Assessment of Normal Myelination with Magnetic Resonance Imaging

 

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Abstract

White matter myelination is essential to postnatal neurologic maturation and can be accurately evaluated by magnetic resonance imaging (MRI). Accordingly, MRI pulse sequences should be optimized for detection of myelin in young children. T1-weighted images are most useful during the first year of life. These demonstrate myelin-related white matter hyperintensity consequent to increasing cholesterol and galactocerebroside within myelin membranes. T2-weighted images are most useful in later stages of myelination, during which time elaboration of myelin leads to reduction in brain water content with associated T2 hypointensity. Additional information regarding the status of myelination can be obtained from T2-weighted fluid attenuation inversion recovery (FLAIR) and diffusion tensor imaging (DTI) pulse sequences. Clinically useful milestones for assessment of myelination across all these MRI pulse sequences are available as guidelines to image interpretation. Evaluation of myelination status using a combination of T1- and T2-weighted images should be routine in the interpretation of all pediatric brain MRI exams.

• References

• 1 Brant-Zawadzki M, Enzmann DR. Using computed tomography of the brain to correlate low white-matter attenuation with early gestational age in neonates. Radiology 1981; 139 (1) 105-108
  PubMedGoogle Scholar
• 2 Holland BA, Haas DK, Norman D, Brant-Zawadzki M, Newton TH. MRI of normal brain maturation. AJNR Am J Neuroradiol 1986; 7 (2) 201-208
  PubMedGoogle Scholar
• 3 Hess CP, Barkovich AJ. Techniques and methods in pediatric neuroimaging. In: Barkovich AJ, Raybaud C, , eds. Pediatric Neuroimaging. 5th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2011: 1-19
  Google Scholar
• 4 Shaw DW, Weinberger E, Astley SJ, Tsuruda JS. Quantitative comparison of conventional spin echo and fast spin echo during brain myelination. J Comput Assist Tomogr 1997; 21 (6) 867-871
  CrossrefPubMedGoogle Scholar
• 5 Kizildağ B, Düşünceli E, Fitoz S, Erden I. The role of classic spin echo and FLAIR sequences for the evaluation of myelination in MR imaging. Diagn Interv Radiol 2005; 11 (3) 130-136
  PubMedGoogle Scholar
• 6 Ruggieri PM. Metabolic and neurodegenerative disorders and disorders with abnormal myelination. In: Ball WS, , ed. Pediatric Neuroradiology. Philadelphia: Lippincott-Raven; 1997: 175-237
  Google Scholar
• 7 Barkovich AJ, Mukherjee P. Normal development of the neonatal and infant brain, skull, and spine. In: Barkovich AJ, Raybaud C, , eds. Pediatric Neuroimaging. 5th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2011: 20-80
  Google Scholar
• 8 Ashikaga R, Araki Y, Ono Y, Nishimura Y, Ishida O. Appearance of normal brain maturation on fluid-attenuated inversion-recovery (FLAIR) MR images. AJNR Am J Neuroradiol 1999; 20 (3) 427-431
  PubMedGoogle Scholar
• 9 Murakami JW, Weinberger E, Shaw DWW. Normal myelination of the pediatric brain imaged with fluid-attenuated inversion-recovery (FLAIR) MR imaging. AJNR Am J Neuroradiol 1999; 20 (8) 1406-1411
  PubMedGoogle Scholar
