# Comprehensive Morphometric MRI Assessment in Children with Breath-Holding Spells: Integration of Automated (Vol2Brain) and Semi-Automated (3D Slicer) Segmentation Methods

## TL;DR

This study finds brain structure differences in children with breath-holding spells, using MRI scans and advanced analysis methods.

## Contribution

The integration of automated and semi-automated segmentation methods provides new insights into brain morphology in children with breath-holding spells.

## Key findings

- Children with BHSs showed reduced amygdala volumes and anterior insula thickness and volume.
- Cortical thickness reductions were observed in bilateral anterior cingulate cortices and right medial frontal cortex.
- Cerebellar subregions like lobule VI and Crus I showed volume reductions in children with BHSs.

## Abstract

This study is among the first to comprehensively evaluate regional brain and cerebellar morphology in children with breath-holding spells (BHSs) by integrating automated (Vol2Brain) and semi-automated (3D Slicer) segmentation methods. Our findings demonstrated significant morphometric differences in the bilateral anterior cingulate cortices, right anterior insular cortex, bilateral amygdalae, right medial frontal cortex, and some cerebellar subregions in children with BHSs. These results suggest that measurable morphometric differences in certain anatomical structures related to the limbic and autonomic systems may be associated with BHSs.

Objectives: To evaluate regional anatomical differences in brain volume, surface area, and cortical thickness between children with breath-holding spells (BHSs) and a control group using morphometric MRI analyses. Methods: Three-dimensional T1-weighted cranial MRI data from 48 children with BHSs and 50 control children were retrospectively analyzed, yielding volumetric, surface area, and cortical thickness measures for 135 brain regions. All measurements were assessed relative to total intracranial volume (ICV). Group comparisons were performed using analysis of covariance with age, sex, and ICV as covariates, followed by Benjamini–Hochberg false discovery rate correction (q < 0.05). Results: The BHS group exhibited reduced bilateral amygdala volumes (left: q = 0.042; right: q = 0.038). Both cortical thickness and volume were reduced in the right anterior insula (thickness: q = 0.046; volume: q = 0.049). In addition, cortical thickness was reduced in the bilateral anterior cingulate cortices (left: p = 0.019, q = 0.045; right: p = 0.017, q = 0.043) as well as in the right medial frontal cortex (p = 0.009, q = 0.036). Subregional cerebellar analysis demonstrated volume reductions in the right lobule VI (q = 0.031), left lobule VIIA (Crus I) (q = 0.043), and vermis IX–X (q = 0.039). Conclusions: Detecting measurable morphometric changes in brain regions involved in autonomic and emotional regulation in children with BHSs will contribute to understanding the neurobiological characteristics associated with BHSs.