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DR.DUONG
What is myelin ?
 Myelin is an electrically insulating phospholipid
layer that surrounds the axons of many neurons.
 Myelin is produced by specialized cells:
Oligodendrocytes in the central nervous system
Schwann cells in the peripheral nervous system.
Stafff
Composition of myelin
 Myelin is composed of about 80% lipid fat
and about 20% protein.
Myelinisation
 Myelin sheaths wrap themselves around
axons.
 Each oligodendrocyte can myelinate several
axons (up to 40), so the destruction of even only
a few oligodendrocytes can have an extensive
demyelination effect.
Function of myelin layer
 The main consequence of a myelin layer is an
increase in the speed at which impulses
propagate along the myelinated fiber.
 Myelination also helps prevent the electrical
current from leaving the axon.
Axons with normal myelin Demyelinated axons: Nerve
impulse conduction slows or
stops completely
Normal Myelination pattern of the
pediatric brain
 Myelination causes changes in the signal
intensity of the brain.
 Myelination starts during the 5th fetal month with
myelination of the cranial nerves and continues
throughout life.
 Myelination progress is from:
caudal to cephalad
dorsal to ventral
central to periphery.
•Starts in the 2nd trimester and continous into adulthood
•Evolves in predictable sequential fashion over the first 2 postnatal years
•Functional significance and psychomotor development of brain
•Beginning with PNS > Spinal cord > Brain stem > Supratentorial brain
Brainstem first > Cerebellum > Internal capsule > Basal ganglia > Corpus
callosum > Cerebral hemispheres
Optic tract in occipital lobe 1st > parietal + frontal
MR imaging is the most sensitive
Stafff
Imaging approaches
MR is the only imaging technique that assesses
myelination.
 T1WI show myelination as increasing
hyperintensity.
 T2WI show myelination as increasing
hypointensity.
 Diffusion imaging shows myelnation as
decreasing diffusivity.
Assessment of myelination
Many ways to assess myelination by MR
 Qualitative method: Assess milestones
when changes of myelination appear on
T1,T2 weighted images.
 Quantitative methods: Assess changes
in diffusivity,FA,MT and compare with
values of age-matched patients.
Basic principles of myelination
on MRI
 Myelinated WM appears hyper intense on
T1W and hypointense on T2W images.
 Unmyelinated white matter appears
hypointense on T1W and hyper intense on
T2W images.
 Increase in signal intensity on T1W images
precede the decrease in signal intensity on
T2W images.
 T1WI:
Most sensitive in children less than 1 year of age 1
Hyper-intense
 T2WI:
Most sensitive in children between the age of 1 and 2
Gradual shift from hyper- to hypo-intense ralative to GM
 Because T2 of the immature brain have relatively poor
grey/white matter distinction due to high water content of
the unmyelinated matter.
FLAIR:
Follows the same pattern as T2 but somewhat lags behind
PD WI
Useful in distinguishing gliosis from
DWI:
In acute setting more sensitive than T1 or T2
MR Spectroscopy
Increased Myo-Inostol and Choline in neonates
NAA increased with myelination (1st yr)
Normal Myelination
Birth (full term)
 Brainstem
 Cerebellum
 Posterior limb of internal capsule
Stafff
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One month
 Deep
cerebellar
white matter
 Corticospinal
tracts
 Pre/
postcentral gyri
 Optic nerves,
tracts
3 Months
 Brachium pontis, cerebellar follia
 Ventral brainstem
 Optic radiations
 Anterior limb of internal capsule
 Occipital subcortical U fibres
 Corpus callosum splenium
Stafff
Stafff
6 Months
 Corpus callosum genu
 Paracentral subcortical U fibres
 Centrum semiovale (partial)
Stafff
8 Months
 Centrum
semiovale
(complete except
for some fronto
temporal areas)
 Subcortical U
fibres (complete
except for most
rostral frontal
areas)
Stafff
12 Months
 Peripheral
extension into the
subcortical WM
begins at about 1
year and is
essentially
complete by 22-24
months except in
the “terminal
zones”
18 Months
 Progressive
myelination in
the IC, CC,
forceps minor,
forceps major
and central and
subcortical
white matter
24 Months
Term birth : Brainstem, cerebellum, posterior limb of the IC
1 months : Deep cerebellar WM
3 months : Anterior limb of the IC, splenium of the CC
6 months : Genu of the CC
8 months: Centrum semiovale
12 months: Peripheral extension into the subcortical WM
18-24 months: Like adult
Terminal zones
 These are areas of known slow myelination
within the brain and should not be mistaken
for areas of ischemia.
