Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
Clinical Research and Imaging Centre, University of Bristol, Bristol, UK.
Dev Med Child Neurol. 2023 Jun;65(6):792-802. doi: 10.1111/dmcn.15453. Epub 2022 Nov 6.
To evaluate mammillary body abnormalities in school-age children without cerebral palsy treated with therapeutic hypothermia for neonatal hypoxic-ischaemic encephalopathy (cases) and matched controls, and associations with cognitive outcome, hippocampal volume, and diffusivity in the mammillothalamic tract (MTT) and fornix.
Mammillary body abnormalities were scored from T1-weighted magnetic resonance imaging (MRI) in 32 cases and 35 controls (median age [interquartile range] 7 years [6 years 7 months-7 years 7 months] and 7 years 4 months [6 years 7 months-7 years 7 months] respectively). Cognition was assessed using the Wechsler Intelligence Scale for Children, Fourth Edition. Hippocampal volume (normalized by total brain volume) was measured from T1-weighted MRI. Radial diffusivity and fractional anisotropy were measured in the MTT and fornix, from diffusion-weighted MRI using deterministic tractography.
More cases than controls had mammillary body abnormalities (34% vs 0%; p < 0.001). Cases with abnormal mammillary bodies had lower processing speed (p = 0.016) and full-scale IQ (p = 0.028) than cases without abnormal mammillary bodies, and lower scores than controls in all cognitive domains (p < 0.05). Cases with abnormal mammillary bodies had smaller hippocampi (left p = 0.016; right p = 0.004) and increased radial diffusivity in the right MTT (p = 0.004) compared with cases without mammillary body abnormalities.
Cooled children with mammillary body abnormalities at school-age have reduced cognitive scores, smaller hippocampi, and altered MTT microstructure compared with those without mammillary body abnormalities, and matched controls.
Cooled children are at higher risk of mammillary body abnormalities than controls. Abnormal mammillary bodies are associated with reduced cognitive scores and smaller hippocampi. Abnormal mammillary bodies are associated with altered mammillothalamic tract diffusivity.
评估接受治疗性低温治疗的新生儿缺氧缺血性脑病（病例组）和匹配对照的学龄期无脑性瘫痪儿童的乳状体异常，并与认知结局、海马体积以及乳状体丘脑束（MTT）和穹窿的弥散相关。
从 32 例病例和 35 例对照（中位数年龄[四分位间距]分别为 7 岁[6 岁 7 个月-7 岁 7 个月]和 7 岁 4 个月[6 岁 7 个月-7 岁 7 个月]）的 T1 加权磁共振成像（MRI）中对乳状体异常进行评分。使用韦氏儿童智力量表第四版评估认知。从 T1 加权 MRI 测量海马体积（按总脑体积归一化）。使用基于确定性追踪的扩散加权 MRI 测量 MTT 和穹窿的径向弥散和各向异性分数。
病例组比对照组更常见乳状体异常（34% vs 0%；p<0.001）。有异常乳状体的病例在处理速度（p=0.016）和全量表智商（p=0.028）方面低于无异常乳状体的病例，在所有认知领域的得分也低于对照组（p<0.05）。与无乳状体异常的病例相比，有异常乳状体的病例的海马体较小（左侧 p=0.016；右侧 p=0.004），右侧 MTT 的径向弥散增加（p=0.004）。
在学龄期，有异常乳状体的冷却儿童与无异常乳状体的病例相比，认知评分较低，海马体较小，MTT 微观结构改变，且与匹配的对照组相比也是如此。
与对照组相比，冷却的儿童更有可能出现乳状体异常。异常的乳状体与认知评分降低和海马体较小有关。异常的乳状体与乳状体丘脑束的弥散改变有关。
