqMRI scale contralateral to the clinical side of hemiplegia correlated with sensorimotor paretic hand function measures and FA of a number of brain structural connections, including connections of brain areas involved in motor control (postcentral, precentral and paracentral gyri in the parietal lobe). More severe lesions correlated with lower sensorimotor performance, with the posterior limb of internal capsule score being the strongest contributor to impaired hand function.

Conclusion: The sqMRI scale demonstrates first evidence of construct validity against impaired motor and sensory function measures and brain structural connectivity in a cohort of children with UCP due to PWM lesions. More severe lesions correlated with poorer paretic hand sensorimotor function and impaired structural connectivity in the hemisphere contralateral to the clinical side of hemiplegia. The quantitative structural MRI scoring may be a useful clinical tool for studying brain structure-function relationships but requires further validation in other populations of CP.

Keywords: AHA, Assisting Hand Assessment; Brain structure; CP, cerebral palsy; Diffusion; FA, fractional anisotropy; GMFCS, Gross Motor Function Classification System; HARDI; JTTHF, Jebsen–Taylor test of hand function; MACS, Manual Ability Classification System; MRI, magnetic resonance imaging; MUUL, Melbourne Assessment of Unilateral Upper Limb function; Magnetic resonance imaging; PWM, periventricular white matter; Sensorimotor function; Unilateral cerebral palsy; sqMRI, semi-quantitative MRI.

MeSH terms

  • Adolescent
  • Cerebral Palsy / etiology
  • Cerebral Palsy / pathology*
  • Child
  • Cohort Studies
  • Connectome*
  • Diffusion Magnetic Resonance Imaging
  • Female
  • Hand / physiopathology*
  • Hemiplegia / etiology
  • Hemiplegia / physiopathology*
  • Humans
  • Leukomalacia, Periventricular / complications
  • Leukomalacia, Periventricular / pathology*
  • Male
  • Psychomotor Performance / physiology*
  • Severity of Illness Index*