 They are seen from about age 16 months
until age 10 years.
Terminal zones
 Persistent
signal intensity
in lateral,
superior, and
posterior to the
lateral
ventricles,
particularly in
the region of
trigones.
Perivascular spaces
 Curvilinear
periventricular
areas that are
iso intense to
CSF on all
imaging
sequences.
Anatomic
Region
T1WI T2WI
Superior
cerebellar
peduncle
28 gest wks 27 gest wks
Median
longitudinal
fasciculus
25 gest wks 29 gest wks
Medial lemnisci 27 gest wks 30 gest wks
Lateral lemnisci 26 gest wks 27 gets wks
Myelination Patterns on MRI
High signal Low signal
Anatomic Region: Brain T1 T2
Cerebellar peduncle, middle 0 0-2 months
Cerebral White matter 0-4 months 3-5 months
Posterior limb internal capsule
Anterior Portion
Posterior Portion
1 month
0
4-7 months
0-2 months
Anterior limb internal capsule 2-3 months 7-11 months
Corpus callosum, genu 4-6 months 5-8 months
Corpus callosum, splenium 3-4 months 4-6 months
Occipital white matter
Central
Peripheral
3-5 months
4-7 months
9-14 months
11-15 months
Frontal white matter
Central
Peripheral
3-6 months
7-11 months
11-16 months
14-18 months
Centrum semiovale 2-4 months 7-11 months
Myelination Patterns on MRI
Stafff
Stafff
Stafff
Stafff
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Stafff
Stafff
Stafff

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Stafff

  • 2. What is myelin ?  Myelin is an electrically insulating phospholipid layer that surrounds the axons of many neurons.  Myelin is produced by specialized cells: Oligodendrocytes in the central nervous system Schwann cells in the peripheral nervous system.
  • 4. Composition of myelin  Myelin is composed of about 80% lipid fat and about 20% protein.
  • 5. Myelinisation  Myelin sheaths wrap themselves around axons.  Each oligodendrocyte can myelinate several axons (up to 40), so the destruction of even only a few oligodendrocytes can have an extensive demyelination effect.
  • 6. Function of myelin layer  The main consequence of a myelin layer is an increase in the speed at which impulses propagate along the myelinated fiber.  Myelination also helps prevent the electrical current from leaving the axon.
  • 7. Axons with normal myelin Demyelinated axons: Nerve impulse conduction slows or stops completely
  • 8. Normal Myelination pattern of the pediatric brain  Myelination causes changes in the signal intensity of the brain.  Myelination starts during the 5th fetal month with myelination of the cranial nerves and continues throughout life.  Myelination progress is from: caudal to cephalad dorsal to ventral central to periphery.
  • 9. •Starts in the 2nd trimester and continous into adulthood •Evolves in predictable sequential fashion over the first 2 postnatal years •Functional significance and psychomotor development of brain •Beginning with PNS > Spinal cord > Brain stem > Supratentorial brain Brainstem first > Cerebellum > Internal capsule > Basal ganglia > Corpus callosum > Cerebral hemispheres Optic tract in occipital lobe 1st > parietal + frontal MR imaging is the most sensitive
  • 11. Imaging approaches MR is the only imaging technique that assesses myelination.  T1WI show myelination as increasing hyperintensity.  T2WI show myelination as increasing hypointensity.  Diffusion imaging shows myelnation as decreasing diffusivity.
