1
|
Drommelschmidt K, Mayrhofer T, Hüning B, Stein A, Foldyna B, Schweiger B, Felderhoff-Müser U, Sirin S. Incidence of brain injuries in a large cohort of very preterm and extremely preterm infants at term-equivalent age: results of a single tertiary neonatal care center over 10 years. Eur Radiol 2024; 34:5239-5249. [PMID: 38279057 PMCID: PMC11255071 DOI: 10.1007/s00330-024-10592-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 11/30/2023] [Accepted: 12/22/2023] [Indexed: 01/28/2024]
Abstract
OBJECTIVES Cerebral magnetic resonance imaging (cMRI) at term-equivalent age (TEA) can detect brain injury (BI) associated with adverse neurological outcomes in preterm infants. This study aimed to assess BI incidences in a large, consecutive cohort of preterm infants born < 32 weeks of gestation, the comparison between very (VPT, ≥ 28 + 0 to < 32 + 0 weeks of gestation) and extremely preterm infants (EPT, < 28 + 0 weeks of gestation) and across weeks of gestation. METHODS We retrospectively analyzed cMRIs at TEA of VPT and EPT infants born at a large tertiary center (2009-2018). We recorded and compared the incidences of BI, severe BI, intraventricular hemorrhage (IVH), periventricular hemorrhagic infarction (PVHI), cerebellar hemorrhage (CBH), cystic periventricular leukomalacia (cPVL), and punctate white matter lesions (PWML) between VPTs, EPTs, and across weeks of gestation. RESULTS We included 507 preterm infants (VPT, 335/507 (66.1%); EPT, 172/507 (33.9%); mean gestational age (GA), 28 + 2 weeks (SD 2 + 2 weeks); male, 52.1%). BIs were found in 48.3% of the preterm infants (severe BI, 12.0%) and increased with decreasing GA. IVH, PVHI, CBH, cPVL, and PWML were seen in 16.8%, 0.8%, 10.5%, 3.4%, and 18.1%, respectively. EPT vs. VPT infants suffered more frequently from BI (59.3% vs. 42.7%, p < 0.001), severe BI (18.6% vs. 8.7%, p = 0.001), IVH (31.9% vs. 9.0%, p < 0.001), and CBH (18.0% vs. 6.6%, p < 0.001). CONCLUSION Brain injuries are common cMRI findings among preterm infants with a higher incidence of EPT compared to VPT infants. These results may serve as reference values for clinical management and research. CLINICAL RELEVANCE STATEMENT Our results with regard to gestational age might provide valuable clinical insights, serving as a key reference for parental advice, structured follow-up planning, and enhancing research and management within the Neonatal Intensive Care Unit. KEY POINTS • Brain injury is a common cMRI finding in preterm infants seen in 48.3% individuals. • Extremely preterm compared to very preterm infants have higher brain injury incidences driven by brain injuries such as intraventricular and cerebellar hemorrhage. • Reference incidence values are crucial for parental advice and structured follow-up planning.
Collapse
Affiliation(s)
- Karla Drommelschmidt
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care, and Pediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (cTNBS), University Medicine Essen, Essen, Germany
| | - Thomas Mayrhofer
- School of Business Studies, Stralsund, University of Applied Sciences, Stralsund, Germany
- Cardiovascular Imaging Research Center, Department of Radiology, Massachusetts General Hospital - Harvard Medical School, Boston, MA, USA
| | - Britta Hüning
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care, and Pediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (cTNBS), University Medicine Essen, Essen, Germany
| | - Anja Stein
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care, and Pediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (cTNBS), University Medicine Essen, Essen, Germany
| | - Borek Foldyna
- Cardiovascular Imaging Research Center, Department of Radiology, Massachusetts General Hospital - Harvard Medical School, Boston, MA, USA
| | - Bernd Schweiger
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Ursula Felderhoff-Müser
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care, and Pediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (cTNBS), University Medicine Essen, Essen, Germany
| | - Selma Sirin
- Department of Diagnostic Imaging, University Children's Hospital Zürich, University of Zürich, Zürich, Switzerland.
| |
Collapse
|
2
|
Mahabee-Gittens EM, Priyanka Illapani VS, Merhar SL, Kline-Fath B, Harun N, He L, Parikh NA. Prenatal Opioid Exposure and Risk for Adverse Brain and Motor Outcomes in Infants Born Premature. J Pediatr 2024; 267:113908. [PMID: 38220065 DOI: 10.1016/j.jpeds.2024.113908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 12/26/2023] [Accepted: 01/09/2024] [Indexed: 01/16/2024]
Abstract
OBJECTIVE To compare brain magnetic resonance imaging (MRI) biomarkers and neurodevelopmental test scores in infants born preterm with and without prenatal opioid exposure (POE). STUDY DESIGN We examined 395 preterm infants (≤32 weeks gestational age) who had term-equivalent brain MRIs, composite scores from the Bayley Scales of Infant and Toddler Development-III at 2 years corrected age, and POE data. MRI parameters included total/regional brain volumes and severe punctate white matter lesions (PWMLs). We conducted bivariable analysis and multivariable logistic regression analyses. RESULTS The mean ± SD gestational age was 29.3 ± 2.5 weeks; 35 (8.9%) had POE and 20 (5.1%) had severe PWML. Compared with unexposed infants, those with POE exhibited higher rates of severe PWML (17.1% vs 3.9%, respectively; P = .002); findings remained significant with an OR of 4.16 (95% CI, 1.26-13.68) after adjusting for confounders. On mediation analysis, the significant relationship between POE and severe PWML was not indirectly mediated through preterm birth/gestational age (OR, 0.93; 95% CI, 0.78-1.10), thus suggesting the association was largely driven by a direct adverse effect of POE on white matter. In multivariable analyses, POE was associated with a significantly lower score by -6.2 (95% CI, -11.8 to -0.6) points on the Bayley Scales of Infant and Toddler Development-III Motor subscale compared with unexposed infants. CONCLUSIONS POE was associated with severe PWML; this outcome may be a direct effect of POE rather than being mediated by premature birth. POE was also associated with worse motor development. Continued follow-up to understand the long-term effects of POE is warranted.
Collapse
Affiliation(s)
- E Melinda Mahabee-Gittens
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, OH.
| | - Venkata Sita Priyanka Illapani
- Neurodevelopmental Disorders Prevention Center, The Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Stephanie L Merhar
- Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, OH; Neurodevelopmental Disorders Prevention Center, The Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Beth Kline-Fath
- Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, OH; Neurodevelopmental Disorders Prevention Center, The Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Nusrat Harun
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Lili He
- Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, OH; Neurodevelopmental Disorders Prevention Center, The Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Nehal A Parikh
- Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, OH; Neurodevelopmental Disorders Prevention Center, The Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| |
Collapse
|
3
|
Quétin P, Leboucq N, Boyer C, Crozier F, Delachartre P, Grinand M, Masson P, Claris O. On punctate white matter lesions in preterm infants: Is ultrasound diagnosis feasible? Eur J Paediatr Neurol 2024; 49:120-128. [PMID: 38492551 DOI: 10.1016/j.ejpn.2024.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 01/25/2024] [Accepted: 02/25/2024] [Indexed: 03/18/2024]
Abstract
OBJECTIVES To observe hyperechoic nodular or punctate white matter lesions (HNPL) in a population of preterm infants using routine cranial ultrasound (cUS), to describe the characteristics of HNPL, and to compare them with punctate white matter lesions (PWML) detected in magnetic resonance imaging (MRI). DESIGN Retrospective observational single-center cohort study. SETTING Level 2B neonatal unit in France. PATIENTS 307 infants born <33 weeks gestation undergoing routine cUS with a total of 961 cUS performed. MAIN OUTCOME MEASURES Description of lesions (HNPL/PWML): presence or absence, number, size, location, and structural distribution. RESULTS Among the 307 included infants, 63 (20.5%) had at least one cerebral lesion, with 453 HNPL for 63 infants. HNPL were numerous (more than three in 66.6% of cases), primarily grouped in clusters (76.2%), located near the lateral ventricles (96.8%), and measuring more than 2 mm (79%). HNPL were diagnosed on day 29 on average and persisted until term. Overall, 43 MRI were performed in 307 infants, on average 18.9 days after last cUS, in 21 of those the indication was presence of HPNL on cUS. Of these 21 MRI, 14/21 presented 118 PWML compared to 173 HNPL on cUS. In the remaining MRI (7/21), no PWML were detected compared to 47 HNPL on cUS. CONCLUSIONS In our population of 307 preterm infants, cUS allowed the diagnosis of HNPL, with a large similarity to PWML in MRI and a better sensitivity. But in the absence of data on inter-observer variability, we cannot exclude overdiagnosis of HNPL.
Collapse
Affiliation(s)
- Philippe Quétin
- Service de Néonatalogie, Centre Hospitalier Henri Duffaut, Avignon, France.
| | - Nicolas Leboucq
- Unité d'Imagerie Pédiatrique, CHU Arnaud de Villeneuve, Montpellier, France
| | - Charlotte Boyer
- Unité d'Imagerie Pédiatrique, CHU Arnaud de Villeneuve, Montpellier, France
| | - Françoise Crozier
- Service de Néonatalogie, Centre Hospitalier Henri Duffaut, Avignon, France
| | - Philippe Delachartre
- Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS, UMR 5220, U1294, Lyon, France
| | - Marilyne Grinand
- Unité de Recherche Clinique, Centre Hospitalier Henri Duffaut, Avignon, France
| | - Philippe Masson
- Service de Néonatalogie, Centre Hospitalier Henri Duffaut, Avignon, France
| | - Olivier Claris
- Service de Néonatalogie et Réanimation Néonatale de la Croix-rousse, Hôpitaux Civils de Lyon, Lyon, France; Service de Néonatalogie et Réanimation Néonatale, Hôpital Femme-Mère-Enfant, Bron, France; EA 4129, Université Claude Bernard Lyon 1, Villeurbanne, France
| |
Collapse
|
4
|
Malova M, Parodi A, Severino M, Tortora D, Calevo MG, Traggiai C, Massirio P, Minghetti D, Uccella S, Preiti D, Nobili L, Rossi A, Ramenghi LA. Neurodevelopmental Outcome at 3 Years of Age in Very Low Birth Weight Infants According to Brain Development and Lesions. Curr Pediatr Rev 2024; 20:94-105. [PMID: 36752291 DOI: 10.2174/1573396319666230208092416] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 01/24/2023] [Accepted: 01/25/2023] [Indexed: 02/09/2023]
Abstract
BACKGROUND During the last decades, severe brain lesions affecting very low birth weight (<1500 gr, VLBW) infants were gradually substituted by milder lesions with debatable prognoses. OBJECTIVE The objective of this study is to define type, frequency and 3 years of neurodevelopmental outcome of prematurity-related brain lesions in a modern cohort of VLBW infants. METHODS VLBW infants admitted to our NICU in 5 years period with brain MRI at term-equivalent age were included. MRI scans were reviewed to identify and grade white matter lesions (WML), intraventricular hemorrhage (IVH), and cerebellar hemorrhage (CBH). Linear measurements of brain size, biparietal width (BPW) and trans-cerebellar diameter (TCD) were carried out. Total maturation score (TMS) was calculated. Developmental Coefficients (DQ) on Griffiths Scale at 3 years of age were compared between patients with different types and grades of lesions and patients without lesions; possible correlations between linear brain measurements, brain maturation and outcome were explored. RESULTS Study included 407 patients. Of them, 187 (46%) had at least one brain lesion on MRI, while 37 (9%) had severe lesions. The most frequent lesion was IVH (28%), followed by WML (21%) and CBH (17%). Mild and severe IVH, moderate and severe WML and all grades of CBH were related to worst outcome at 3 years. In patients without lesions, small BPW and small TCD were associated with worse outcomes. No correlations were observed between TMS and outcome. CONCLUSION We have observed that even mild brain lesions have a negative influence on neurological outcome at 3 years of age.
Collapse
Affiliation(s)
- Mariya Malova
- Neonatal Intensive Care Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Alessandro Parodi
- Neonatal Intensive Care Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | | | - Domenico Tortora
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Maria Grazia Calevo
- Epidemiology and Biostatistics Unit, Scientific Direction, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Cristina Traggiai
- Neonatal Intensive Care Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Paolo Massirio
- Neonatal Intensive Care Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Diego Minghetti
- Neonatal Intensive Care Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Sara Uccella
- Child Neuropsychiatry Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Deborah Preiti
- Psychology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Lino Nobili
- Child Neuropsychiatry Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Andrea Rossi
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Luca Antonio Ramenghi
- Neonatal Intensive Care Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| |
Collapse
|
5
|
Pascal A, de Bruyn N, Naulaers G, Ortibus E, Hanssen B, Oostra A, de Coen K, Sonnaert M, Cloet E, Casaer A, D'Haese J, Laroche S, Jonckheere A, Plaskie K, van Mol C, Bruneel E, van Hoestenberghe MR, Samijn B, Govaert P, Van den Broeck C. The Impact of Intraventricular Hemorrhage and Periventricular Leukomalacia on Mortality and Neurodevelopmental Outcome in Very Preterm and Very Low Birthweight Infants: A Prospective Population-based Cohort Study. J Pediatr 2023; 262:113600. [PMID: 37402440 DOI: 10.1016/j.jpeds.2023.113600] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 06/09/2023] [Accepted: 06/27/2023] [Indexed: 07/06/2023]
Abstract
OBJECTIVE To survey the incidence of intraventricular hemorrhage (IVH) and periventricular leukomalacia (PVL) by gestational age and to report the impact on mortality and neurodevelopmental outcome in very preterm/very low birthweight infants. STUDY DESIGN This was a population-based cohort study of 1927 very preterm/very low birthweight infants born in 2014-2016 and admitted to Flemish neonatal intensive care units. Infants underwent standard follow-up assessment until 2 years corrected age with the Bayley Scales of Infant and Toddler Development and neurological assessments. RESULTS No brain lesion was present in 31% of infants born at <26 weeks of gestation and 75.8% in infants born at 29-32 weeks of gestation. The prevalence of low-grade IVH/PVL (grades I and II) was 16.8% and 12.7%, respectively. Low-grade IVH/PVL was not related significantly to an increased likelihood of mortality, motor delay, or cognitive delay, except for PVL grade II, which was associated with a 4-fold increase in developing cerebral palsy (OR, 4.1; 95% CI, 1.2-14.6). High-grade lesions (III-IV) were present in 22.0% of the infants born at <26 weeks of gestational and 3.1% at 29-32 weeks of gestation, and the odds of death were ≥14.0 (IVH: OR, 14.0; 95% CI, 9.0-21.9; PVL: OR, 14.1; 95% CI, 6.6-29.9). PVL grades III-IV showed an increased odds of 17.2 for motor delay and 12.3 for cerebral palsy, but were not found to be associated significantly with cognitive delay (OR, 2.9; 95% CI, 0.5-17.5; P = .24). CONCLUSIONS Both the prevalence and severity of IVH/PVL decreased significantly with advancing gestational age. More than 75% of all infants with low grades of IVH/PVL showed normal motor and cognitive outcome at 2 years corrected age. High-grade PVL/IVH has become less common and is associated with adverse outcomes.
