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Riordan K, Barness B, Sumdani H, Avellino AM, Weinand ME. Utility of Diffusion Tensor Imaging in Preterm Infants with Germinal Matrix Hemorrhage and Intraventricular Hemorrhage: A Systematic Review. World Neurosurg 2024:S1878-8750(24)01425-6. [PMID: 39151695 DOI: 10.1016/j.wneu.2024.08.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 08/07/2024] [Accepted: 08/08/2024] [Indexed: 08/19/2024]
Abstract
OBJECTIVE Intraventricular hemorrhage (IVH) and germinal matrix hemorrhage (GMH) are the most common brain injuries in preterm infants. Neonates with these injuries are at greater risk of impaired neurodevelopmental outcome. Current guidelines recommend screening infants with cranial ultrasound (CUS); however, this is prone to missing subtle injury patterns, particularly within the posterior fossa. The present report sought to discuss the utility of diffusion tensor imaging (DTI) in preterm infants. METHODS A systematic review of PubMed, Ovid MEDLINE, and Ovid EMBASE was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Included manuscripts were methodically scrutinized for quality, DTI use, and neurologic outcome. RESULTS Twenty studies with 1574 infants who underwent DTI were included. There were 574 preterm infants with GMH-IVH on DTI. Twelve studies documented decreased fractional anisotropy, whereas 6 demonstrated structural segregation and asymmetrical white matter myelination in these infants. Seven studies documented concurrent CUS use with 2 studies comparing DTI findings with CUS findings. In both studies, DTI more accurately detected presence of GMH, especially within the cerebellum. Among GMH-IVH preterm infants, 58.5% demonstrated cognitive, intellectual, and language delays at follow-up (mean, 32.4 months). Additionally, lower fractional anisotropy values on initial DTI were associated with cognitive, language, and motor delays. CONCLUSIONS Although DTI is more sensitive for picking up subtle injury patterns, CUS remains the standard of care when screening for injuries that would necessitate surgical intervention. DTI offers a refined understanding of the sequelae of GMH-IVH with microstructural changes found on DTI being associated with childhood motor and cognitive outcomes.
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Affiliation(s)
- Katherine Riordan
- College of Medicine, University of Arizona College of Medicine-Tucson, Tucson, Arizona, USA
| | - Brenden Barness
- College of Medicine, University of Arizona College of Medicine-Tucson, Tucson, Arizona, USA
| | - Hasan Sumdani
- Department of Neurosurgery, Banner University Medical Center/University of Arizona, Tucson, Arizona, USA
| | - Anthony M Avellino
- Department of Neurosurgery, Banner University Medical Center/University of Arizona, Tucson, Arizona, USA
| | - Martin E Weinand
- Department of Neurosurgery, Banner University Medical Center/University of Arizona, Tucson, Arizona, USA.
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Verschuur AS, King R, Tax CMW, Boomsma MF, van Wezel-Meijler G, Leemans A, Leijser LM. Methodological considerations on diffusion MRI tractography in infants aged 0-2 years: a scoping review. Pediatr Res 2024:10.1038/s41390-024-03463-2. [PMID: 39143201 DOI: 10.1038/s41390-024-03463-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 07/20/2024] [Accepted: 07/24/2024] [Indexed: 08/16/2024]
Abstract
Diffusion MRI (dMRI) enables studying the complex architectural organization of the brain's white matter (WM) through virtual reconstruction of WM fiber tracts (tractography). Despite the anticipated clinical importance of applying tractography to study structural connectivity and tract development during the critical period of rapid infant brain maturation, detailed descriptions on how to approach tractography in young infants are limited. Over the past two decades, tractography from infant dMRI has mainly been applied in research settings and focused on diffusion tensor imaging (DTI). Only few studies used techniques superior to DTI in terms of disentangling information on the brain's organizational complexity, including crossing fibers. While more advanced techniques may enhance our understanding of the intricate processes of normal and abnormal brain development and extensive knowledge has been gained from application on adult scans, their applicability in infants has remained underexplored. This may partially be due to the higher technical requirements versus the need to limit scan time in young infants. We review various previously described methodological practices for tractography in the infant brain (0-2 years-of-age) and provide recommendations to optimize advanced tractography approaches to enable more accurate reconstructions of the brain WM's complexity. IMPACT: Diffusion tensor imaging is the technique most frequently used for fiber tracking in the developing infant brain but is limited in capability to disentangle the complex white matter organization. Advanced tractography techniques allow for reconstruction of crossing fiber bundles to better reflect the brain's complex organization. Yet, they pose practical and technical challenges in the fast developing young infant's brain. Methods on how to approach advanced tractography in the young infant's brain have hardly been described. Based on a literature review, recommendations are provided to optimize tractography for the developing infant brain, aiming to advance early diagnosis and neuroprotective strategies.
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Affiliation(s)
- Anouk S Verschuur
- Department of Radiology, Isala Hospital Zwolle, Zwolle, The Netherlands.
- Department of Pediatrics, Section of Newborn Critical Care, University of Calgary, Calgary, Canada.