  • 12. Assessment of myelination Many ways to assess myelination by MR  Qualitative method: Assess milestones when changes of myelination appear on T1,T2 weighted images.  Quantitative methods: Assess changes in diffusivity,FA,MT and compare with values of age-matched patients.
  • 13. Basic principles of myelination on MRI  Myelinated WM appears hyper intense on T1W and hypointense on T2W images.  Unmyelinated white matter appears hypointense on T1W and hyper intense on T2W images.  Increase in signal intensity on T1W images precede the decrease in signal intensity on T2W images.
  • 14.  T1WI: Most sensitive in children less than 1 year of age 1 Hyper-intense  T2WI: Most sensitive in children between the age of 1 and 2 Gradual shift from hyper- to hypo-intense ralative to GM  Because T2 of the immature brain have relatively poor grey/white matter distinction due to high water content of the unmyelinated matter.
  • 15. FLAIR: Follows the same pattern as T2 but somewhat lags behind PD WI Useful in distinguishing gliosis from DWI: In acute setting more sensitive than T1 or T2 MR Spectroscopy Increased Myo-Inostol and Choline in neonates NAA increased with myelination (1st yr)
  • 16. Normal Myelination Birth (full term)  Brainstem  Cerebellum  Posterior limb of internal capsule
  • 20. One month  Deep cerebellar white matter  Corticospinal tracts  Pre/ postcentral gyri  Optic nerves, tracts
  • 21. 3 Months  Brachium pontis, cerebellar follia  Ventral brainstem  Optic radiations  Anterior limb of internal capsule  Occipital subcortical U fibres  Corpus callosum splenium
  • 24. 6 Months  Corpus callosum genu  Paracentral subcortical U fibres  Centrum semiovale (partial)
  • 26. 8 Months  Centrum semiovale (complete except for some fronto temporal areas)  Subcortical U fibres (complete except for most rostral frontal areas)
  • 28. 12 Months  Peripheral extension into the subcortical WM begins at about 1 year and is essentially complete by 22-24 months except in the “terminal zones”
  • 29. 18 Months  Progressive myelination in the IC, CC, forceps minor, forceps major and central and subcortical white matter
  • 31. Term birth : Brainstem, cerebellum, posterior limb of the IC 1 months : Deep cerebellar WM 3 months : Anterior limb of the IC, splenium of the CC 6 months : Genu of the CC 8 months: Centrum semiovale 12 months: Peripheral extension into the subcortical WM 18-24 months: Like adult
  • 32. Terminal zones  These are areas of known slow myelination within the brain and should not be mistaken for areas of ischemia.  They are seen from about age 16 months until age 10 years.
  • 33. Terminal zones  Persistent signal intensity in lateral, superior, and posterior to the lateral ventricles, particularly in the region of trigones.
  • 34. Perivascular spaces  Curvilinear periventricular areas that are iso intense to CSF on all imaging sequences.
  • 35. Anatomic Region T1WI T2WI Superior cerebellar peduncle 28 gest wks 27 gest wks Median longitudinal fasciculus 25 gest wks 29 gest wks Medial lemnisci 27 gest wks 30 gest wks Lateral lemnisci 26 gest wks 27 gets wks Myelination Patterns on MRI
  • 36. High signal Low signal Anatomic Region: Brain T1 T2 Cerebellar peduncle, middle 0 0-2 months Cerebral White matter 0-4 months 3-5 months Posterior limb internal capsule Anterior Portion Posterior Portion 1 month 0 4-7 months 0-2 months Anterior limb internal capsule 2-3 months 7-11 months Corpus callosum, genu 4-6 months 5-8 months Corpus callosum, splenium 3-4 months 4-6 months Occipital white matter Central Peripheral 3-5 months 4-7 months 9-14 months 11-15 months Frontal white matter Central Peripheral 3-6 months 7-11 months 11-16 months 14-18 months Centrum semiovale 2-4 months 7-11 months Myelination Patterns on MRI