Collapse
Affiliation(s)
- Aurelie Pascal
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium; Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Nele de Bruyn
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - Gunnar Naulaers
- Department of Neonatology, University Hospital Gasthuisberg, Leuven, Belgium
| | - Els Ortibus
- Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium; Center for Developmental Disabilities, University Hospital Gasthuisberg, Leuven, Belgium
| | - Britta Hanssen
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium; Department of Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Ann Oostra
- Center for Developmental Disorders, University Hospital Ghent, Ghent, Belgium
| | - Kris de Coen
- Department of Neonatology, University Hospital Ghent, Ghent, Belgium
| | - Michel Sonnaert
- Department of Neonatology, University Hospital Brussels, Brussels, Belgium
| | - Eva Cloet
- Department of Pediatric Neurology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Alexandra Casaer
- Center for Developmental Disorders, University Hospital Ghent, Ghent, Belgium; Department of Neonatology, AZ Sint-Jan, Brugge, Brugge, Belgium
| | - James D'Haese
- Department of Neonatology, AZ Sint-Jan, Brugge, Brugge, Belgium
| | - Sabine Laroche
- Department of Neonatology, University Hospital Antwerp, Antwerp, Belgium; Center for Developmental Disorders, University Hospital Antwerp, Antwerp, Belgium
| | - An Jonckheere
- Center for Developmental Disorders, University Hospital Antwerp, Antwerp, Belgium
| | - Katleen Plaskie
- Department of Neonatology, GasthuisZusters Antwerpen, Antwerp, Belgium
| | - Christine van Mol
- Department of Neonatology, GasthuisZusters Antwerpen, Antwerp, Belgium
| | - Els Bruneel
- Department of Neonatology, Algemeen Ziekenhuis Oost-Limburg, Genk, Belgium
| | | | - Bieke Samijn
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - Paul Govaert
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | | |
Collapse
|
6
|
Sun X, Niwa T, Okazaki T, Kameda S, Shibukawa S, Horie T, Kazama T, Uchiyama A, Hashimoto J. Automatic detection of punctate white matter lesions in infants using deep learning of composite images from two cases. Sci Rep 2023; 13:4426. [PMID: 36932141 PMCID: PMC10023755 DOI: 10.1038/s41598-023-31403-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 03/11/2023] [Indexed: 03/19/2023] Open
Abstract
Punctate white matter lesions (PWMLs) in infants may be related to neurodevelopmental outcomes based on the location or number of lesions. This study aimed to assess the automatic detectability of PWMLs in infants on deep learning using composite images created from several cases. To create the initial composite images, magnetic resonance (MR) images of two infants with the most PWMLs were used; their PWMLs were extracted and pasted onto MR images of infants without abnormality, creating many composite PWML images. Deep learning models based on a convolutional neural network, You Only Look Once v3 (YOLOv3), were constructed using the training set of 600, 1200, 2400, and 3600 composite images. As a result, a threshold of detection probability of 20% and 30% for all deep learning model sets yielded a relatively high sensitivity for automatic PWML detection (0.908-0.957). Although relatively high false-positive detections occurred with the lower threshold of detection probability, primarily, in the partial volume of the cerebral cortex (≥ 85.8%), those can be easily distinguished from the white matter lesions. Relatively highly sensitive automatic detection of PWMLs was achieved by creating composite images from two cases using deep learning.
Collapse
Affiliation(s)
- Xuyang Sun
- Department of Radiology, Tokai University School of Medicine, 143 Shimokasuka, Isehara, 259-1193, Japan
| | - Tetsu Niwa
- Department of Radiology, Tokai University School of Medicine, 143 Shimokasuka, Isehara, 259-1193, Japan.
| | - Takashi Okazaki
- Department of Radiology, Tokai University School of Medicine, 143 Shimokasuka, Isehara, 259-1193, Japan
| | - Sadanori Kameda
- Department of Radiology, Tokai University School of Medicine, 143 Shimokasuka, Isehara, 259-1193, Japan
| | - Shuhei Shibukawa
- Department of Radiology, Tokai University School of Medicine, 143 Shimokasuka, Isehara, 259-1193, Japan
- Department of Radiological Technology, Faculty of Health Science, Juntendo University, Bunkyo-Ku, Tokyo, Japan
| | - Tomohiko Horie
- Department of Radiology, Tokai University Hospital, Isehara, Japan
| | - Toshiki Kazama
- Department of Radiology, Tokai University School of Medicine, 143 Shimokasuka, Isehara, 259-1193, Japan
| | - Atsushi Uchiyama
- Department of Pediatrics, Tokai University School of Medicine, Isehara, Japan
| | - Jun Hashimoto
- Department of Radiology, Tokai University School of Medicine, 143 Shimokasuka, Isehara, 259-1193, Japan
| |
Collapse
|
7
|
Butera CD, Rhee C, Kelly CE, Dhollander T, Thompson DK, Wisnowski J, Molinini RM, Sargent B, Lepore N, Vorona G, Bessom D, Shall MS, Burnsed J, Stevenson RD, Brown S, Harper A, Hendricks-Muñoz KD, Dusing SC. Effect of a NICU to Home Physical Therapy Intervention on White Matter Trajectories, Motor Skills, and Problem-Solving Skills of Infants Born Very Preterm: A Case Series. J Pers Med 2022; 12:2024. [PMID: 36556244 PMCID: PMC9784100 DOI: 10.3390/jpm12122024] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/30/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022] Open
Abstract
Infants born very preterm (VPT; ≤29 weeks of gestation) are at high risk of developmental disabilities and abnormalities in neural white matter characteristics. Early physical therapy interventions such as Supporting Play Exploration and Early Development Intervention (SPEEDI2) are associated with improvements in developmental outcomes. Six VPT infants were enrolled in a randomised clinical trial of SPEEDI2 during the transition from the neonatal intensive care unit to home over four time points. Magnetic resonance imaging scans and fixel-based analysis were performed, and fibre density (FD), fibre cross-section (FC), and fibre density and cross-section values (FDC) were computed. Changes in white matter microstructure and macrostructure were positively correlated with cognitive, motor, and motor-based problem solving over time on developmental assessments. In all infants, the greatest increase in FD, FC, and FDC occurred between Visit 1 and 2 (mean chronological age: 2.68-6.22 months), suggesting that this is a potential window of time to optimally support adaptive development. Results warrant further studies with larger groups to formally compare the impact of intervention and disparity on neurodevelopmental outcomes in infants born VPT.
Collapse
Affiliation(s)
- Christiana Dodd Butera
- Division of Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA 90033, USA
| | - Claire Rhee
- Division of Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA 90033, USA
| | - Claire E. Kelly
- Victorian Infant Brain Studies and Developmental Imaging, Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, VIC 3000, Australia
| | - Thijs Dhollander
- Developmental Imaging, Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia
| | - Deanne K. Thompson
- Victorian Infant Brain Studies and Developmental Imaging, Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia
- Department of Paediatrics, University of Melbourne, Parkville, VIC 3052, Australia
| | - Jessica Wisnowski
- Departments of Radiology and Pediatrics (Neonatology), Children’s Hospital Los Angeles, Los Angeles, CA 90027, USA
| | - Rebecca M. Molinini
- Department of Physical Therapy, Virginia Commonwealth University, Richmond, VA 23284, USA
| | - Barbara Sargent
- Division of Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA 90033, USA
| | - Natasha Lepore
- CIBORG Laboratory, Department of Radiology, University of Southern California, Los Angeles, CA 90089, USA
- Departments of Pediatrics and Biomedical Engineering, University of Southern California, Los Angeles, CA 90089, USA
| | - Greg Vorona
- Department of Radiology, Virginia Commonwealth University, Richmond, VA 23284, USA
| | - Dave Bessom
- Department of Radiology, Children’s Hospital of Richmond at VCU, Richmond, VA 23284, USA
| | - Mary S. Shall
- Department of Physical Therapy, Virginia Commonwealth University, Richmond, VA 23284, USA
| | - Jennifer Burnsed
- Division of Neonatology, Departments of Pediatrics and Neurology, University of Virginia, Charlottesville, VA 22903, USA
| | - Richard D. Stevenson
- Division of Neurodevelopmental and Behavioral Pediatrics, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA 22903, USA
| | - Shaaron Brown
- Department of Physical Therapy, Virginia Commonwealth University, Richmond, VA 23284, USA
| | - Amy Harper
- Department of Neurology, Virginia Commonwealth University, Richmond, VA 23284, USA
| | - Karen D. Hendricks-Muñoz
- Department of Pediatrics, Virginia Commonwealth University School of Medicine, Children’s Hospital of Richmond at VCU, Richmond, VA 23284, USA
| | - Stacey C. Dusing
- Division of Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA 90033, USA
- Department of Physical Therapy, Virginia Commonwealth University, Richmond, VA 23284, USA
| |
Collapse
|
8
|
Kline JE, Dudley J, Illapani VSP, Li H, Kline-Fath B, Tkach J, He L, Yuan W, Parikh NA. Diffuse excessive high signal intensity in the preterm brain on advanced MRI represents widespread neuropathology. Neuroimage 2022; 264:119727. [PMID: 36332850 PMCID: PMC9908008 DOI: 10.1016/j.neuroimage.2022.119727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 10/26/2022] [Accepted: 10/31/2022] [Indexed: 11/06/2022] Open
Abstract
Preterm brains commonly exhibit elevated signal intensity in the white matter on T2-weighted MRI at term-equivalent age. This signal, known as diffuse excessive high signal intensity (DEHSI) or diffuse white matter abnormality (DWMA) when quantitatively assessed, is associated with abnormal microstructure on diffusion tensor imaging. However, postmortem data are largely lacking and difficult to obtain, and the pathological significance of DEHSI remains in question. In a cohort of 202 infants born preterm at ≤32 weeks gestational age, we leveraged two newer diffusion MRI models - Constrained Spherical Deconvolution (CSD) and neurite orientation dispersion and density index (NODDI) - to better characterize the macro and microstructural properties of DWMA and inform the ongoing debate around the clinical significance of DWMA. With increasing DWMA volume, fiber density broadly decreased throughout the white matter and fiber cross-section decreased in the major sensorimotor tracts. Neurite orientation dispersion decreased in the centrum semiovale, corona radiata, and temporal lobe. These findings provide insight into DWMA's biological underpinnings and demonstrate that it is a serious pathology.
Collapse
Affiliation(s)
- Julia E Kline
- Neurodevelopmental Disorders Prevention Center, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Jon Dudley
- Imaging Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Venkata Sita Priyanka Illapani
- Neurodevelopmental Disorders Prevention Center, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Hailong Li
- Neurodevelopmental Disorders Prevention Center, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Imaging Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Beth Kline-Fath
- Neurodevelopmental Disorders Prevention Center, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Jean Tkach
- Neurodevelopmental Disorders Prevention Center, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Imaging Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Lili He
- Neurodevelopmental Disorders Prevention Center, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Imaging Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Weihong Yuan
- Neurodevelopmental Disorders Prevention Center, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Imaging Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Nehal A Parikh
- Neurodevelopmental Disorders Prevention Center, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States.
| |
Collapse
|
9
|
Neurodevelopmental consequences of preterm punctate white matter lesions: a systematic review. Pediatr Res 2022; 93:1480-1490. [PMID: 36085366 DOI: 10.1038/s41390-022-02232-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 07/11/2022] [Accepted: 07/18/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To evaluate punctate white matter lesion (PWML) influence in preterm infants on the long-term neurodevelopmental outcome (NDO). METHODS PubMed and EMBASE were searched from January 1, 2000, to May 31, 2021. Studies were included in which PWML in preterm infants on MRI around term-equivalent age (TEA) and NDO at ≥12 months were reported. Study and patient characteristics and NDO on motor, cognitive, and behavioral domains were extracted. The quality of studies was assessed using the Cochrane-approved Quality in Prognosis Studies tool. RESULTS This analysis included nine studies with a total of 1655 patients. Mean incidence of isolated PWML was 22.1%. All studies showed a relationship between PWML and motor delay. Two studies found a significant correlation between cognitive and behavioral outcomes and PWML. Number and PWML location are related to severity and impairment types. LIMITATIONS PWML were not always separately described from generalized WMI, only studies with imaging around TEA were included, and studies were heterogenic in design and quality. CONCLUSIONS PWML is common in preterm infants and predictive of adverse NDO, in particular on motor outcomes and less on cognitive and behavioral outcomes. The type and severity of impairments are related to the number and location of PMWL. IMPACT PWML is common in preterm infants and seems predictive of adverse NDO. DWI and SWI MRI sequences are informative because the different patterns suggest a difference in the underlying pathology. The type and severity of impairments are related to the number and location of PMWL. Our review can inform clinicians and parents about the NDO of preterm infants with a diagnosis of PWML. Prospective neuroimaging case-control cohort studies are recommended.
Collapse
|
10
|
Perrone S, Lembo C, Gironi F, Petrolini C, Catalucci T, Corbo G, Buonocore G, Gitto E, Esposito SMR. Erythropoietin as a Neuroprotective Drug for Newborn Infants: Ten Years after the First Use. Antioxidants (Basel) 2022; 11:antiox11040652. [PMID: 35453337 PMCID: PMC9031072 DOI: 10.3390/antiox11040652] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/19/2022] [Accepted: 03/24/2022] [Indexed: 01/27/2023] Open
Abstract
Protective strategies against perinatal brain injury represent a major challenge for modern neonatology. Erythropoietin (Epo) enhances endogenous mechanisms of repair and angiogenesis. In order to analyse the newest evidence on the role of Epo in prematurity, hypoxic ischemic encephalopathy (HIE) and perinatal stroke, a critical review using 2020 PRISMA statement guidelines was conducted. This review uncovered 26 clinical trials examining the use of Epo for prematurity and brain injury-related outcomes. The effects of Epo on prematurity were analysed in 16 clinical trials. Erythropoietin was provided until 32–35 weeks of corrected postnatal age with a dosage between 500–3000 UI/kg/dose. Eight trials reported the Epo effects on HIE term newborn infants: Erythropoietin was administered in the first weeks of life, at different multiple doses between 250–2500 UI/kg/dose, as either an adjuvant therapy with hypothermia or a substitute for hypothermia. Two trials investigated Epo effects in perinatal stroke. Erythropoietin was administered at a dose of 1000 IU/kg for three days. No beneficial effect in improving morbidity was observed after Epo administration in perinatal stroke. A positive effect on neurodevelopmental outcome seems to occur when Epo is used as an adjuvant therapy with hypothermia in the HIE newborns. Administration of Epo in preterm infants still presents inconsistencies with regard to neurodevelopmental outcome. Clinical trials show significant differences mainly in target population and intervention scheme. The identification of specific markers and their temporal expression at different time of recovery after hypoxia-ischemia in neonates might be implemented to optimize the therapeutic scheme after hypoxic-ischemic injury in the developing brain. Additional studies on tailored regimes, accounting for the risk stratification of brain damage in newborns, are required.
Collapse
Affiliation(s)
- Serafina Perrone
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (C.P.); (S.M.R.E.)
- Correspondence:
| | - Chiara Lembo
- Department of Molecular and Developmental Medicine, University of Siena, 53100 Siena, Italy; (C.L.); (F.G.); (T.C.); (G.C.); (G.B.)
| | - Federica Gironi
- Department of Molecular and Developmental Medicine, University of Siena, 53100 Siena, Italy; (C.L.); (F.G.); (T.C.); (G.C.); (G.B.)
| | - Chiara Petrolini
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (C.P.); (S.M.R.E.)
| | - Tiziana Catalucci
- Department of Molecular and Developmental Medicine, University of Siena, 53100 Siena, Italy; (C.L.); (F.G.); (T.C.); (G.C.); (G.B.)
| | - Giulia Corbo
- Department of Molecular and Developmental Medicine, University of Siena, 53100 Siena, Italy; (C.L.); (F.G.); (T.C.); (G.C.); (G.B.)
| | - Giuseppe Buonocore
- Department of Molecular and Developmental Medicine, University of Siena, 53100 Siena, Italy; (C.L.); (F.G.); (T.C.); (G.C.); (G.B.)
| | - Eloisa Gitto
- Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, University of Messina, 98125 Messina, Italy;
| | | |
Collapse
|
11
|
Jeong MH, Jeong SH, Park SJ, Lee N, Bae MH, Park KH, Byun SY, Kim C, Han YM. Neurodevelopmental Outcomes of Very-Low-Birth-Weight Infants without Severe Brain Lesions and Impact of Postnatal Steroid Use: A Single-Center Korean Study. NEONATAL MEDICINE 2022. [DOI: 10.5385/nm.2022.29.1.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Purpose: We used the Bayley Scales of Infant and Toddler Development (BSID)-III to analyze the incidence and risk factors of developmental delay in very-low-birth-weight infants without severe brain lesions. We further examined the correlation between the cumulative dexamethasone dose and developmental assessment results.Methods: We retrospectively analyzed data of preterm infants (birth weight <1,500 g) admitted to our neonatal intensive care unit between January 2014 to December 2020. The BSID-III scores obtained between the corrected ages of 12 and 24 months and after 24 months were analyzed. Developmental delay was defined as a composite score of <85 for the cognition, language, and motor domains. Univariate and multivariate analyses of developmental delay risk factors and developmental changes from the first to second BSID-III were performed. Correlations between the accumulated dexamethasone dose used for bronchopulmonary dysplasia (BPD) and the first and second test scores were analyzed.Results: Seventy-one and thirty-six infants completed the first and second tests, respectively. In both tests, developmental delay was most commonly observed in the language domain (26.8%, 47.2%). In multivariate analysis, mild BPD was identified as a developmental delay risk factor (P<0.05), whereas prenatal steroid use reduced the developmental delay risk (P<0.05). All domain scores were lower in the second test than in the first test. The cognition and language domain scores in the second test decreased with increasing cumulative dexamethasone doses.Conclusion: Very-low-birth-weight infants typically experience language delay, which can persist as they age.
