Evaluation of subcortical white matter and deep white matter tracts in malformations of cortical development

Aims: Abnormal cortical development will lead to abnormal axons in white matter. The purpose was to investigate (1) the microstructural changes in subcortical white matter adjacent to malformations of cortical development (MCD) and (2) the deep white matter tracts using diffusion tensor imaging (DTI). Methods: Thirteen children with a variety of MCD were recruited. The fractional anisotropy (FA), trace, and eigenvalues (λmajor, λmedium, λminor) of subcortical white matter of MCD were compared with contralateral normal side. The deep white matter tracts were graded based on the size, color hues and displacement of the tracts as visualized on color vector maps and tractography; grade 1 was normal tract size and color hue, grade 2 was reduced tract size but preserved color hue and grade 3 was loss of color hue or failure of tracking on tractography. Results: The subcortical white matter adjacent to abnormal cortex demonstrated reduced FA (p < 0.05) and tendency to increase trace (p = 0.06). There was a significant elevation in λmedium and λminor (p < 0.05), but no significant change in λmajor (p > 0.05). Twelve cases demonstrated alteration in white matter tracts. Seven cases of focal cortical dysplasia and two cases of transmantle MCD demonstrated grade 3 pattern of white matter tract. Conclusion: Reduced FA is a sensitive but nonspecific marker of alteration in microstructure of white matter. The elevated λmedium and λminor may reflect a dominant effect of abnormal myelin. Alteration in white matter tracts was observed in most cases of MCD.