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Regan King
- Department of Pediatrics, Section of Newborn Critical Care, University of Calgary, Calgary, Canada
| | - Chantal M W Tax
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands
- CUBRIC, School of Physics and Astronomy, Cardiff University, Cardiff, United Kingdom
| | - Martijn F Boomsma
- Department of Radiology, Isala Hospital Zwolle, Zwolle, The Netherlands
- Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Gerda van Wezel-Meijler
- Department of Neonatology, Isala Women and Children's Hospital Zwolle, Zwolle, The Netherlands
| | - Alexander Leemans
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Lara M Leijser
- Department of Pediatrics, Section of Newborn Critical Care, University of Calgary, Calgary, Canada
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Musiime GM, Mohammad K, Momin S, Kwong GPS, Riva-Cambrin J, Scott J, Zein H, Hendson L, Leijser LM. Prediction of post-hemorrhagic ventricular dilatation trajectory using a growth mixture model in preterm infants. Pediatr Res 2024:10.1038/s41390-024-03396-w. [PMID: 38982166 DOI: 10.1038/s41390-024-03396-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 06/20/2024] [Accepted: 06/25/2024] [Indexed: 07/11/2024]
Abstract
BACKGROUND Early intervention for post-hemorrhagic ventricular dilatation (PHVD), guided by ventricular size measurements from cranial ultrasound (cUS), is associated with improved neurodevelopmental outcomes in preterm infants but benefits must be balanced against intervention risks. METHODS Anterior horn width (AHW) and ventricular index (VI) were measured from cUS for preterm infants (<29 weeks) with intraventricular hemorrhage admitted from 2010-2018. PHVD was defined as AHW > 6 mm or VI >97th percentile for postmenstrual age. Individual ventricular size trajectories were plotted, and a growth mixture model (GMM) used to identify latent trajectory classes and compare these to predetermined outcome of neurosurgical intervention. RESULTS Measurements were obtained from 1543 cUS in 249 infants, of whom 39 had PHVD without and 17 PHVD with neurosurgical intervention based on signs of raised intracranial pressure. The GMM predicted trajectory identified: 93.3% of infants without PHVD, 88.2% and 30.8% of infants with PHVD with and without intervention using AHW; 100% of infants without PHVD, 52.9% and 59.0% of infants with PHVD with and without intervention using VI. CONCLUSIONS The AHW GMM identified a significant proportion of infants with severe PHVD. Model refinement offers a promising approach for identifying differences in PHVD trajectory at an early stage to guide management. IMPACT It is difficult to distinguish the trajectory of PHVD in the early stage of development, in particular PHVD that spontaneously arrests from slowly progressive PHVD which eventually requires intervention. We report the first modeling-based evaluation of PHVD trajectory for the prediction of short-term outcome of PHVD progression and neurosurgical intervention. With additional clinical validation and optimization to increase accuracy, predictive modeling has the potential to identify important differences in PHVD trajectory at an early stage in the clinical course, allowing for more individualized data-driven risk-benefit assessments to guide decisions on early intervention.
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Affiliation(s)
- Grace M Musiime
- Department of Pediatrics, Section of Newborn Critical Care, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Khorshid Mohammad
- Department of Pediatrics, Section of Newborn Critical Care, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Sarfaraz Momin
- Department of Pediatrics, Section of Newborn Critical Care, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Grace P S Kwong
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Department of Community Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Faculty of Veterinary Medicine, University of Calgary, Calgary, AB, Canada
| | - Jay Riva-Cambrin
- Division of Neurosurgery, Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - James Scott
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Hussein Zein
- Department of Pediatrics, Section of Newborn Critical Care, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Leonora Hendson
- Department of Pediatrics, Section of Newborn Critical Care, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Lara M Leijser
- Department of Pediatrics, Section of Newborn Critical Care, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada.
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.
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Abstract
During the last decade, an increasing number of studies have been conducted to improve the outcome of post-hemorrhagic hydrocephalus (PHH), a complication of severe intraventricular hemorrhage (IVH) in preterm infants. Two randomized controlled trials have shown that treatment should be initiated prior to the onset of clinical symptoms. Ventricular access devices and subgaleal shunts are used as temporary neurosurgical interventions whereas ventriculoperitoneal shunts are performed for infants with progressive hydrocephalus. Recently, techniques such as neuro-endoscopic lavage have also been introduced to eliminate toxic blood products and debris from the cerebral ventricles and have shown promise in early clinical studies. The objective of this review is to provide an update on management of PHVD and PHH in the preterm infant.
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Affiliation(s)
- David D Limbrick
- T.S. Park Chair and Chief of Pediatric Neurosurgery, Executive Vice Chair of Neurological Surgery, Washington University School of Medicine; Neurosurgeon-in-Chief, St. Louis Children's Hospital.
| | - Linda S de Vries
- Em. Professor in Neonatal Neurology, Department of Neonatology, University Medical Center Utrecht and Leiden University Medical Center, the Netherlands
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