Collapse
|
12
|
Khurana S, Evans ME, Kelly CE, Thompson DK, Burnsed J, Harper A, Hendricks-Munoz K, Shall MS, Stevenson RD, Inamdar K, Vorona G, Dusing SC. Longitudinal Changes in the Sensorimotor Pathways of Very Preterm Infants During the First Year of Life With and Without Intervention: A Pilot Study. Dev Neurorehabil 2021; 24:448-455. [PMID: 34160340 PMCID: PMC8429051 DOI: 10.1080/17518423.2021.1903602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objective: Evaluate longitudinal changes in brain microstructure and volumes in very preterm infants during the first year of life with and without intervention.Design: Descriptive pilot study.Methods: Five preterm infants in a three-arm clinical trial, one SPEEDI Early, two SPEEDI Late, and two usual care. Brain structural and diffusion MRI's were acquired within 72 hours after neonatal intensive care unit discharge (n = 5), three months post-baseline (n = 5), and six months post-baseline (n = 3). Fractional anisotropy (FA), Mean diffusivity (MD), and volume metrics were computed for five brain regions.Results: More than 60% of eligible participants completed 100% of the scheduled MRIs. FA and volume increased from baseline to six months across all brain regions. Rate of white matter volume change from baseline to six months was highest in SPEEDI Early.Conclusions: Non-sedated longitudinal MRI is feasible in very preterm infants and appears to demonstrate longitudinal changes in brain structure and connectivity.
Collapse
Affiliation(s)
- Sonia Khurana
- Motor Development Lab, Virginia Commonwealth University, Richmond, Virginia
| | - Megan E Evans
- Motor Development Lab, Virginia Commonwealth University, Richmond, Virginia
| | - Claire E Kelly
- Victorian Infant Brain Studies (VIBeS) and Developmental Imaging, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
| | - Deanne K Thompson
- Victorian Infant Brain Studies (VIBeS) and Developmental Imaging, Murdoch Children’s Research Institute, Parkville, Victoria, Australia; Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Jennifer Burnsed
- Division of Neonatology, University of Virginia, Charlottesville, Virginia
| | - Amy Harper
- Department of Neurology, Virginia Commonwealth University, Richmond, Virginia
| | - Karen Hendricks-Munoz
- Department of Pediatrics, Virginia Commonwealth University School of Medicine, Children’s Hospital of Richmond at VCU Richmond, Virginia
| | - Mary S Shall
- Department of Physical Therapy, Virginia Commonwealth University, Richmond, Virginia
| | - Richard D Stevenson
- Division of Neurodevelopmental and Behavioral Pediatrics, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Ketaki Inamdar
- Rehabilitation and Movement Sciences, Motor Development Lab, Virginia Commonwealth University, Richmond, Virginia
| | - Greg Vorona
- Department of Radiology, Virginia Commonwealth University, Richmond, Virginia
| | - Stacey C Dusing
- Motor Development Lab, Department of Biokinesiology and Physical Therapy, University of Southern California
| |
Collapse
|
13
|
Mild brain lesions do not affect brain volumes in moderate-late preterm infants. Eur J Paediatr Neurol 2021; 34:91-98. [PMID: 34438235 DOI: 10.1016/j.ejpn.2021.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 07/27/2021] [Accepted: 08/15/2021] [Indexed: 11/21/2022]
Abstract
PURPOSE It is unknown whether frequently occurring mild brain lesions affect brain volumes in moderate (MP2; 32+0-33+6 weeks' gestation) and late (LP3; 34+0-35+6 weeks' gestation) preterm infants. Therefore, we aimed to investigate the effect of mild brain lesions on brain volumes in moderate-late preterm (MLPT4) infants and to compare brain volumes between MP and LP infants. METHODS From August 2017 to November 2019, eligible MLPT infants born at Isala Women and Children's Hospital were enrolled in a prospective cohort study (Brain Imaging in Moderate-late Preterm infants 'BIMP-study'). MRI was performed around term equivalent age (TEA5). MRI scans were assessed for (mild) brain lesions. T2-weighted images were used for automatic segmentation of eight brain structures. Linear regression analysis was performed to compare absolute and relative brain volumes between infants with and without mild brain lesions and between MP and LP infants. RESULTS 36 MP and 68 LP infants were included. In infants with mild brain lesions, intracranial volume (B = 27.4 cm3, p = 0.02), cerebrospinal fluid (B = 8.78 cm3, p = 0.01) and cerebellar volumes (B = 1.70 cm3, p = 0.03) were significantly larger compared to infants without mild brain lesions. After correction for weight and postmenstrual age at MRI, these volumes were no longer significantly different. LP infants had larger brain volumes than MP infants, but differences were not significant. Relative brain volumes showed no significant differences in both analyses. CONCLUSION Neither having mild brain lesions, nor being born moderate prematurely affected brain volumes at TEA in MLPT infants.
Collapse
|
14
|
Diagnostic Value of Diffusion Tensor Imaging for Infants' Brain Development Retardation Caused by Pre-Eclampsia. CONTRAST MEDIA & MOLECULAR IMAGING 2021; 2021:5545178. [PMID: 34366725 PMCID: PMC8302371 DOI: 10.1155/2021/5545178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 06/18/2021] [Accepted: 06/30/2021] [Indexed: 12/15/2022]
Abstract
Objective Pre-eclampsia (PE) can cause brain development delay in infants. This work aims to characterize the pattern differences of brain white matter development in premature infants under PE conditions and those without. Methods Eighty preterm infants delivered by women with PE were selected as the PE group, and ninety-six preterm infants of the same period born to women without high-risk perinatal factors were used as control. All infants underwent diffusion tensor imaging (DTI) examination. The fractional anisotropy (FA) was measured in five regions of interests (ROIs), including posterior limbs of internal capsule (PLIC), splenium of the corpus callosum (SCC), superior frontal gyrus (SFG), superior parietal lobule (SPL), and superior occipital gyrus (SOG). The relationship between the FA values and postmenstrual age (PMA) was analyzed. Results After adjusting for the birth weight and gestational ages, in the SCC and PLIC, the PMA and FA values showed a low-to-medium intensity positive correlation in the control group (r = 0.30, p=0.003; r = 0.53, p < 0.0001), while no positive relevance was detected in the PE group (r = 0.08, p=0.47; r = 0.19, p < 0.08). In the PE and control groups, in the SPL and SOG, the PMA and FA values showed a near-consistent positive correlation (r = 0.57, r = 0.55 vs. r = 0.31, r = 0.55; all p < 0.05). In the control group, in SFG, the PMA and FA values had a medium intensity positive correlation (r = 0.47, p < 0.0001), but there was no statistical difference in correlation in PE (r = 0.10, p=0.39). Conclusion PE may cause lagging brain development in the SCC, PLIC, and SFG during infancy. DTI may be an effective and sensitive detection tool.
Collapse
|
15
|
Dimitrova R, Arulkumaran S, Carney O, Chew A, Falconer S, Ciarrusta J, Wolfers T, Batalle D, Cordero-Grande L, Price AN, Teixeira RPAG, Hughes E, Egloff A, Hutter J, Makropoulos A, Robinson EC, Schuh A, Vecchiato K, Steinweg JK, Macleod R, Marquand AF, McAlonan G, Rutherford MA, Counsell SJ, Smith SM, Rueckert D, Hajnal JV, O’Muircheartaigh J, Edwards AD. Phenotyping the Preterm Brain: Characterizing Individual Deviations From Normative Volumetric Development in Two Large Infant Cohorts. Cereb Cortex 2021; 31:3665-3677. [PMID: 33822913 PMCID: PMC8258435 DOI: 10.1093/cercor/bhab039] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/15/2021] [Accepted: 02/05/2021] [Indexed: 12/20/2022] Open
Abstract
The diverse cerebral consequences of preterm birth create significant challenges for understanding pathogenesis or predicting later outcome. Instead of focusing on describing effects common to the group, comparing individual infants against robust normative data offers a powerful alternative to study brain maturation. Here we used Gaussian process regression to create normative curves characterizing brain volumetric development in 274 term-born infants, modeling for age at scan and sex. We then compared 89 preterm infants scanned at term-equivalent age with these normative charts, relating individual deviations from typical volumetric development to perinatal risk factors and later neurocognitive scores. To test generalizability, we used a second independent dataset comprising of 253 preterm infants scanned using different acquisition parameters and scanner. We describe rapid, nonuniform brain growth during the neonatal period. In both preterm cohorts, cerebral atypicalities were widespread, often multiple, and varied highly between individuals. Deviations from normative development were associated with respiratory support, nutrition, birth weight, and later neurocognition, demonstrating their clinical relevance. Group-level understanding of the preterm brain disguises a large degree of individual differences. We provide a method and normative dataset that offer a more precise characterization of the cerebral consequences of preterm birth by profiling the individual neonatal brain.
Collapse
Affiliation(s)
- Ralica Dimitrova
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AF, UK
| | - Sophie Arulkumaran
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
| | - Olivia Carney
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
| | - Andrew Chew
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
| | - Shona Falconer
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
| | - Judit Ciarrusta
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AF, UK
| | - Thomas Wolfers
- Donders Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen 6525EN, the Netherlands
- Department of Cognitive Neuroscience, Radboud University Medical Centre, Nijmegen 6525EN, the Netherlands
| | - Dafnis Batalle
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AF, UK
| | - Lucilio Cordero-Grande
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
- Biomedical Image Technologies, ETSI Telecomunicacion, Universidad Politecnica de Madrid and CIBER-BBN, Madrid 28040, Spain
| | - Anthony N Price
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
| | - Rui P A G Teixeira
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
| | - Emer Hughes
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
| | - Alexia Egloff
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
| | - Jana Hutter
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
| | - Antonios Makropoulos
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London SW7 2AZ, UK
| | - Emma C Robinson
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
| | - Andreas Schuh
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London SW7 2AZ, UK
| | - Katy Vecchiato
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AF, UK
| | - Johannes K Steinweg
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
| | - Russell Macleod
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
| | - Andre F Marquand
- Donders Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen 6525EN, the Netherlands
- Department of Cognitive Neuroscience, Radboud University Medical Centre, Nijmegen 6525EN, the Netherlands
| | - Grainne McAlonan
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AF, UK
- MRC Centre for Neurodevelopmental Disorders, King’s College London, London SE1 1UL, UK
- South London and Maudsley NHS Foundation Trust, London SE5 8AZ, UK
| | - Mary A Rutherford
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
| | - Serena J Counsell
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
| | - Stephen M Smith
- Centre for Functional MRI of the Brain (FMRIB), Wellcome Centre for Integrative Neuroimaging, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX3 9DU, UK
| | - Daniel Rueckert
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London SW7 2AZ, UK
| | - Joseph V Hajnal
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
| | - Jonathan O’Muircheartaigh
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AF, UK
- MRC Centre for Neurodevelopmental Disorders, King’s College London, London SE1 1UL, UK
| | - A David Edwards
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
- MRC Centre for Neurodevelopmental Disorders, King’s College London, London SE1 1UL, UK
| |
Collapse
|
16
|
Jansen L, van Steenis A, van den Berg-Huysmans AA, Wiggers-de Bruine ST, Rijken M, de Vries LS, Vermeiren RRJM, Peeters-Scholte CMPCD, Steggerda SJ. Associations between Neonatal Magnetic Resonance Imaging and Short- and Long-Term Neurodevelopmental Outcomes in a Longitudinal Cohort of Very Preterm Children. J Pediatr 2021; 234:46-53.e2. [PMID: 33577803 DOI: 10.1016/j.jpeds.2021.02.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 01/29/2021] [Accepted: 02/03/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To assess associations between neonatal brain injury assessed by magnetic resonance imaging and cognitive, motor, and behavioral outcomes at 2 and 10 years of age, in a longitudinal cohort of children born very preterm. STUDY DESIGN There were 112 children born at <32 weeks of gestation who participated in a longitudinal prospective study on brain injury and neurodevelopmental outcome. Using the Kidokoro score, neonatal brain injury and altered brain growth in white matter, cortical and deep gray matter, and the cerebellum were assessed. Cognitive, motor, and behavioral outcomes were assessed during follow-up visits at both 2 (corrected) and 10 years of age. RESULTS After adjusting for perinatal factors and level of maternal education, the global brain abnormality score was associated with cognition (B = -1.306; P = .005), motor skills (B = -3.176; P < .001), and behavior (B = 0.666; P = .005) at 2 years of age, but was not associated with cognition at 10 years of age. In the subgroup of children with a moderate-severe global brain abnormality score, magnetic resonance imaging was independently associated with cognitive impairment at 10 years of age. For children with milder forms of brain injury, only birth weight and level of maternal education were associated with cognitive outcomes. CONCLUSIONS Neonatal brain injury, assessed by a standardized scoring system, was associated with short-term neurodevelopmental outcomes, but only with motor skills and behavior in childhood. Environmental factors, such as level of maternal education, become more important for cognitive development as children grow older, especially for children with relatively mild neonatal brain injury.
Collapse
Affiliation(s)
- Lisette Jansen
- Department of Medical Psychology, Leiden University Medical Center, Leiden, the Netherlands; Curium-LUMC Department of Child and Adolescent Psychiatry, Leiden, the Netherlands.
| | - Andrea van Steenis
- Department of Neonatology, Leiden University Medical Center, Leiden, the Netherlands
| | | | | | - Monique Rijken
- Department of Neonatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Linda S de Vries
- Department of Neonatology, Leiden University Medical Center, Leiden, the Netherlands
| | | | | | - Sylke J Steggerda
- Department of Neonatology, Leiden University Medical Center, Leiden, the Netherlands
| |
Collapse
|
17
|
Kline JE, Illapani VSP, Li H, He L, Yuan W, Parikh NA. Diffuse white matter abnormality in very preterm infants at term reflects reduced brain network efficiency. NEUROIMAGE-CLINICAL 2021; 31:102739. [PMID: 34237685 PMCID: PMC8378797 DOI: 10.1016/j.nicl.2021.102739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/28/2021] [Accepted: 06/21/2021] [Indexed: 01/23/2023]
Abstract
Most preterm infants exhibit regions of high signal
intensity on T2 MRI at term. Debate remains as to whether this signal (DWMA) is
pathological. We quantified DWMA and used graph theory to measure
brain network efficiency. Whole-brain and regional network efficiency at term
decreased with greater DWMA. DWMA in very preterm infants is associated with
reduced brain efficiency at term.
Between 50 and 80% of very preterm infants (<32 weeks
gestational age) exhibit increased white matter signal intensity on T2-weighted
MRI at term-equivalent age, known as diffuse white matter abnormality (DWMA). A
few studies have linked DWMA with microstructural abnormalities, but the exact
relationship remains poorly understood. We related DWMA extent to graph theory
measures of network efficiency at term in a representative cohort of 343 very
preterm infants. We performed anatomic and diffusion MRI at term and quantified
DWMA volume with our novel, semi-automated algorithm. From diffusion-weighted
structural connectomes, we calculated the graph theory metrics local efficiency
and clustering coefficient, which measure the ability of groups of nodes to
perform specialized processing, and global efficiency, which assesses the
ability of brain regions to efficiently combine information. We computed partial
correlations between these measures and DWMA volume, adjusted for confounders.
Increasing DWMA volume was associated with decreased global efficiency of the
entire very preterm brain and decreased local efficiency and clustering
coefficient in a variety of regions supporting cognitive, linguistic, and motor
function. We show that DWMA is associated with widespread decreased brain
network efficiency, suggesting that it is pathologic and likely has adverse
developmental consequences.
