Systematic review of diffusion tensor imaging in spina bifida myelomeningocele: clinical implications in the era of prenatal repair.

OBJECTIVE

Spina bifida myelomeningocele (SBM) is a neural tube defect associated with altered brain development and impaired cognitive function. Structural brain abnormalities in SBM are well documented but less is known about potential white matter abnormalities. Diffusion tensor imaging (DTI) is a unique MRI technique able to evaluate the integrity of brain microstructure. The primary objectives of this systematic review were to describe the utility of MRI/DTI and discuss the neuroanatomical and neuropsychological effects of affected tracts, as well as the potential clinical implications in SBM care.

METHODS

A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The inclusion criteria required that the studies 1) included patients with SBM who had undergone pre- or postnatal repair, and 2) reported DTI metrics for the brain in postnatal imaging studies.

RESULTS

Nineteen articles met the designated eligibility criteria. Abnormal microstructural anomalies were detected in the corpus callosum (n = 8), limbic fiber tracts (n = 4), tectocortical pathways (n = 4), and caudate putamen tract (n = 3). Disruptions were also noted in the middle cerebellar peduncle (n = 2), interhemispheric temporal tracts (n = 2), internal capsule (n = 2), inferior longitudinal fasciculus (n = 2), arcuate fasciculus (n = 1), inferior fronto-occipital fasciculus (n = 1), uncinate fasciculus (n = 1), and thalamotemporal tract (n = 1).

CONCLUSIONS

SBM is associated with white matter brain abnormalities that have the potential to impact cognitive functioning (e.g., self-management skills) and related clinician recommendations. The detection of white matter microstructural injury in SBM may be useful to improve point-of-care recommendations and family education. Systematic review registration no.: CRD420251252084 (PROSPERO).