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Is the Spatial Distribution of Brain Lesions Associated with Closed-Head Injury Predictive of Subsequent Development of Attention-Deficit/Hyperactivity Disorder? Analysis with Brain-Image Database¹

¹ From the Division of Neuroradiology (E.H.H., V.M., C.D.), the Department of Biostatistics, School of Public Health (E.H.H., A.C.), and the Department of Psychiatry, Bayview Medical Center (J.P.G.), Johns Hopkins Medical Institutions, 600 N Wolfe St, Baltimore, MD 21287-7619; and the Department of Diagnostic Radiology, National Institutes of Health, Bethesda, Md (R.N.B.). From the 1998 RSNA scientific assembly. Received September 22, 1998; revision requested November 24; revision received February 24, 1999; accepted June 8. Supported in part by National Institutes of Health grant R01 AG13743-03 and by an Engines for Innovation grant from Illustra. Address reprint requests to E.H.H. (e-mail: ehh@jhmi.edu).

PURPOSE: To determine whether there is an association between the spatial distribution of lesions detected at magnetic resonance (MR) imaging of the brain in children after closed-head injury and the development of secondary attention-deficit/hyperactivity disorder (ADHD).

MATERIALS AND METHODS: Data obtained from 76 children without prior history of ADHD were analyzed. MR images were obtained 3 months after closed-head injury. After manual delineation of lesions, images were registered to the Talairach coordinate system. For each subject, registered images and secondary ADHD status were integrated into a brain-image database, which contains depiction (visualization) and statistical analysis software. Using this database, we assessed visually the spatial distributions of lesions and performed statistical analysis of image and clinical variables.

RESULTS: Of the 76 children, 15 developed secondary ADHD. Depiction of the data suggested that children who developed secondary ADHD had more lesions in the right putamen than children who did not develop secondary ADHD; this impression was confirmed statistically. After Bonferroni correction, we could not demonstrate significant differences between secondary ADHD status and lesion burdens for the right caudate nucleus or the right globus pallidus.

CONCLUSION: Closed-head injury–induced lesions in the right putamen in children are associated with subsequent development of secondary ADHD. Depiction software is useful in guiding statistical analysis of image data.

Index terms: Attention-deficit/hyperactivity disorder, 10.43 • Brain, injuries, 10.43 • Brain, MR, 10.121412 • Children, central nervous system, 10.43 • Images, analysis, 10.12149 • Images, display, 10.12149

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