Collapse
Affiliation(s)
- Julia E Kline
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | | | - Hailong Li
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Lili He
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Weihong Yuan
- Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Nehal A Parikh
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States; Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.
| |
Collapse
|
18
|
Parikh NA, Sharma P, He L, Li H, Altaye M, Illapani VSP. Perinatal Risk and Protective Factors in the Development of Diffuse White Matter Abnormality on Term-Equivalent Age Magnetic Resonance Imaging in Infants Born Very Preterm. J Pediatr 2021; 233:58-65.e3. [PMID: 33259857 PMCID: PMC8290900 DOI: 10.1016/j.jpeds.2020.11.058] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/24/2020] [Accepted: 11/24/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To identify perinatal clinical diseases and treatments that are associated with the development of objectively diagnosed diffuse white matter abnormality (DWMA) on structural magnetic resonance imaging (MRI) at term-equivalent age in infants born very preterm. STUDY DESIGN A prospective cohort of 392 infants born very preterm (≤32 weeks of gestational age) was enrolled from 5 level III/IV neonatal intensive care units between September 2016 and November 2019. MRIs of the brain were collected at 39 to 45 weeks of postmenstrual age to evaluate DWMA volume. A predefined list of pertinent maternal characteristics, pregnancy/delivery data, and neonatal intensive care unit data were collected for enrolled patients to identify antecedents of objectively diagnosed DWMA. RESULTS Of the 392 infants in the cohort, 377 (96%) had high-quality MRI data. Their mean (SD) gestational age was 29.3 (2.5) weeks. In multivariable linear regression analyses, pneumothorax (P = .027), severe bronchopulmonary dysplasia (BPD) (P = .009), severe retinopathy of prematurity (P < .001), and male sex (P = .041) were associated with increasing volume of DWMA. The following factors were associated with decreased risk of DWMA: postnatal dexamethasone therapy for severe BPD (P = .004), duration of caffeine therapy for severe BPD (P = .009), and exclusive maternal milk diet at neonatal intensive care unit discharge (P = .049). CONCLUSIONS Severe retinopathy of prematurity and BPD exhibited the strongest adverse association with development of DWMA. We also identified treatments and nutritional factors that appear protective against the development of DWMA that also have implications for the clinical care of infants born very preterm.
Collapse
Affiliation(s)
- Nehal A. Parikh
- The Perinatal Institute, Cincinnati Children’s Hospital Medical Center, United States,Department of Pediatrics, University of Cincinnati, College of Medicine United States,Correspondence: Nehal A. Parikh, DO, MS, Professor of Pediatrics, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, MLC 4009, Cincinnati, OH, 45229, United States, , Phone number: 513.803.7584
| | - Puneet Sharma
- The Perinatal Institute, Cincinnati Children’s Hospital Medical Center, United States,Department of Pediatrics, University of Cincinnati, College of Medicine United States
| | - Lili He
- The Perinatal Institute, Cincinnati Children’s Hospital Medical Center, United States,Department of Pediatrics, University of Cincinnati, College of Medicine United States
| | - Hailong Li
- The Perinatal Institute, Cincinnati Children’s Hospital Medical Center, United States
| | - Mekibib Altaye
- Department of Pediatrics, University of Cincinnati, College of Medicine United States,Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, United States
| | | | | |
Collapse
|
19
|
Guillot M, Sebastianski M, Lemyre B. Comparative performance of head ultrasound and MRI in detecting preterm brain injury and predicting outcomes: A systematic review. Acta Paediatr 2021; 110:1425-1432. [PMID: 33206399 DOI: 10.1111/apa.15670] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/05/2020] [Accepted: 11/13/2020] [Indexed: 11/28/2022]
Abstract
AIM To systematically review the literature to compare the performance of head ultrasound (HUS) and magnetic resonance imaging (MRI) in their ability to detect brain injury and their predictive value for neurodevelopmental outcomes. METHODS This was a systematic review based on literature search in three electronic databases (MEDLINE, EMBASE, Cochrane Library) and additional sources for studies on routine brain injury screening in preterm neonates published during 2000-May 2020. Studies were included if they reported on the comparative performance of HUS and MRI in detecting preterm brain injury and/or their predictive value for neurodevelopmental outcomes. Findings from the included studies underwent narrative synthesis. RESULTS Forty-six studies were included. In comparison with HUS, MRI detected more anomalies and provided more details on the severity and the extent of preterm brain injury, particularly for white matter injury and cerebellar haemorrhage. Neonatal neuroimaging predicted outcomes with high negative predictive value but relatively low positive predictive value. The prognostic value of neonatal neuroimaging varied according to several factors including modality and timing of imaging, and tools used for grading brain injury. CONCLUSION Compared with HUS, MRI offers a better characterisation of preterm brain injury and may enhance the ability to predict neurodevelopmental outcomes.
Collapse
Affiliation(s)
- Mireille Guillot
- Department of Pediatrics (Neurology) University of Toronto and the Hospital for Sick Children Toronto Ontario Canada
- Department of Pediatrics (Neonatology) Université Laval and Centre Hospitalier Universitaire de Québec Québec City Québec Canada
| | - Meghan Sebastianski
- Alberta Strategy for Patient‐Oriented Research (SPOR) SUPPORT Unit Knowledge Translation Platform University of Alberta Edmonton Alberta Canada
| | - Brigitte Lemyre
- Department of Pediatrics (Neonatology) University of Ottawa and the Children’s Hospital of Eastern Ontario Ottawa Ontario Canada
| |
Collapse
|
20
|
Malova M, Morelli E, Cardiello V, Tortora D, Severino M, Calevo MG, Parodi A, De Angelis LC, Minghetti D, Rossi A, Ramenghi LA. Nosological Differences in the Nature of Punctate White Matter Lesions in Preterm Infants. Front Neurol 2021; 12:657461. [PMID: 33995255 PMCID: PMC8117674 DOI: 10.3389/fneur.2021.657461] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 03/31/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The pathogenesis of punctuate white matter lesions (PWMLs), a mild form of white matter damage observed in preterm infants, is still a matter of debate. Susceptibility-weighted imaging (SWI) allows to differentiate PWMLs based on the presence (SWI+) or absence (SWI-) of hemosiderin, but little is known about the significance of this distinction. This retrospective study aimed to compare neuroradiological and clinical characteristics of SWI+ and SWI- PWMLs. Materials and Methods: MR images of all VLBW infants scanned consecutively at term-equivalent age between April 2012 and May 2018 were retrospectively reviewed, and infants with PWMLs defined as small areas of high T1 and/or low T2 signal in the periventricular white matter were selected and included in the study. Each lesion was analyzed separately and characterized by localization, organization pattern, and distance from the lateral ventricle. Clinical data were retrieved from the department database. Results: A total of 517 PWMLs were registered in 81 patients, with 93 lesions (18%) visible on SWI (SWI+), revealing the presence of hemosiderin deposits. On univariate analysis, compared to SWI- PWML, SWI+ lesions were closer to the ventricle wall, more frequently organized in linear pattern and associated with lower birth weight, lower gestational age, lower admission temperature, need for intubation, bronchopulmonary dysplasia, retinopathy of prematurity, and presence of GMH-IVH. On multivariate analysis, closer distance to the ventricle wall on axial scan and lower birth weight were associated with visibility of PMWLs on SWI (p = 0.003 and p = 0.0001, respectively). Conclusions: Our results suggest a nosological difference between SWI+ and SWI- PWMLs. Other prospective studies are warranted to corroborate these observations.
Collapse
Affiliation(s)
- Mariya Malova
- Neonatal Intensive Care Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Elena Morelli
- Neonatal Intensive Care Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | | | - Domenico Tortora
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | | | - Maria Grazia Calevo
- Epidemiology and Biostatistics Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Alessandro Parodi
- Neonatal Intensive Care Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | | | - Diego Minghetti
- Neonatal Intensive Care Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Andrea Rossi
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | | |
Collapse
|
21
|
Li H, Chen M, Wang J, Illapani VSP, Parikh NA, He L. Automatic Segmentation of Diffuse White Matter Abnormality on T2-weighted Brain MR Images Using Deep Learning in Very Preterm Infants. Radiol Artif Intell 2021; 3:e200166. [PMID: 34142089 PMCID: PMC8166113 DOI: 10.1148/ryai.2021200166] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 01/20/2021] [Accepted: 01/22/2021] [Indexed: 11/11/2022]
Abstract
About 50%-80% of very preterm infants (VPIs) (≤ 32 weeks gestational age) exhibit diffuse white matter abnormality (DWMA) on their MR images at term-equivalent age. It remains unknown if DWMA is associated with developmental impairments, and further study is warranted. To aid in the assessment of DWMA, a deep learning model for DWMA quantification on T2-weighted MR images was developed. This secondary analysis of prospective data was performed with an internal cohort of 98 VPIs (data collected from December 2014 to April 2016) and an external cohort of 28 VPIs (data collected from January 2012 to August 2014) who had already undergone MRI at term-equivalent age. Ground truth DWMA regions were manually annotated by two human experts with the guidance of a prior published semiautomated algorithm. In a twofold cross-validation experiment using the internal cohort of 98 infants, the three-dimensional (3D) ResU-Net model accurately segmented DWMA with a Dice similarity coefficient of 0.907 ± 0.041 (standard deviation) and balanced accuracy of 96.0% ± 2.1, outperforming multiple peer deep learning models. The 3D ResU-Net model that was trained with the whole internal cohort (n = 98) was further tested on an independent external test cohort (n = 28) and achieved a Dice similarity coefficient of 0.877 ± 0.059 and balanced accuracy of 92.3% ± 3.9. The externally validated 3D ResU-Net deep learning model for accurately segmenting DWMA may facilitate the clinical diagnosis of DWMA in VPIs. Supplemental material is available for this article. Keywords: Brain/Brain Stem, Convolutional Neural Network (CNN), MR-Imaging, Pediatrics, Segmentation, Supervised learning © RSNA, 2021.
Collapse
|
22
|
Rath CP, Desai S, Rao SC, Patole S. Diffuse excessive high signal intensity on term equivalent MRI does not predict disability: a systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed 2021; 106:9-16. [PMID: 32451357 DOI: 10.1136/archdischild-2019-318207] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 03/25/2020] [Accepted: 04/22/2020] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To evaluate whether diffuse excessive high signal intensity (DEHSI) on term equivalent age MRI (TEA-MRI) predicts disability in preterm infants. DESIGN This is a systematic review and meta-analysis. Medline, EMBASE, Cochrane Library, EMCARE, Google Scholar and MedNar databases were searched in July 2019. Studies comparing developmental outcomes of isolated DEHSI on TEA-MRI versus normal TEA-MRI were included. Two reviewers independently extracted data and assessed the risk of bias. Meta-analysis was undertaken where data were available in a format suitable for pooling. MAIN OUTCOME MEASURES Neurodevelopmental outcomes ≥1 year of corrected age based on validated tools. RESULTS A total of 15 studies (n=1832) were included, of which data from 9 studies were available for meta-analysis. The pooled estimate (n=7) for sensitivity of DEHSI in predicting cognitive/mental disability was 0.58 (95% CI 0.34 to 0.79) and for specificity was 0.46 (95% CI 0.20 to 0.74). The summary area under the receiver operating characteristics (ROC) curve was low at 0.54 (CI 0.50 to 0.58). A pooled diagnostic OR (DOR) of 1 indicated that DEHSI does not discriminate preterm infants with and without mental disability. The pooled estimate (n=8) for sensitivity of DEHSI in predicting cerebral palsy (CP) was 0.57 (95% CI 0.37 to 0.75) and for specificity was 0.41 (95% CI 0.24 to 0.62). The summary area under the ROC curve was low at 0.51 (CI 0.46 to 0.55). A pooled DOR of 1 indicated that DEHSI does not discriminate between preterm infants with and without CP. CONCLUSIONS DEHSI on TEA-MRI did not predict future development of cognitive/mental disabilities or CP. PROSPERO REGISTRATION NUMBER CRD42019130576.
Collapse
Affiliation(s)
- Chandra Prakash Rath
- Neonatal Intensive Care Unit, Perth Children's Hospital, Nedlands, Western Australia, Australia.,Neonatal Intensive Care Unit, King Edward Memorial Hospital for Women Perth, Subiaco, Western Australia, Australia
| | - Saumil Desai
- Neonatal Intensive Care Unit, Perth Children's Hospital, Nedlands, Western Australia, Australia.,Neonatal Intensive Care Unit, King Edward Memorial Hospital for Women Perth, Subiaco, Western Australia, Australia
| | - Shripada C Rao
- Neonatal Intensive Care Unit, Perth Children's Hospital, Nedlands, Western Australia, Australia .,Neonatal Intensive Care Unit, King Edward Memorial Hospital for Women Perth, Subiaco, Western Australia, Australia.,School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Sanjay Patole
- Neonatal Intensive Care Unit, King Edward Memorial Hospital for Women Perth, Subiaco, Western Australia, Australia.,School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| |
Collapse
|
23
|
Jansen L, Peeters-Scholte CMPCD, van den Berg-Huysmans AA, van Klink JMM, Rijken M, van Egmond-van Dam JC, Vermeiren RRJM, Steggerda SJ. Longitudinal Follow-Up of Children Born Preterm: Neurodevelopment From 2 to 10 Years of Age. Front Pediatr 2021; 9:674221. [PMID: 34235124 PMCID: PMC8257021 DOI: 10.3389/fped.2021.674221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 05/25/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: To investigate the rate and stability of impairments in children born preterm by assessing (1) early and school-age outcome in four developmental domains and (2) individual changes in outcome at both timepoints. Design: Prospective, longitudinal cohort study in children born in 2006-2007, <32 weeks' gestation. Follow-up at 2 and 10 years of age included standardized neurological, motor, cognitive and behavioral assessments. Children were categorized as having no, mild or moderate-severe impairment in these four domains. A composite impairment score was composed and the number of domains with impairments counted. For each child, individual outcomes at both timepoints were compared. Results: Follow-up at both time-points was available in 71/113(63%) children. At group level, there were no significant changes in the severity of impairments per domain. However, at individual level, there were less children with a mild abnormal composite score at 10 years of age (44 vs. 20%; p = 0.006), and more with a moderate-severe abnormal composite score (12 vs. 35%; p = 0.001). Especially children with normal/mild outcome at 2 years were likely to shift to other outcome categories over time. Conclusions: Children with early severe impairment are likely experiencing impairments later on, but early normal/mild abnormal outcomes should be interpreted with care, considering the large individual shifts over time. Long-term follow-up in all children born very preterm should therefore be continued to at least school-age.
Collapse
Affiliation(s)
- Lisette Jansen
- Department of Medical Psychology, Leiden University Medical Center, Leiden, Netherlands.,Department of Child and Adolescent Psychiatry, Leiden University Medical Center, Curium, Leiden, Netherlands
| | | | | | - Jeanine M M van Klink
- Department of Medical Psychology, Leiden University Medical Center, Leiden, Netherlands
| | - Monique Rijken
- Department of Neonatology, Leiden University Medical Center, Leiden, Netherlands
| | | | - Robert R J M Vermeiren
- Department of Child and Adolescent Psychiatry, Leiden University Medical Center, Curium, Leiden, Netherlands
| | - Sylke J Steggerda
- Department of Neonatology, Leiden University Medical Center, Leiden, Netherlands
| |
Collapse
|
24
|
Boswinkel V, Krüse-Ruijter MF, Nijboer-Oosterveld J, Nijholt IM, Edens MA, Mulder-de Tollenaer SM, Smit-Wu MN, Boomsma MF, de Vries LS, van Wezel-Meijler G. Incidence of brain lesions in moderate-late preterm infants assessed by cranial ultrasound and MRI: The BIMP-study. Eur J Radiol 2020; 136:109500. [PMID: 33429207 DOI: 10.1016/j.ejrad.2020.109500] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/16/2020] [Accepted: 12/20/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE To evaluate the incidence and characteristics of brain lesions in moderate-late preterm (MLPT) infants, born at 32-36 weeks' gestation using cranial ultrasound (cUS) and magnetic resonance imaging (MRI). METHODS Prospective cohort study carried out at Isala Women and Children's Hospital between August 2017 and November 2019. cUS was performed at postnatal day 3-4 (early-cUS), before discharge and repeated at term equivalent age (TEA) in MLPT infants born between 32+0 and 35+6 weeks' gestation. At TEA, MRI was also performed. Several brain lesions were assessed e.g. hemorrhages, white matter and deep gray matter injury. Brain maturation was visually evaluated. Lesions were classified as mild or moderate-severe. Incidences and confidence intervals were calculated. RESULTS 166 MLPT infants were included of whom 127 underwent MRI. One or more mild lesions were present in 119/166 (71.7 %) and moderate-severe lesions in 6/166 (3.6 %) infants on cUS and/or MRI. The most frequent lesions were signs suggestive of white matter injury: inhomogeneous echogenicity in 50/164 infants (30.5 %) at early-cUS, in 12/148 infants (8.1 %) at TEA-cUS and diffuse white matter signal changes (MRI) in 27/127 (23.5 %) infants. Cerebellar hemorrhage (MRI) was observed in 16/127 infants (12.6 %). Delayed maturation (MRI) was seen in 17/117 (13.4 %) infants. Small hemorrhages and punctate white matter lesions were more frequently detected on MRI than on cUS. CONCLUSIONS In MLPT infants mild brain lesions were frequently encountered, especially signs suggestive of white matter injury and small hemorrhages. Moderate-severe lesions were less frequently seen.