• 10 Jellison BJ, Field AS, Medow J, Lazar M, Salamat MS, Alexander AL. Diffusion tensor imaging of cerebral white matter: a pictorial review of physics, fiber tract anatomy, and tumor imaging patterns. AJNR Am J Neuroradiol 2004; 25 (3) 356-369
  PubMedGoogle Scholar
• 11 McGraw P, Liang L, Provenzale JM. Evaluation of normal age-related changes in anisotropy during infancy and childhood as shown by diffusion tensor imaging. AJR Am J Roentgenol 2002; 179 (6) 1515-1522
  CrossrefPubMedGoogle Scholar
• 12 Mukherjee P, Miller JH, Shimony JS , et al. Diffusion-tensor MR imaging of gray and white matter development during normal human brain maturation. AJNR Am J Neuroradiol 2002; 23 (9) 1445-1456
  PubMedGoogle Scholar
• 13 Hermoye L, Saint-Martin C, Cosnard G , et al. Pediatric diffusion tensor imaging: normal database and observation of the white matter maturation in early childhood. Neuroimage 2006; 29 (2) 493-504
  CrossrefPubMedGoogle Scholar
• 14 van Buchem MA, Steens SCA, Vrooman HA , et al. Global estimation of myelination in the developing brain on the basis of magnetization transfer imaging: a preliminary study. AJNR Am J Neuroradiol 2001; 22 (4) 762-766
  PubMedGoogle Scholar
• 15 Rademacher J, Engelbrecht V, Bürgel U, Freund H, Zilles K. Measuring in vivo myelination of human white matter fiber tracts with magnetization transfer MR. Neuroimage 1999; 9 (4) 393-406
  CrossrefPubMedGoogle Scholar
• 16 Ding X-Q, Kucinski T, Wittkugel O , et al. Normal brain maturation characterized with age-related T2 relaxation times: an attempt to develop a quantitative imaging measure for clinical use. Invest Radiol 2004; 39 (12) 740-746
  CrossrefPubMedGoogle Scholar
• 17 Hagmann P, Sporns O, Madan N , et al. White matter maturation reshapes structural connectivity in the late developing human brain. Proc Natl Acad Sci U S A 2010; 107 (44) 19067-19072
  CrossrefPubMedGoogle Scholar
• 18 Deoni SC, Mercure E, Blasi A , et al. Mapping infant brain myelination with magnetic resonance imaging. J Neurosci 2011; 31 (2) 784-791
  CrossrefPubMedGoogle Scholar
• 19 Koenig SH, Brown III RD, Spiller M, Lundbom N. Relaxometry of brain: why white matter appears bright in MRI. Magn Reson Med 1990; 14 (3) 482-495
  CrossrefPubMedGoogle Scholar
• 20 Kucharczyk W, Macdonald PM, Stanisz GJ, Henkelman RM. Relaxivity and magnetization transfer of white matter lipids at MR imaging: importance of cerebrosides and pH. Radiology 1994; 192 (2) 521-529
  PubMedGoogle Scholar
• 21 Barkovich AJ. Concepts of myelin and myelination in neuroradiology. AJNR Am J Neuroradiol 2000; 21 (6) 1099-1109
  PubMedGoogle Scholar
• 22 Dietrich RB, Bradley WG, Zaragoza IV EJ , et al. MR evaluation of early myelination patterns in normal and developmentally delayed infants. AJR Am J Roentgenol 1988; 150 (4) 889-896
  CrossrefPubMedGoogle Scholar
• 23 Barkovich AJ, Lyon G, Evrard P. Formation, maturation, and disorders of white matter. AJNR Am J Neuroradiol 1992; 13 (2) 447-461
  PubMedGoogle Scholar
• 24 Svennerholm L, Vanier MT. Lipid and fatty acid composition of human cerebral myelin during development. Adv Exp Med Biol 1978; 100: 27-41
  PubMedGoogle Scholar
• 25 Barkovich AJ, Kjos BO, Jackson Jr DE, Norman D. Normal maturation of the neonatal and infant brain: MR imaging at 1.5 T. Radiology 1988; 166 (1 Pt 1) 173-180
  PubMedGoogle Scholar
