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Multiparametric cerebellar imaging and clinical phenotype in childhood ataxia telangiectasia

Dineen, Rob A.; Raschke, Felix; McGlashan, Hannah L.; Pszczolkowski, Stefan; Hack, Lorna; Cooper, Andrew D.; Prasad, Manish; Chow, Gabriel; Whitehouse, William P.; Auer, Dorothee P.

Authors

Felix Raschke

Hannah L. McGlashan

Lorna Hack

Andrew D. Cooper

Manish Prasad

Gabriel Chow



Abstract

Background
Ataxia Telangiectasia (A-T) is an inherited multisystem disorder with cerebellar neurodegeneration. The relationships between imaging metrics of cerebellar health and neurological function across childhood in A-T are unknown, but may be important for determining timing and impact of therapeutic interventions.

Purpose
To test the hypothesis that abnormalities of cerebellar structure, physiology and cellular health occur in childhood A-T and correlate with neurological disability, we performed multiparametric cerebellar MRI and establish associations with disease status in childhood A-T.

Methods
Prospective cross-sectional observational study. 22 young people (9 females / 13 males, age 6.6-17.8 years) with A-T and 24 matched healthy controls underwent 3-Tesla MRI with volumetric, diffusion and proton spectroscopic acquisitions. Participants with A-T underwent structured neurological assessment, and expression / activity of ataxia-telangiectasia mutated (ATM) kinase were recorded.

Results
Ataxia-telangiectasia participants had cerebellar volume loss (fractional total cerebellar volume: 5.3% vs 8.7%, P less than 0.0005, fractional 4th ventricular volumes: 0.19% vs 0.13%, P less than 0.0005), that progressed with age (fractional cerebellar volumes, r=-0.66, P=0.001), different from the control group (t=-4.88, P less than 0.0005). The relationship between cerebellar volume and age was similar for A-T participants with absent ATM kinase production and those producing non-functioning ATM kinase. Markers of cerebellar white matter injury were elevated in ataxia-telangiectasia vs controls (apparent diffusion coefficient: 0.89×10−3mm2s−1 vs 0.69×10−3mm2s−1, p less than 0.0005) and correlated (age-corrected) with neurometabolite ratios indicating impaired neuronal viability (N-acetylaspartate:creatine r=-0.70, P less than 0.001); gliosis (inositol:creatine r=0.50, P=0.018; combined glutamine/glutamate:creatine r=-0.55, P=0.008) and increased myelin turnover (choline:creatine r=0.68, P less than 0.001). Fractional 4th ventricular volume was the only variable retained in the regression model predicting neurological function (adjusted r2=0.29, P=0.015).

Conclusions
Quantitative MRI demonstrates cerebellar abnormalities in children with A-T, providing non-invasive measures of progressive cerebellar injury and markers reflecting neurological status. These MRI metrics may be of value in determining timing and impact of interventions aimed at altering the natural history of A-T.

Citation

Dineen, R. A., Raschke, F., McGlashan, H. L., Pszczolkowski, S., Hack, L., Cooper, A. D., …Auer, D. P. (2020). Multiparametric cerebellar imaging and clinical phenotype in childhood ataxia telangiectasia. NeuroImage: Clinical, 25, https://doi.org/10.1016/j.nicl.2019.102110

Journal Article Type Article
Acceptance Date Nov 25, 2019
Online Publication Date Nov 26, 2019
Publication Date 2020
Deposit Date Dec 10, 2019
Publicly Available Date Dec 10, 2019
Journal NeuroImage: Clinical
Electronic ISSN 2213-1582
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 25
Article Number 102110
DOI https://doi.org/10.1016/j.nicl.2019.102110
Keywords Ataxia Telangiectasia; Magnetic resonance imaging; Magnetic resonance spectroscopy; Diffusion weighted imaging; Cerebellum
Public URL https://nottingham-repository.worktribe.com/output/3523894
Publisher URL https://www.sciencedirect.com/science/article/pii/S2213158219304577?via%3Dihub

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