Collapse
Affiliation(s)
- Vivian Boswinkel
- Department of Neonatology, Isala Women and Children's Hospital, Zwolle, the Netherlands; University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, the Netherlands.
| | | | | | - Ingrid M Nijholt
- Department of Radiology, Isala Hospital, Zwolle, the Netherlands
| | - Mireille A Edens
- Department of Innovation and Science, Isala Hospital, Zwolle, the Netherlands
| | | | - Mei-Nga Smit-Wu
- Department of Pediatrics, Isala Women and Children's Hospital, Zwolle, the Netherlands
| | | | - Linda S de Vries
- Department of Neonatology, University Medical Center Utrecht, Utrecht, the Netherlands
| | | |
Collapse
|
25
|
Automated brain MRI metrics in the EPIRMEX cohort of preterm newborns: Correlation with the neurodevelopmental outcome at 2 years. Diagn Interv Imaging 2020; 102:225-232. [PMID: 33187906 DOI: 10.1016/j.diii.2020.10.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 09/30/2020] [Accepted: 10/21/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE The purpose of this study was to identify in the EPIRMEX cohort the correlations between MRI brain metrics, including diffuse excessive high signal intensities (DEHSI) obtained with an automated quantitative method and neurodevelopmental outcomes at 2 years. MATERIALS AND METHODS A total of 390 very preterm infants (gestational age at birth≤32 weeks) who underwent brain MRI at term equivalent age at 1.5T (n=338) or 3T (n=52) were prospectively included. Using a validated algorithm, automated metrics of the main brain surfaces (cortical and deep gray matter, white matter, cerebrospinal fluid) and DEHSI with three thresholds were obtained. Linear adjust regressions were performed to assess the correlation between brain metrics with the ages and stages questionnaire (ASQ) score at 2 years. RESULTS Basal ganglia and thalami, cortex and white matter surfaces positively and significantly correlated with the global ASQ score. For all ASQ sub-domains, basal ganglia and thalami surfaces significantly correlated with the scores. DEHSI was present in 289 premature newborns (74%) without any correlation with the ASQ score. Metrics of DEHSI were greater at 3T than at 1.5T. CONCLUSION Brain MRI metrics obtained in our multicentric cohort correlate with the neurodevelopmental outcome at 2 years of age. The quantitative detection of DEHSI is not predictive of adverse outcomes. Our automated algorithm might easily provide useful predictive information in daily practice.
Collapse
|
26
|
Parikh NA, Harpster K, He L, Illapani VSP, Khalid FC, Klebanoff MA, O'Shea TM, Altaye M. Novel diffuse white matter abnormality biomarker at term-equivalent age enhances prediction of long-term motor development in very preterm children. Sci Rep 2020; 10:15920. [PMID: 32985533 PMCID: PMC7523012 DOI: 10.1038/s41598-020-72632-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 08/31/2020] [Indexed: 01/09/2023] Open
Abstract
Our objective was to evaluate the independent prognostic value of a novel MRI biomarker-objectively diagnosed diffuse white matter abnormality volume (DWMA; diffuse excessive high signal intensity)-for prediction of motor outcomes in very preterm infants. We prospectively enrolled a geographically-based cohort of very preterm infants without severe brain injury and born before 32 weeks gestational age. Structural brain MRI was obtained at term-equivalent age and DWMA volume was objectively quantified using a published validated algorithm. These results were compared with visually classified DWMA. We used multivariable linear regression to assess the value of DWMA volume, independent of known predictors, to predict motor development as assessed using the Bayley Scales of Infant & Toddler Development, Third Edition at 3 years of age. The mean (SD) gestational age of the cohort was 28.3 (2.4) weeks. In multivariable analyses, controlling for gestational age, sex, and abnormality on structural MRI, DWMA volume was an independent prognostic biomarker of Bayley Motor scores ([Formula: see text]= -12.59 [95% CI -18.70, -6.48] R2 = 0.41). Conversely, visually classified DWMA was not predictive of motor development. In conclusion, objectively quantified DWMA is an independent prognostic biomarker of long-term motor development in very preterm infants and warrants further study.
Collapse
Affiliation(s)
- Nehal A Parikh
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, USA. .,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA. .,Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.
| | - Karen Harpster
- Division of Occupational Therapy and Physical Therapy, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Lili He
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | | | - Fatima Chughtai Khalid
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, USA
| | - Mark A Klebanoff
- Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.,Departments of Pediatrics and Obstetrics and Gynecology, The Ohio State University, Columbus, OH, USA
| | - T Michael O'Shea
- Departments of Pediatrics, University of North Carolina At Chapel Hill, Chapel Hill, NC, USA
| | - Mekibib Altaye
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Division of Biostatistics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| |
Collapse
|
27
|
Dimitrova R, Pietsch M, Christiaens D, Ciarrusta J, Wolfers T, Batalle D, Hughes E, Hutter J, Cordero-Grande L, Price AN, Chew A, Falconer S, Vecchiato K, Steinweg JK, Carney O, Rutherford MA, Tournier JD, Counsell SJ, Marquand AF, Rueckert D, Hajnal JV, McAlonan G, Edwards AD, O’Muircheartaigh J. Heterogeneity in Brain Microstructural Development Following Preterm Birth. Cereb Cortex 2020; 30:4800-4810. [PMID: 32306044 PMCID: PMC7391275 DOI: 10.1093/cercor/bhaa069] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 01/24/2020] [Accepted: 02/23/2020] [Indexed: 01/08/2023] Open
Abstract
Preterm-born children are at increased risk of lifelong neurodevelopmental difficulties. Group-wise analyses of magnetic resonance imaging show many differences between preterm- and term-born infants but do not reliably predict neurocognitive prognosis for individual infants. This might be due to the unrecognized heterogeneity of cerebral injury within the preterm group. This study aimed to determine whether atypical brain microstructural development following preterm birth is significantly variable between infants. Using Gaussian process regression, a technique that allows a single-individual inference, we characterized typical variation of brain microstructure using maps of fractional anisotropy and mean diffusivity in a sample of 270 term-born neonates. Then, we compared 82 preterm infants to these normative values to identify brain regions with atypical microstructure and relate observed deviations to degree of prematurity and neurocognition at 18 months. Preterm infants showed strikingly heterogeneous deviations from typical development, with little spatial overlap between infants. Greater and more extensive deviations, captured by a whole brain atypicality index, were associated with more extreme prematurity and predicted poorer cognitive and language abilities at 18 months. Brain microstructural development after preterm birth is highly variable between individual infants. This poorly understood heterogeneity likely relates to both the etiology and prognosis of brain injury.
Collapse
Affiliation(s)
- Ralica Dimitrova
- Centre for the Developing Brain, Department of Perinatal Imaging and Health, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, SE1 7EH, UK
- Department for Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, SE5 8AF, UK
| | - Maximilian Pietsch
- Centre for the Developing Brain, Department of Perinatal Imaging and Health, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, SE1 7EH, UK
| | - Daan Christiaens
- Centre for the Developing Brain, Department of Perinatal Imaging and Health, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, SE1 7EH, UK
- Department of Electrical Engineering, ESAT/PSI, KU Leuven, Leuven, 3001, Belgium
| | - Judit Ciarrusta
- Centre for the Developing Brain, Department of Perinatal Imaging and Health, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, SE1 7EH, UK
- Department for Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, SE5 8AF, UK
| | - Thomas Wolfers
- Donders Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radbound University, Nijmegen, 6525EN, the Netherlands
- Department of Cognitive Neuroscience, Radbound University Medical Centre, Nijmegen, 6525EN, the Netherlands
| | - Dafnis Batalle
- Centre for the Developing Brain, Department of Perinatal Imaging and Health, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, SE1 7EH, UK
- Department for Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, SE5 8AF, UK
| | - Emer Hughes
- Centre for the Developing Brain, Department of Perinatal Imaging and Health, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, SE1 7EH, UK
| | - Jana Hutter
- Centre for the Developing Brain, Department of Perinatal Imaging and Health, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, SE1 7EH, UK
| | - Lucilio Cordero-Grande
- Centre for the Developing Brain, Department of Perinatal Imaging and Health, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, SE1 7EH, UK
- Biomedical Image Technologies, ETSI Telecomunicacion, Universidad Politecnica de Madrid and CIBER-BBN, Madrid, 28040, Spain
| | - Anthony N Price
- Centre for the Developing Brain, Department of Perinatal Imaging and Health, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, SE1 7EH, UK
| | - Andrew Chew
- Centre for the Developing Brain, Department of Perinatal Imaging and Health, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, SE1 7EH, UK
| | - Shona Falconer
- Centre for the Developing Brain, Department of Perinatal Imaging and Health, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, SE1 7EH, UK
| | - Katy Vecchiato
- Centre for the Developing Brain, Department of Perinatal Imaging and Health, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, SE1 7EH, UK
- Department for Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, SE5 8AF, UK
| | - Johannes K Steinweg
- Centre for the Developing Brain, Department of Perinatal Imaging and Health, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, SE1 7EH, UK
| | - Olivia Carney
- Centre for the Developing Brain, Department of Perinatal Imaging and Health, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, SE1 7EH, UK
| | - Mary A Rutherford
- Centre for the Developing Brain, Department of Perinatal Imaging and Health, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, SE1 7EH, UK
| | - J-Donald Tournier
- Centre for the Developing Brain, Department of Perinatal Imaging and Health, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, SE1 7EH, UK
| | - Serena J Counsell
- Centre for the Developing Brain, Department of Perinatal Imaging and Health, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, SE1 7EH, UK
| | - Andre F Marquand
- Donders Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radbound University, Nijmegen, 6525EN, the Netherlands
- Department of Cognitive Neuroscience, Radbound University Medical Centre, Nijmegen, 6525EN, the Netherlands
| | - Daniel Rueckert
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London, SW7 2AZ, UK
| | - Joseph V Hajnal
- Centre for the Developing Brain, Department of Perinatal Imaging and Health, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, SE1 7EH, UK
| | - Grainne McAlonan
- Department for Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, SE5 8AF, UK
- MRC Centre for Neurodevelopmental Disorders, King’s College London, London, SE1 1UL, UK
- South London and Maudsley NHS Foundation Trust, London, SE5 8AZ, UK
| | - A David Edwards
- Centre for the Developing Brain, Department of Perinatal Imaging and Health, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, SE1 7EH, UK
- MRC Centre for Neurodevelopmental Disorders, King’s College London, London, SE1 1UL, UK
| | - Jonathan O’Muircheartaigh
- Centre for the Developing Brain, Department of Perinatal Imaging and Health, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, SE1 7EH, UK
- Department for Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, SE5 8AF, UK
- MRC Centre for Neurodevelopmental Disorders, King’s College London, London, SE1 1UL, UK
| |
Collapse
|
28
|
Gano D, Cowan FM, de Vries LS. Cerebral palsy after very preterm birth - an imaging perspective. Semin Fetal Neonatal Med 2020; 25:101106. [PMID: 32317152 DOI: 10.1016/j.siny.2020.101106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Neonatal brain imaging undoubtedly can provide the most accurate information from which to determine whether cerebral palsy is likely to affect an individual infant born preterm. The sensitivity and specificity of that information is different between cranial ultrasound and MRI, depending on what approaches and sequences are used and the timing of the examinations. In this chapter we highlight the changing incidence of different patterns of brain injury in the preterm newborn and present a comparison of cranial ultrasound and MRI for predicting cerebral palsy in preterm infants affected by the commoner intracranial pathologies.
Collapse
Affiliation(s)
- Dawn Gano
- Department of Neurology, University of California, San Francisco, CA, United States
| | - Frances M Cowan
- Department of Paediatrics, Imperial College London, London, United Kingdom
| | - Linda S de Vries
- Department of Neonatology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands.
| |
Collapse
|
29
|
Parikh NA, He L, Illapani VSP, Altaye M, Folger AT, Yeates KO. Objectively Diagnosed Diffuse White Matter Abnormality at Term Is an Independent Predictor of Cognitive and Language Outcomes in Infants Born Very Preterm. J Pediatr 2020; 220:56-63. [PMID: 32147220 PMCID: PMC7583652 DOI: 10.1016/j.jpeds.2020.01.034] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 12/07/2019] [Accepted: 01/14/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To externally validate the independent value of objectively diagnosed diffuse white matter abnormality (DWMA; also known as diffuse excessive high signal intensity) volume to predict neurodevelopmental outcomes in very preterm infants (≤31 weeks of gestational age). STUDY DESIGN A prospective, multicenter, regional population-based cohort study in 98 very preterm infants without severe brain injury on magnetic resonance imaging (MRI). DWMA volume was diagnosed objectively on structural MRI at term-equivalent age using our published algorithm. Multivariable linear regression was used to assess the value of DWMA volume to predict cognitive and language scores on the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III) at 2 years corrected age. RESULTS Of the infants who returned for follow-up (n = 74), the mean (SD) gestational age was 28.2 (2.4) weeks, and 42 (56.8%) were boys. In bivariable analyses, DWMA volume was a significant predictor of Bayley-III cognitive and language scores. In multivariable analyses, controlling for known predictors of Bayley-III scores (ie, socioeconomic status, gestational age, sex, and global brain abnormality score), DWMA volume remained a significant predictor of cognitive (P < .001) and language (P = .04) scores at 2 years. When dichotomized, objectively diagnosed severe DWMA was a significant predictor of cognitive and language impairments, whereas visual qualitative diagnosis of DWMA was a poor predictor. CONCLUSIONS In this multicenter, prospective cohort study, we externally validated our previous findings that objectively diagnosed DWMA is an independent predictor of cognitive and language development in very preterm infants. We also demonstrated again that visually-diagnosed DWMA is not predictive of neurodevelopmental outcomes.