• 26 Martin E, Kikinis R, Zuerrer M , et al. Developmental stages of human brain: an MR study. J Comput Assist Tomogr 1988; 12 (6) 917-922
  CrossrefPubMedGoogle Scholar
• 27 Girard N, Raybaud C, du Lac P. MRI study of brain myelination. J Neuroradiol 1991; 18 (4) 291-307
  PubMedGoogle Scholar
• 28 Hüppi PS, Dubois J. Diffusion tensor imaging of brain development. Semin Fetal Neonatal Med 2006; 11 (6) 489-497
  CrossrefPubMedGoogle Scholar
• 29 Wimberger DM, Roberts TP, Barkovich AJ, Prayer LM, Moseley ME, Kucharczyk J. Identification of “premyelination” by diffusion-weighted MRI. J Comput Assist Tomogr 1995; 19 (1) 28-33
  CrossrefPubMedGoogle Scholar
• 30 Mukherjee P, Miller JH, Shimony JS , et al. Normal brain maturation during childhood: developmental trends characterized with diffusion-tensor MR imaging. Radiology 2001; 221 (2) 349-358
  CrossrefPubMedGoogle Scholar
• 31 van der Knaap MS, Valk J, Bakker CJ , et al. Myelination as an expression of the functional maturity of the brain. Dev Med Child Neurol 1991; 33 (10) 849-857
  PubMedGoogle Scholar
• 32 Pujol J, Soriano-Mas C, Ortiz H, Sebastián-Gallés N, Losilla JM, Deus J. Myelination of language-related areas in the developing brain. Neurology 2006; 66 (3) 339-343
  CrossrefPubMedGoogle Scholar
• 33 Brody BA, Kinney HC, Kloman AS, Gilles FH. Sequence of central nervous system myelination in human infancy. I. An autopsy study of myelination. J Neuropathol Exp Neurol 1987; 46 (3) 283-301
  CrossrefPubMedGoogle Scholar
• 34 Kinney HC, Brody BA, Kloman AS, Gilles FH. Sequence of central nervous system myelination in human infancy. II. Patterns of myelination in autopsied infants. J Neuropathol Exp Neurol 1988; 47 (3) 217-234
  CrossrefPubMedGoogle Scholar
• 35 van der Knaap MS, Valk J, Barkhof F. Magnetic resonance of myelination and myelin disorders. 3rd ed. Berlin, New York: Springer; 2005: 12
  Google Scholar
• 36 Girard N, Gouny SC, Viola A , et al. Assessment of normal fetal brain maturation in utero by proton magnetic resonance spectroscopy. Magn Reson Med 2006; 56 (4) 768-775
  CrossrefPubMedGoogle Scholar
• 37 Girard N, Confort-Gouny S, Schneider J , et al. MR imaging of brain maturation. J Neuroradiol 2007; 34 (5) 290-310
  CrossrefPubMedGoogle Scholar
• 38 Parazzini C, Baldoli C, Scotti G, Triulzi F. Terminal zones of myelination: MR evaluation of children aged 20-40 months. AJNR Am J Neuroradiol 2002; 23 (10) 1669-1673
  PubMedGoogle Scholar
• 39 Baker LL, Stevenson DK, Enzmann DR. End-stage periventricular leukomalacia: MR evaluation. Radiology 1988; 168 (3) 809-815
  CrossrefPubMedGoogle Scholar
• 40 Skranes JS, Nilsen G, Smevik O, Vik T, Rinck P, Brubakk AM. Cerebral magnetic resonance imaging (MRI) of very low birth weight infants at one year of corrected age. Pediatr Radiol 1992; 22 (6) 406-409
  CrossrefPubMedGoogle Scholar
• 41 Valk J, van der Knaap MS. Magnetic resonance of myelin, myelination, and myelin disorders. Berlin, New York: Springer-Verlag; 1989: 34
  Google Scholar
• 42 Counsell SJ, Maalouf EF, Fletcher AM , et al. MR imaging assessment of myelination in the very preterm brain. AJNR Am J Neuroradiol 2002; 23 (5) 872-881
  PubMedGoogle Scholar
• 43 Girard N, Raybaud C, Poncet M. In vivo MR study of brain maturation in normal fetuses. AJNR Am J Neuroradiol 1995; 16 (2) 407-413
  PubMedGoogle Scholar