Collapse
Affiliation(s)
- Nehal A. Parikh
- Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH,Center for Perinatal Research, The Research Institute at Nationwide Children’s Hospital, Columbus, OH,Imaging Research Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH,Corresponding author’s contact information: Nehal A. Parikh, DO, MS, Professor of Pediatrics, Cincinnati Children’s Hospital, 3333 Burnet Ave, MLC 7009, Cincinnati, OH 45229, (513) 636-7584 (Business), (513) 803-0969 (Fax),
| | - Lili He
- Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH,Imaging Research Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Venkata Sita Priyanka Illapani
- Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Mekibib Altaye
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH,Divison of Biostatistics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Alonzo T. Folger
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH,Divison of Biostatistics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Keith O. Yeates
- Department of Psychology, AlbertaChildren’s Hospital Research Institute and Hotchkiss Brain Institute, and University of Calgary, Alberta, Canada
| |
Collapse
|
30
|
Hedderich DM, Boeckh-Behrens T, Bäuml JG, Menegaux A, Daamen M, Zimmer C, Bartmann P, Scheef L, Boecker H, Wolke D, Sorg C, Spiro JE. Sequelae of Premature Birth in Young Adults : Incidental Findings on Routine Brain MRI. Clin Neuroradiol 2020; 31:325-333. [PMID: 32291477 PMCID: PMC8211575 DOI: 10.1007/s00062-020-00901-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 02/10/2020] [Indexed: 01/14/2023]
Abstract
Background and Purpose Qualitative studies about the abnormalities appreciated on routine magnetic resonance imaging (MRI) sequences in prematurely born adults are lacking. This article aimed at filling this knowledge gap by (1) qualitatively describing routine imaging findings in prematurely born adults, (2) evaluating measures for routine image interpretation and (3) investigating the impact of perinatal variables related to premature birth. Methods In this study two board-certified radiologists assessed T1-weighted and FLAIR-weighted images of 100 prematurely born adults born very preterm (VP <32 weeks) and/or at very low birth weight (VLBW <1500 g) and 106 controls born at full term (FT) (mean age 26.8 ± 0.7 years). The number of white matter lesions (WML) was counted according to localization. Lateral ventricle volume (LVV) was evaluated subjectively and by measurements of Evans’ index (EI) and frontal-occipital-horn ratio (FOHR). Freesurfer-based volumetry served as reference standard. Miscellaneous incidental findings were noted as free text. Results The LVV was increased in 24.7% of VP/VLBW individuals and significantly larger than in FT controls. This was best identified by measurement of FOHR (AUC = 0.928). Ventricular enlargement was predicted by low gestational age (odds ratio: 0.71, 95% CI 0.51–0.98) and presence of neonatal intracranial hemorrhage (odds ratio: 0.26, 95% CI 0.07–0.92). The numbers of deep and periventricular WML were increased while subcortical WMLs were not. Conclusion Enlargement of the LVV and deep and periventricular WMLs are typical sequelae of premature birth that can be appreciated on routine brain MRI. To increase sensitivity of abnormal LVV detection, measurement of FOHR seems feasible in clinical practice. Electronic supplementary material The online version of this article (10.1007/s00062-020-00901-6) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Dennis M Hedderich
- TUM-NIC Neuroimaging Center, Munich, Germany. .,Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Tobias Boeckh-Behrens
- TUM-NIC Neuroimaging Center, Munich, Germany.,Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Ismaninger Str. 22, 81675, Munich, Germany
| | - Josef G Bäuml
- TUM-NIC Neuroimaging Center, Munich, Germany.,Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Ismaninger Str. 22, 81675, Munich, Germany
| | - Aurore Menegaux
- TUM-NIC Neuroimaging Center, Munich, Germany.,Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Ismaninger Str. 22, 81675, Munich, Germany
| | - Marcel Daamen
- Functional Neuroimaging Group, Department of Radiology, University Hospital Bonn, Bonn, Germany
| | - Claus Zimmer
- Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Ismaninger Str. 22, 81675, Munich, Germany
| | - Peter Bartmann
- Department of Neonatology, University Hospital Bonn, Bonn, Germany
| | - Lukas Scheef
- Functional Neuroimaging Group, Department of Radiology, University Hospital Bonn, Bonn, Germany
| | - Henning Boecker
- Functional Neuroimaging Group, Department of Radiology, University Hospital Bonn, Bonn, Germany
| | - Dieter Wolke
- Department of Psychology, University of Warwick, Coventry, UK.,Warwick Medical School, University of Warwick, Coventry, UK
| | - Christian Sorg
- TUM-NIC Neuroimaging Center, Munich, Germany.,Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Ismaninger Str. 22, 81675, Munich, Germany.,Department of Psychiatry, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| | - Judith E Spiro
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| |
Collapse
|
31
|
O'Muircheartaigh J, Robinson EC, Pietsch M, Wolfers T, Aljabar P, Grande LC, Teixeira RPAG, Bozek J, Schuh A, Makropoulos A, Batalle D, Hutter J, Vecchiato K, Steinweg JK, Fitzgibbon S, Hughes E, Price AN, Marquand A, Reuckert D, Rutherford M, Hajnal JV, Counsell SJ, Edwards AD. Modelling brain development to detect white matter injury in term and preterm born neonates. Brain 2020; 143:467-479. [PMID: 31942938 PMCID: PMC7009541 DOI: 10.1093/brain/awz412] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 10/30/2019] [Accepted: 11/19/2019] [Indexed: 01/09/2023] Open
Abstract
Premature birth occurs during a period of rapid brain growth. In this context, interpreting clinical neuroimaging can be complicated by the typical changes in brain contrast, size and gyrification occurring in the background to any pathology. To model and describe this evolving background in brain shape and contrast, we used a Bayesian regression technique, Gaussian process regression, adapted to multiple correlated outputs. Using MRI, we simultaneously estimated brain tissue intensity on T1- and T2-weighted scans as well as local tissue shape in a large cohort of 408 neonates scanned cross-sectionally across the perinatal period. The resulting model provided a continuous estimate of brain shape and intensity, appropriate to age at scan, degree of prematurity and sex. Next, we investigated the clinical utility of this model to detect focal white matter injury. In individual neonates, we calculated deviations of a neonate's observed MRI from that predicted by the model to detect punctate white matter lesions with very good accuracy (area under the curve > 0.95). To investigate longitudinal consistency of the model, we calculated model deviations in 46 neonates who were scanned on a second occasion. These infants' voxelwise deviations from the model could be used to identify them from the other 408 images in 83% (T2-weighted) and 76% (T1-weighted) of cases, indicating an anatomical fingerprint. Our approach provides accurate estimates of non-linear changes in brain tissue intensity and shape with clear potential for radiological use.
Collapse
Affiliation(s)
- Jonathan O'Muircheartaigh
- Department of Forensic and Neurodevelopmental Sciences, Sackler Institute for Translational Neurodevelopment, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Centre for the Developing Brain, School Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, London, UK
- MRC Centre for Neurodevelopmental Disorders, King’s College London, London, UK
| | - Emma C Robinson
- Centre for the Developing Brain, School Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, London, UK
- Department of Bioengineering, Imperial College London, London, UK
| | - Maximillian Pietsch
- Centre for the Developing Brain, School Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, London, UK
| | - Thomas Wolfers
- Donders Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
- Department of Cognitive Neuroscience, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Paul Aljabar
- Centre for the Developing Brain, School Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, London, UK
| | - Lucilio Cordero Grande
- Centre for the Developing Brain, School Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, London, UK
| | - Rui P A G Teixeira
- Centre for the Developing Brain, School Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, London, UK
| | - Jelena Bozek
- Faculty of Electrical Engineering and Computing, University of Zagreb, Zagreb, Croatia
| | - Andreas Schuh
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London, UK
| | - Antonios Makropoulos
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London, UK
| | - Dafnis Batalle
- Department of Forensic and Neurodevelopmental Sciences, Sackler Institute for Translational Neurodevelopment, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Centre for the Developing Brain, School Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, London, UK
| | - Jana Hutter
- Centre for the Developing Brain, School Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, London, UK
| | - Katy Vecchiato
- Centre for the Developing Brain, School Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, London, UK
| | - Johannes K Steinweg
- Centre for the Developing Brain, School Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, London, UK
| | - Sean Fitzgibbon
- Centre for Functional MRI of the Brain (FMRIB), Wellcome Centre for Integrative Neuroimaging, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Emer Hughes
- Centre for the Developing Brain, School Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, London, UK
| | - Anthony N Price
- Centre for the Developing Brain, School Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, London, UK
| | - Andre Marquand
- Donders Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
- Department of Cognitive Neuroscience, Radboud University Medical Centre, Nijmegen, The Netherlands
- Department of Neuroimaging, Centre for Neuroimaging Sciences, Institute of Psychiatry, King’s College London, London, UK
| | - Daniel Reuckert
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London, UK
| | - Mary Rutherford
- Centre for the Developing Brain, School Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, London, UK
| | - Joseph V Hajnal
- Centre for the Developing Brain, School Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, London, UK
| | - Serena J Counsell
- Centre for the Developing Brain, School Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, London, UK
| | - A David Edwards
- Centre for the Developing Brain, School Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, London, UK
- MRC Centre for Neurodevelopmental Disorders, King’s College London, London, UK
| |
Collapse
|
32
|
Merhar SL, Parikh NA, Braimah A, Poindexter BB, Tkach J, Kline-Fath B. White Matter Injury and Structural Anomalies in Infants with Prenatal Opioid Exposure. AJNR Am J Neuroradiol 2019; 40:2161-2165. [PMID: 31624119 DOI: 10.3174/ajnr.a6282] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 09/03/2019] [Indexed: 01/24/2023]
Abstract
Previous studies have not found structural injury or brain malformations in infants and children with prenatal opioid exposure. As part of an ongoing study evaluating neuroimaging in infants with prenatal opioid exposure, we reviewed structural brain MR imaging in 20 term infants with prenatal opioid exposure and 20 term controls at 4-8 weeks of age. We found that 8 of the 20 opioid-exposed infants had punctate white matter lesions or white matter signal abnormality on structural MR imaging, and 2 of the opioid-exposed infants had a septopreoptic fusion anomaly. No controls had white matter injury or structural malformations. Our findings underscore the importance of clinical neurodevelopmental follow-up and the need for more comprehensive imaging and long-term outcomes research following prenatal opioid exposure.
Collapse
Affiliation(s)
- S L Merhar
- From the Perinatal Institute, Division of Neonatology (S.L.M., N.A.P., B.B.P.)
- Department of Pediatrics (S.L.M., N.A.P., B.B.P.), University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - N A Parikh
- From the Perinatal Institute, Division of Neonatology (S.L.M., N.A.P., B.B.P.)
- Department of Pediatrics (S.L.M., N.A.P., B.B.P.), University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - A Braimah
- Pediatric Neuroimaging Research Consortium (A.B.)
| | - B B Poindexter
- From the Perinatal Institute, Division of Neonatology (S.L.M., N.A.P., B.B.P.)
- Department of Pediatrics (S.L.M., N.A.P., B.B.P.), University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - J Tkach
- Department of Radiology (J.T., B.K.-F.), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - B Kline-Fath
- Department of Radiology (J.T., B.K.-F.), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| |
Collapse
|
33
|
Jansen L, Peeters-Scholte C, Bruine SWD, van den Berg-Huysmans A, van Klink J, van Steenis A, Rijken M, Vermeiren R, Steggerda S. Classroom-evaluated school performance at nine years of age after very preterm birth. Early Hum Dev 2019; 140:104834. [PMID: 31671378 DOI: 10.1016/j.earlhumdev.2019.104834] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 08/13/2019] [Accepted: 08/13/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To determine classroom-evaluated school performance nine years after preterm birth, predicted by perinatal risk factors and neonatal brain abnormalities. STUDY DESIGN Children were recruited from a consecutive cohort of 113 preterm infants (<32 weeks' gestation), participating in a longitudinal prospective study, investigating brain injury and neurodevelopmental outcome. Data on perinatal risk factors, presence of brain injury at term-equivalent age, and maternal education were collected. Information on school performance included enrollment in special (primary) education, grade repetition and school results from the nationwide standardized Dutch Pupil Monitoring System regarding reading comprehension, spelling, and mathematics. RESULTS Information on school enrollment was available for 87 children (77%), of whom 7 (8%) were in special primary education and 19 (22%) repeated a grade. This was significantly higher compared to national rates (p ≤ .05). Results on school performance were available for 74 children (65%) and showed clearly below average scores in reading comprehension (p = .006), spelling (p = .014) and mathematics (p < .001). Univariate analysis showed that lower performance in reading comprehension was predicted by male sex and low maternal education; spelling by male sex; and mathematics by Bronchopulmonary Dysplasia, white matter injury and maternal education. In a multivariate model, male sex and maternal education were predictive for reading comprehension and white matter injury for mathematics. CONCLUSION Preterm born children more often need special primary education and have higher grade repeat rates. They perform poorer on reading comprehension, spelling and mathematics. Regular follow-up remains important for preterm born children during school age.
Collapse
Affiliation(s)
- Lisette Jansen
- Department of Medical Psychology, Leiden University Medical Center, the Netherlands.
| | | | | | | | - Jeanine van Klink
- Department of Medical Psychology, Leiden University Medical Center, the Netherlands
| | - Andrea van Steenis
- Department of Neonatology, Leiden University Medical Center, the Netherlands
| | - Monique Rijken
- Department of Neonatology, Leiden University Medical Center, the Netherlands
| | - Robert Vermeiren
- Department of Child and Adolescent Psychiatry, University Medical Center, Curium, Leiden, the Netherlands
| | - Sylke Steggerda
- Department of Neonatology, Leiden University Medical Center, the Netherlands
| |
Collapse
|
34
|
Gotardo JW, Volkmer NDFV, Stangler GP, Dornelles AD, Bohrer BBDA, Carvalho CG. Impact of peri-intraventricular haemorrhage and periventricular leukomalacia in the neurodevelopment of preterms: A systematic review and meta-analysis. PLoS One 2019; 14:e0223427. [PMID: 31600248 PMCID: PMC6786801 DOI: 10.1371/journal.pone.0223427] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 09/20/2019] [Indexed: 11/29/2022] Open
Abstract
CONTEXT Whether all degrees of periventricular leukomalacia (PVL) and peri-intraventricular haemorrhage (PIVH) have a negative impact on neurodevelopment. OBJECTIVE To determine the impact of PVL and PIVH in the incidence of cerebral palsy, sensorineural impairment and development scores in preterm neonates. Registered in PROSPERO (CRD42017073113). DATA SOURCES PubMed, Embase, SciELO, LILACS, and Cochrane databases. STUDY SELECTION Prospective cohort studies evaluating neurodevelopment in children born preterm which performed brain imaging in the neonatal period. DATA EXTRACTION Two independent researchers extracted data using a predesigned data extraction sheet. STATISTICAL METHODS A random-effects model was used, with Mantel-Haenszel approach and a Sidik-Jonkman method for the estimation of variances, combined with Hartung-Knapp-Sidik-Jonkman correction. Heterogeneity was assessed through the I2 statistic and sensitivity analysis were performed when possible. No funnel plots were generated but publication bias was discussed as a possible limitation. RESULTS Our analysis concluded premature children with any degree of PIVH are at increased risk for cerebral palsy (CP) when compared to children with no PIVH (3.4, 95% CI 1.60-7.22; 9 studies), a finding that persisted on subgroup analysis for studies with mean birth weight of less than 1000 grams. Similarly, PVL was associated with CP, both in its cystic (19.12, 95% CI 4.57-79.90; 2 studies) and non-cystic form (9.27, 95% CI 5.93-14.50; 2 studies). We also found children with cystic PVL may be at risk for visual and hearing impairment compared to normal children, but evidence is weak. LIMITATIONS Major limitations were the lack of data for PVL in general, especially for the outcome of neurodevelopment, the high heterogeneity among methods used to assess neurodevelopment and the small number of studies, which led to meta-analysis with high heterogeneity and wide confidence intervals. CONCLUSIONS There was no evidence supporting the hypothesis that PIVH causes impairment in neuropsychomotor development in our meta-analysis, but review of newer studies show an increased risk for lower intelligence scores in children with severe lesions, both PIVH and PVL. There is evidence to support the hypothesis that children with any degree of PIVH, especially those born below 1000 grams and those with severe haemorrhage, are at increased risk of developing CP, as well as children with PVL, both cystic and non-cystic.
Collapse
|
35
|
Cayam-Rand D, Guo T, Grunau RE, Benavente-Fernández I, Synnes A, Chau V, Branson H, Latal B, McQuillen P, Miller SP. Predicting developmental outcomes in preterm infants: A simple white matter injury imaging rule. Neurology 2019; 93:e1231-e1240. [PMID: 31467250 PMCID: PMC7011867 DOI: 10.1212/wnl.0000000000008172] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 05/03/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To develop a simple imaging rule to predict neurodevelopmental outcomes at 4.5 years in a cohort of preterm neonates with white matter injury (WMI) based on lesion location and examine whether clinical variables enhance prediction. METHODS Sixty-eight preterm neonates born 24-32 weeks' gestation (median 27.7 weeks) were diagnosed with WMI on early brain MRI scans (median 32.3 weeks). 3D T1-weighted images of 60 neonates with 4.5-year outcomes were reformatted and aligned to the posterior commissure-eye plane and WMI was classified by location: anterior or posterior-only to the midventricle line on the reformatted axial plane. Adverse outcomes at 4.5 years were defined as Wechsler Preschool and Primary Scale of Intelligence full-scale IQ <85, cerebral palsy, or Movement Assessment Battery for Children, second edition percentile <5. The prediction of adverse outcome by WMI location, intraventricular hemorrhage (IVH), bronchopulmonary dysplasia (BPD), and retinopathy of prematurity (ROP) was assessed using multivariable logistic regression. RESULTS Six children had adverse cognitive outcomes and 17 had adverse motor outcomes. WMI location predicted cognitive outcomes in 90% (area under receiver operating characteristic curve [AUC] 0.80) and motor outcomes in 85% (AUC 0.75). Adding IVH, BPD, and ROP to the model enhances the predictive strength for cognitive and motor outcomes (AUC 0.83 and 0.88, respectively). Rule performance was confirmed in an independent cohort of children with WMI. CONCLUSIONS WMI on early MRI can be classified by location to predict preschool age outcomes in children born preterm. The predictive value of this WMI classification is enhanced by considering clinical factors apparent by term-equivalent age.
Collapse
Affiliation(s)
- Dalit Cayam-Rand
- From the Departments of Paediatrics (Neurology) (D.C.-R., T.G., I.B.-F., V.C., S.P.M.) and Radiology (H.B.), The Hospital for Sick Children and the University of Toronto; BC Children's Hospital Research Institute (R.E.G., A.S.); Department of Pediatrics (Neonatology) (R.E.G., A.S.), University of British Columbia and BC Women's Hospital and Health Centre, Vancouver, Canada; Department of Pediatrics (Neonatology) (I.B.-F.), University Hospital Puerta del Mar, Cadiz, Spain; Department of Pediatrics (Child Development Center) (B.L.), University Children's Hospital Zurich, Switzerland; and Department of Pediatrics (P.M.), University of California, San Francisco
| | - Ting Guo
- From the Departments of Paediatrics (Neurology) (D.C.-R., T.G., I.B.-F., V.C., S.P.M.) and Radiology (H.B.), The Hospital for Sick Children and the University of Toronto; BC Children's Hospital Research Institute (R.E.G., A.S.); Department of Pediatrics (Neonatology) (R.E.G., A.S.), University of British Columbia and BC Women's Hospital and Health Centre, Vancouver, Canada; Department of Pediatrics (Neonatology) (I.B.-F.), University Hospital Puerta del Mar, Cadiz, Spain; Department of Pediatrics (Child Development Center) (B.L.), University Children's Hospital Zurich, Switzerland; and Department of Pediatrics (P.M.), University of California, San Francisco
| | - Ruth E Grunau
- From the Departments of Paediatrics (Neurology) (D.C.-R., T.G., I.B.-F., V.C., S.P.M.) and Radiology (H.B.), The Hospital for Sick Children and the University of Toronto; BC Children's Hospital Research Institute (R.E.G., A.S.); Department of Pediatrics (Neonatology) (R.E.G., A.S.), University of British Columbia and BC Women's Hospital and Health Centre, Vancouver, Canada; Department of Pediatrics (Neonatology) (I.B.-F.), University Hospital Puerta del Mar, Cadiz, Spain; Department of Pediatrics (Child Development Center) (B.L.), University Children's Hospital Zurich, Switzerland; and Department of Pediatrics (P.M.), University of California, San Francisco
| | - Isabel Benavente-Fernández
- From the Departments of Paediatrics (Neurology) (D.C.-R., T.G., I.B.-F., V.C., S.P.M.) and Radiology (H.B.), The Hospital for Sick Children and the University of Toronto; BC Children's Hospital Research Institute (R.E.G., A.S.); Department of Pediatrics (Neonatology) (R.E.G., A.S.), University of British Columbia and BC Women's Hospital and Health Centre, Vancouver, Canada; Department of Pediatrics (Neonatology) (I.B.-F.), University Hospital Puerta del Mar, Cadiz, Spain; Department of Pediatrics (Child Development Center) (B.L.), University Children's Hospital Zurich, Switzerland; and Department of Pediatrics (P.M.), University of California, San Francisco
| | - Anne Synnes
- From the Departments of Paediatrics (Neurology) (D.C.-R., T.G., I.B.-F., V.C., S.P.M.) and Radiology (H.B.), The Hospital for Sick Children and the University of Toronto; BC Children's Hospital Research Institute (R.E.G., A.S.); Department of Pediatrics (Neonatology) (R.E.G., A.S.), University of British Columbia and BC Women's Hospital and Health Centre, Vancouver, Canada; Department of Pediatrics (Neonatology) (I.B.-F.), University Hospital Puerta del Mar, Cadiz, Spain; Department of Pediatrics (Child Development Center) (B.L.), University Children's Hospital Zurich, Switzerland; and Department of Pediatrics (P.M.), University of California, San Francisco
| | - Vann Chau
- From the Departments of Paediatrics (Neurology) (D.C.-R., T.G., I.B.-F., V.C., S.P.M.) and Radiology (H.B.), The Hospital for Sick Children and the University of Toronto; BC Children's Hospital Research Institute (R.E.G., A.S.); Department of Pediatrics (Neonatology) (R.E.G., A.S.), University of British Columbia and BC Women's Hospital and Health Centre, Vancouver, Canada; Department of Pediatrics (Neonatology) (I.B.-F.), University Hospital Puerta del Mar, Cadiz, Spain; Department of Pediatrics (Child Development Center) (B.L.), University Children's Hospital Zurich, Switzerland; and Department of Pediatrics (P.M.), University of California, San Francisco
| | - Helen Branson
- From the Departments of Paediatrics (Neurology) (D.C.-R., T.G., I.B.-F., V.C., S.P.M.) and Radiology (H.B.), The Hospital for Sick Children and the University of Toronto; BC Children's Hospital Research Institute (R.E.G., A.S.); Department of Pediatrics (Neonatology) (R.E.G., A.S.), University of British Columbia and BC Women's Hospital and Health Centre, Vancouver, Canada; Department of Pediatrics (Neonatology) (I.B.-F.), University Hospital Puerta del Mar, Cadiz, Spain; Department of Pediatrics (Child Development Center) (B.L.), University Children's Hospital Zurich, Switzerland; and Department of Pediatrics (P.M.), University of California, San Francisco
| | - Beatrice Latal
- From the Departments of Paediatrics (Neurology) (D.C.-R., T.G., I.B.-F., V.C., S.P.M.) and Radiology (H.B.), The Hospital for Sick Children and the University of Toronto; BC Children's Hospital Research Institute (R.E.G., A.S.); Department of Pediatrics (Neonatology) (R.E.G., A.S.), University of British Columbia and BC Women's Hospital and Health Centre, Vancouver, Canada; Department of Pediatrics (Neonatology) (I.B.-F.), University Hospital Puerta del Mar, Cadiz, Spain; Department of Pediatrics (Child Development Center) (B.L.), University Children's Hospital Zurich, Switzerland; and Department of Pediatrics (P.M.), University of California, San Francisco
| | - Patrick McQuillen
- From the Departments of Paediatrics (Neurology) (D.C.-R., T.G., I.B.-F., V.C., S.P.M.) and Radiology (H.B.), The Hospital for Sick Children and the University of Toronto; BC Children's Hospital Research Institute (R.E.G., A.S.); Department of Pediatrics (Neonatology) (R.E.G., A.S.), University of British Columbia and BC Women's Hospital and Health Centre, Vancouver, Canada; Department of Pediatrics (Neonatology) (I.B.-F.), University Hospital Puerta del Mar, Cadiz, Spain; Department of Pediatrics (Child Development Center) (B.L.), University Children's Hospital Zurich, Switzerland; and Department of Pediatrics (P.M.), University of California, San Francisco
| | - Steven P Miller
- From the Departments of Paediatrics (Neurology) (D.C.-R., T.G., I.B.-F., V.C., S.P.M.) and Radiology (H.B.), The Hospital for Sick Children and the University of Toronto; BC Children's Hospital Research Institute (R.E.G., A.S.); Department of Pediatrics (Neonatology) (R.E.G., A.S.), University of British Columbia and BC Women's Hospital and Health Centre, Vancouver, Canada; Department of Pediatrics (Neonatology) (I.B.-F.), University Hospital Puerta del Mar, Cadiz, Spain; Department of Pediatrics (Child Development Center) (B.L.), University Children's Hospital Zurich, Switzerland; and Department of Pediatrics (P.M.), University of California, San Francisco.
| |
Collapse
|
36
|
Detection of occult abnormalities in the deep gray matter nuclei of neonates with punctate white matter lesions by magnetic resonance spectroscopy. Neuroradiology 2019; 61:1447-1456. [PMID: 31511919 DOI: 10.1007/s00234-019-02291-0] [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: 05/06/2019] [Accepted: 09/02/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Punctate white matter lesions (PWML) are common in preterm neonates and have also been reported in the full term. While most studies focus on white matter abnormalities, gray matter (GM) alterations are generally ignored due to the lack of abnormalities on conventional MRI. This study aims to investigate whether magnetic resonance spectroscopy is a sensitive and practical method to detect occult alterations of deep GM nuclei in these neonates. METHODS Neonates with PWML and controls with no MRI abnormalities were retrospectively studied. Apparent diffusion coefficient values and metabolic ratios (Cho/Cr, NAA/Cho, and NAA/Cr) in the lenticular nucleus and the thalamus were compared between the PWML and control groups. RESULTS Forty-two neonates with PWML (grades I, II, and III contained 14, 21, and 7 subjects, respectively) and 50 controls were enrolled. Apparent diffusion coefficient values in the lenticular nucleus and the thalamus were not significantly different between the PWML and the control groups. The NAA/Cho ratio was significantly lower in the PWML group than in the control group in both regions, whereas a lower NAA/Cr ratio was only observed in the thalamus. Significantly lower ratios of NAA/Cho in both regions and NAA/Cr in the thalamus were detected in the grade II and III subgroup, whereas the thalamic NAA/Cho ratio was decreased in the grade I group compared with controls. CONCLUSIONS Magnetic resonance spectroscopy is a sensitive method for detecting the occult deep GM abnormalities for the study cohort of neonates with PWML when compared with subjects without PWML.
Collapse
|
37
|
Parodi A, Malova M, Cardiello V, Raffa S, Re M, Calevo MG, Severino M, Tortora D, Morana G, Rossi A, Ramenghi LA. Punctate white matter lesions of preterm infants: Risk factor analysis. Eur J Paediatr Neurol 2019; 23:733-739. [PMID: 31307922 DOI: 10.1016/j.ejpn.2019.06.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 06/17/2019] [Accepted: 06/18/2019] [Indexed: 11/18/2022]
Abstract
AIM Punctate white matter lesions (PWML) are frequently detected in preterm infants undergoing brain MRI at term equivalent age (TEA). The aims of this study were to assess prevalence of PWML and to identify risk factors for PWML in VLBW infants. METHODS Brain MRI scans obtained at TEA and clinical charts of a consecutive sample of very low birth weight (VLBW) infants admitted to Gaslini Children's Hospital NICU between 2012 and 2016 were retrospectively analyzed. MRI protocol included Susceptibility Weighted Imaging (SWI) sequence in order to identify hemosiderin depositions as a result of previous microbleeds. PWML were classified according to their number (≤6 lesions and >6 lesions) and signal characteristics (SWI+ lesions and SWI- lesions). Univariate and multivariable analysis were performed in order to identify risk factors for PWML (as a whole) and for each subgroup of PWML. RESULTS 321 VLBW infants were included. PWML were identified in 61 subjects (19%), 26 of whom (8% of the study population) had more than 6 lesions. Risk factors for PWML (as a whole) were higher birth weight (OR = 1.001; p = 0.04) and absent or incomplete antenatal steroid course (OR = 2.13; p = 0.02). Risk factors for >6 PWML were need for intubation (OR = 11.9; p = 0.003) and higher Apgar score at 5 min (OR = 1.8; p = 0.02). Presence of GMH-IVH was the only identified risk factor for SWI + lesions. CONCLUSIONS Our results confirm the high prevalence of PWML among VLBW infants. Differentiation between SWI+ and SWI- lesions is crucial as they have different risk factors and may likely represent two different entities.
Collapse
Affiliation(s)
- Alessandro Parodi
- Neonatal Intensive Care Unit, IRCCS Istituto G. Gaslini, Genoa, Italy
| | - Mariya Malova
- Neonatal Intensive Care Unit, IRCCS Istituto G. Gaslini, Genoa, Italy.
| | | | - Sarah Raffa
- Neonatal Intensive Care Unit, IRCCS Istituto G. Gaslini, Genoa, Italy
| | - Martina Re
- Neonatal Intensive Care Unit, IRCCS Istituto G. Gaslini, Genoa, Italy
| | - Maria Grazia Calevo
- Epidemiology, Biostatistics and Committees Unit, IRCCS Istituto G. Gaslini, Genoa, Italy
| | | | | | - Giovanni Morana
- Neuroradiology Unit, IRCCS Istituto G. Gaslini, Genoa, Italy
| | - Andrea Rossi
- Neuroradiology Unit, IRCCS Istituto G. Gaslini, Genoa, Italy
| | | |
Collapse
|
38
|
Li H, Parikh NA, Wang J, Merhar S, Chen M, Parikh M, Holland S, He L. Objective and Automated Detection of Diffuse White Matter Abnormality in Preterm Infants Using Deep Convolutional Neural Networks. Front Neurosci 2019; 13:610. [PMID: 31275101 PMCID: PMC6591530 DOI: 10.3389/fnins.2019.00610] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 05/28/2019] [Indexed: 11/19/2022] Open
Abstract
Diffuse white matter abnormality (DWMA), or diffuse excessive high signal intensity is observed in 50-80% of very preterm infants at term-equivalent age. It is subjectively defined as higher than normal signal intensity in periventricular and subcortical white matter in comparison to normal unmyelinated white matter on T2-weighted MRI images. Despite the well-documented presence of DWMA, it remains debatable whether DWMA represents pathological tissue injury or a transient developmental phenomenon. Manual tracing of DWMA exhibits poor reliability and reproducibility and unduly increases image processing time. Thus, objective and ideally automatic assessment is critical to accurately elucidate the biologic nature of DWMA. We propose a deep learning approach to automatically identify DWMA regions on T2-weighted MRI images. Specifically, we formulated DWMA detection as an image voxel classification task; that is, the voxels on T2-weighted images are treated as samples and exclusively assigned as DWMA or normal white matter voxel classes. To utilize the spatial information of individual voxels, small image patches centered on the given voxels are retrieved. A deep convolutional neural networks (CNN) model was developed to differentiate DWMA and normal voxels. We tested our deep CNN in multiple validation experiments. First, we examined DWMA detection accuracy of our CNN model using computer simulations. This was followed by in vivo assessments in a cohort of very preterm infants (N = 95) using cross-validation and holdout validation. Finally, we tested our approach on an independent preterm cohort (N = 28) to externally validate our model. Our deep CNN model achieved Dice similarity index values ranging from 0.85 to 0.99 for DWMA detection in the aforementioned validation experiments. Our proposed deep CNN model exhibited significantly better performance than other popular machine learning models. We present an objective and automated approach for accurately identifying DWMA that may facilitate the clinical diagnosis of DWMA in very preterm infants.
Collapse
Affiliation(s)
- Hailong Li
- The Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - Nehal A. Parikh
- The Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
- Department of Pediatrics, Nationwide Children’s Hospital, Columbus, OH, United States
| | - Jinghua Wang
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Stephanie Merhar
- The Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Ming Chen
- The Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
- Department of Electronic Engineering and Computing Systems, University of Cincinnati, Cincinnati, OH, United States
| | - Milan Parikh
- The Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - Scott Holland
- Medpace Inc., Cincinnati, OH, United States
- Department of Physics, University of Cincinnati, Cincinnati, OH, United States
| | - Lili He
- The Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| |
Collapse
|
39
|
Nguyen AL, Ding Y, Suffren S, Londono I, Luck D, Lodygensky GA. The brain's kryptonite: Overview of punctate white matter lesions in neonates. Int J Dev Neurosci 2019; 77:77-88. [DOI: 10.1016/j.ijdevneu.2019.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 03/28/2019] [Accepted: 04/26/2019] [Indexed: 10/26/2022] Open
Affiliation(s)
- Annie L.A. Nguyen
- Sainte‐Justine Hospital Research CenterDepartment of PediatricsUniversity of MontrealMontrealH3T 1C5Canada
- The Canadian Neonatal Brain Platform (CNBP)Canada
| | - Yang Ding
- Sainte‐Justine Hospital Research CenterDepartment of PediatricsUniversity of MontrealMontrealH3T 1C5Canada
- The Canadian Neonatal Brain Platform (CNBP)Canada
| | - Sabrina Suffren
- Sainte‐Justine Hospital Research CenterDepartment of PediatricsUniversity of MontrealMontrealH3T 1C5Canada
- The Canadian Neonatal Brain Platform (CNBP)Canada
| | - Irène Londono
- Sainte‐Justine Hospital Research CenterDepartment of PediatricsUniversity of MontrealMontrealH3T 1C5Canada
- The Canadian Neonatal Brain Platform (CNBP)Canada
| | - David Luck
- Sainte‐Justine Hospital Research CenterDepartment of PediatricsUniversity of MontrealMontrealH3T 1C5Canada
- The Canadian Neonatal Brain Platform (CNBP)Canada
| | - Gregory A. Lodygensky
- Sainte‐Justine Hospital Research CenterDepartment of PediatricsUniversity of MontrealMontrealH3T 1C5Canada
- Department of Pharmacology and PhysiologyUniversity of MontrealMontrealH3T 1J4Canada
- The Canadian Neonatal Brain Platform (CNBP)Canada
| |
Collapse
|
40
|
Wang M, Liu H, Liu C, Li X, Jin C, Sun Q, Liu Z, Zheng J, Yang J. Prediction of adverse motor outcome for neonates with punctate white matter lesions by MRI images using radiomics strategy: protocol for a prospective cohort multicentre study. BMJ Open 2019; 9:e023157. [PMID: 30948562 PMCID: PMC6500102 DOI: 10.1136/bmjopen-2018-023157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Punctate white matter lesions (PWML) are prevalent white matter disease in preterm neonates, and may cause motor disorders and even cerebral palsy. However, precise individual-based diagnosis of lesions that result in an adverse motor outcome remains unclear, and an effective method is urgently needed to guide clinical diagnosis and treatment. Advanced radiomics for multiple modalities data can provide a possible look for biomarkers and determine prognosis quantitatively. The study aims to develop and validate a model for prediction of adverse motor outcomes at a corrected age (CA) of 24 months in neonates with PWML. METHODS AND ANALYSIS A prospective cohort multicentre study will be conducted in 11 Chinese hospitals. A total of 394 neonates with PWML confirmed by MRI will undergo a clinical assessment (modified Neonatal Behavioural Assessment Scale). At a CA of 18 months, the motor function will be assessed by Bayley Scales of Infant and Toddler Development-III (Bayley-III). Mild-to-severe motor impairments will be confirmed using the Bayley-III and Gross Motor Function Classification System at a CA of 24 months. During the data collection, the perinatal and clinical information will also be recorded. According to the radiomics strategy, the extracted imaging features and clinical information will be combined for exploratory analysis. After using multiple-modelling methodology, the accuracy, sensitivity and specificity will be computed. Internal and external validations will be used to evaluate the performance of the radiomics model. ETHICS AND DISSEMINATION This study has been approved by the institutional review board of The First Affiliated Hospital of Xi'an Jiaotong University (XJTU1AF2015LSK-172). All parents of eligible participants will be provided with a detailed explanation of the study and written consent will be obtained. The results of this study will be published in peer-reviewed journals and presented at local, national and international conferences. TRIAL REGISTRATION NUMBER NCT02637817; Pre-results.
Collapse
Affiliation(s)
- Miaomiao Wang
- Department of Diagnostic Radiology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Heng Liu
- Department of Diagnostic Radiology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- Department of Biomedical Engineering, School of Life Science and Technology, Xi’an Jiaotong University, Xi’an, China
| | - Congcong Liu
- Department of Diagnostic Radiology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Xianjun Li
- Department of Diagnostic Radiology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Chao Jin
- Department of Diagnostic Radiology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Qinli Sun
- Department of Diagnostic Radiology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- Department of Biomedical Engineering, School of Life Science and Technology, Xi’an Jiaotong University, Xi’an, China
| | - Zhe Liu
- Department of Diagnostic Radiology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- Department of Biomedical Engineering, School of Life Science and Technology, Xi’an Jiaotong University, Xi’an, China
| | - Jie Zheng
- Clinical Research Centre, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Jian Yang
- Department of Diagnostic Radiology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- Department of Biomedical Engineering, School of Life Science and Technology, Xi’an Jiaotong University, Xi’an, China
| |
Collapse
|
41
|
Hayman M, van Wezel-Meijler G, van Straaten H, Brilstra E, Groenendaal F, de Vries LS. Punctate white-matter lesions in the full-term newborn: Underlying aetiology and outcome. Eur J Paediatr Neurol 2019; 23:280-287. [PMID: 30744982 DOI: 10.1016/j.ejpn.2019.01.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 01/16/2019] [Accepted: 01/19/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Punctate white matter lesions (PWMLs) are small focal patches of increased signal intensity (SI) on T1- and decreased SI on T2-weighted magnetic resonance imaging (MRI). To date, there have been few reports of PWMLs in term born infants. OBJECTIVE To identify associated diagnoses and factors predictive of clinical outcome in (near) term infants with PWMLs. METHODS MRI studies and clinical records of (near) term infants, with PWMLs on MRI scans performed in two institutions in the first 28 postnatal days were reviewed. The PWMLs were classified according to their number, pattern and distribution. The medical records were examined to assess the associated diagnoses and determine the neurodevelopmental outcome at >12 months of age. Infants with congenital heart defect(s), those who had neonatal surgery, or those with perinatal arterial ischemic stroke were not eligible for the study. RESULTS Forty-two (near) term infants with PWMLs were included. The major clinical association was perinatal asphyxia, present in 19/42 (45%). Ten (24%) had a history of seizures unrelated to asphyxia or a genetic diagnosis. Eleven (26%) had pathological genetic mutations. Other diagnoses, without seizures were identified in 2 (5%). The lesion load of PWMLs was high (>6) in 30/42 (71%). Evidence of irreversible white matter injury was present in 5 infants who had follow-up MRI performed between 18 and 24 months of age, because of clinical concerns. Five infants died and 37 had follow-up at a median age of 24 months. Neurodevelopmental outcome was poorest amongst 6 infants (16%) whose PWMLs occurred in the setting of a genetic disorder. CONCLUSION PWMLs in (near) term infants represent white matter injury that may evolve into gliosis and/or white matter loss. Infants with PWMLs in the setting of a genetic disorder appeared at most risk of a poor outcome.
Collapse
Affiliation(s)
- Michael Hayman
- Department of Neurology, Royal Children's Hospital, Parkville, Australia; Department of Paediatric Neurology, Monash Children's Hospital, Clayton, Australia; University of Melbourne, Department of Paediatrics, Parkville, Australia; Monash University, Department of Paediatrics, Clayton, Australia; Murdoch Children's Research Institute, Parkville, Australia.
| | | | - Henrica van Straaten
- Department of Neonatology, Isala Women & Children's Hospital, Zwolle, the Netherlands
| | - Eva Brilstra
- Department of Genetics, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Floris Groenendaal
- Department of Neonatology, Wilhelmina Children's Hospital, Utrecht, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Linda S de Vries
- Department of Neonatology, Wilhelmina Children's Hospital, Utrecht, University Medical Center Utrecht, Utrecht University, the Netherlands
| |
Collapse
|
42
|
Mürner-Lavanchy IM, Kidokoro H, Thompson DK, Doyle LW, Cheong JL, Hunt RW, Inder TE, Anderson PJ. Thirteen-Year Outcomes in Very Preterm Children Associated with Diffuse Excessive High Signal Intensity on Neonatal Magnetic Resonance Imaging. J Pediatr 2019; 206:66-71.e1. [PMID: 30414629 PMCID: PMC8898561 DOI: 10.1016/j.jpeds.2018.10.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 08/29/2018] [Accepted: 10/09/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate the association between white matter diffuse excessive high signal intensity (DEHSI) on neonatal magnetic resonance imaging in very preterm infants and neurobehavioral outcomes at the age of 13 years. STUDY DESIGN Magnetic resonance images of very preterm children (<30 weeks gestational age or <1250 g birth weight) were evaluated at term-equivalent age with DEHSI classified into 5 grades. Additionally, visibility of the posterior periventricular crossroads was assessed. General intelligence, memory, attention, executive function, motor abilities, and behavior were examined in 125 children at age 13 years and related to DEHSI grades using linear regression. RESULTS DEHSI was detected in 93% of infants; 21% grade 1, 22% grade 2, 32% grade 3, and 18% grade 4. Neurobehavioral outcomes were similar for all DEHSI groups. There was weak evidence that higher DEHSI grades related to higher verbal IQ and attention and that lower DEHSI grades related to better planning ability. Adjustment for gestational age, birth weight standard score, and sex further weakened these effects. Only 12 children had invisible posterior crossroads and showed slightly poorer outcomes at 13 years of age. CONCLUSIONS There was little evidence that neonatal DEHSI serves as a sensitive biomarker for later impairment. Further investigation on the importance of invisible posterior periventricular crossroads in larger samples is needed.
Collapse
Affiliation(s)
- Ines M. Mürner-Lavanchy
- Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Australia,Murdoch Children’s Research Institute, Melbourne, Australia
| | - Hiroyuki Kidokoro
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Deanne K. Thompson
- Murdoch Children’s Research Institute, Melbourne, Australia,Florey Institute of Neuroscience and Mental Health, Melbourne, Australia,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Lex W. Doyle
- Murdoch Children’s Research Institute, Melbourne, Australia,Department of Paediatrics, University of Melbourne, Melbourne, Australia,Department of Obstetrics and Gynaecology, The Royal Women’s Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Jeanie L.Y. Cheong
- Murdoch Children’s Research Institute, Melbourne, Australia,Department of Paediatrics, University of Melbourne, Melbourne, Australia,Department of Obstetrics and Gynaecology, The Royal Women’s Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Rod W. Hunt
- Murdoch Children’s Research Institute, Melbourne, Australia,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Terrie E. Inder
- Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, USA
| | - Peter J. Anderson
- Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Australia,Murdoch Children’s Research Institute, Melbourne, Australia
| |
Collapse
|
43
|
Martinez-Biarge M, Groenendaal F, Kersbergen KJ, Benders MJNL, Foti F, van Haastert IC, Cowan FM, de Vries LS. Neurodevelopmental Outcomes in Preterm Infants with White Matter Injury Using a New MRI Classification. Neonatology 2019; 116:227-235. [PMID: 31108490 DOI: 10.1159/000499346] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 02/26/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate whether a new MRI scoring system for preterm non-haemorrhagic white matter injury (WMI), derived from the analysis of the natural evolution of WMI throughout the neonatal period until term-equivalent age, can be used for outcome prediction. METHODS Eighty-two infants <36 weeks gestation with WMI diagnosed from sequential cranial ultrasound and confirmed on neonatal MRI were retrospectively included. WMI was classified in four grades of severity. Neurodevelopmental data at a median age of 24 months were analysed. RESULTS In 74 surviving children WMI severity was strongly associated with the presence and severity of cerebral palsy (CP) and other neurodevelopmental impairments (Spearman's rank correlation 0.88, p < 0.001). Only 3 children with grade I WMI (9%) developed CP (all ambulant) and their developmental scores were not different to those from the controls, although they started walking significantly later (p = 0.036). Of the 6 children with grade II, 83% developed CP (mild in most), whereas 91% of the 34 children with grade III had CP (moderate-severe in 76%) and all had some degree of neurodevelopmental impairment. Three children with grade III WMI did not develop CP; their imaging showed, in contrast to children who developed CP, that the cysts did not affect the corticospinal tracts; also, myelin in the posterior limb of the internal capsule appeared normal in 2 children and suboptimal in 1. CONCLUSIONS This MRI scoring system for preterm WMI can be used to predict neurodevelopmental outcomes. Individualized assessment of the site of lesions and the progression of myelination improves prognostic accuracy.
Collapse
Affiliation(s)
| | - Floris Groenendaal
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Karina J Kersbergen
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Manon J N L Benders
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Francesca Foti
- Department of Paediatrics, Imperial College London, London, United Kingdom
| | - Ingrid C van Haastert
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Frances M Cowan
- Department of Paediatrics, Imperial College London, London, United Kingdom
| | - Linda S de Vries
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| |
Collapse
|
44
|
Ibrahim J, Mir I, Chalak L. Brain imaging in preterm infants <32 weeks gestation: a clinical review and algorithm for the use of cranial ultrasound and qualitative brain MRI. Pediatr Res 2018; 84:799-806. [PMID: 30315272 DOI: 10.1038/s41390-018-0194-6] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 09/21/2018] [Accepted: 09/22/2018] [Indexed: 02/07/2023]
Abstract
The aim is to review the evidence about the utility of term-equivalent age (TEA) magnetic resonance imaging (MRI) in predicting neurodevelopmental outcomes for preterm neonates. Preterm birth accounts for ~12% of all deliveries in the United States and is the leading cause of neurologic disabilities in children. From the neonatologist perspective, it is critically important to identify preterm infants at risk of subsequent neurodevelopmental disability who may benefit from early intervention services. However "the choose wisely campaign" also emphasizes the need to have ongoing cost/benefit discussions regarding care of preterm newborns to avoid waste that comes from subjecting infants to procedures that do not help. We performed a MEDLINE EMBASE database review from 2000 to 2018 to account for the technical evolution in the cranial ultrasound machines and introduction of MRI imaging in the NICU. Studies were graded based on the strength of their design using the GRADE guidelines and summarized with respect to brain MRI vs. cranial US (1) detection of white matter injury; (2) cerebellar hemorrhage; (3) long-term neurodevelopmental outcomes and impact on parental anxiety. We conclude with a hospital-specific guideline algorithm for performing TEA MRI based on risk evaluations ≤32 weeks.
Collapse
Affiliation(s)
- John Ibrahim
- University of Texas Southwestern Medical Center Dallas, Dallas, TX, USA
| | - Imran Mir
- University of Texas Southwestern Medical Center Dallas, Dallas, TX, USA
| | - Lina Chalak
- University of Texas Southwestern Medical Center Dallas, Dallas, TX, USA.
| |
Collapse
|
45
|
Proper timing for the evaluation of neonatal brain white matter development: a diffusion tensor imaging study. Eur Radiol 2018; 29:1527-1537. [DOI: 10.1007/s00330-018-5665-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 06/27/2018] [Accepted: 07/13/2018] [Indexed: 10/28/2022]
|
46
|
The challenge of cerebral magnetic resonance imaging in neonates: A new method using mathematical morphology for the segmentation of structures including diffuse excessive high signal intensities. Med Image Anal 2018; 48:75-94. [PMID: 29852312 DOI: 10.1016/j.media.2018.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 05/04/2018] [Accepted: 05/09/2018] [Indexed: 11/20/2022]
Abstract
Preterm birth is a multifactorial condition associated with increased morbidity and mortality. Diffuse excessive high signal intensity (DEHSI) has been recently described on T2-weighted MR sequences in this population and thought to be associated with neuropathologies. To date, no robust and reproducible method to assess the presence of white matter hyperintensities has been developed, perhaps explaining the current controversy over their prognostic value. The aim of this paper is to propose a new semi-automated framework to detect DEHSI on neonatal brain MR images having a particular pattern due to the physiological lack of complete myelination of the white matter. A novel method for semi- automatic segmentation of neonatal brain structures and DEHSI, based on mathematical morphology and on max-tree representations of the images is thus described. It is a mandatory first step to identify and clinically assess homogeneous cohorts of neonates for DEHSI and/or volume of any other segmented structures. Implemented in a user-friendly interface, the method makes it straightforward to select relevant markers of structures to be segmented, and if needed, apply eventually manual corrections. This method responds to the increasing need for providing medical experts with semi-automatic tools for image analysis, and overcomes the limitations of visual analysis alone, prone to subjectivity and variability. Experimental results demonstrate that the method is accurate, with excellent reproducibility and with very few manual corrections needed. Although the method was intended initially for images acquired at 1.5T, which corresponds to the usual clinical practice, preliminary results on images acquired at 3T suggest that the proposed approach can be generalized.
Collapse
|
47
|
Tusor N, Benders MJ, Counsell SJ, Nongena P, Ederies MA, Falconer S, Chew A, Gonzalez-Cinca N, Hajnal JV, Gangadharan S, Chatzi V, Kersbergen KJ, Kennea N, Azzopardi DV, Edwards AD. Punctate White Matter Lesions Associated With Altered Brain Development And Adverse Motor Outcome In Preterm Infants. Sci Rep 2017; 7:13250. [PMID: 29038505 PMCID: PMC5643493 DOI: 10.1038/s41598-017-13753-x] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 10/02/2017] [Indexed: 11/18/2022] Open
Abstract
Preterm infants who develop neurodevelopmental impairment do not always have recognized abnormalities on cerebral ultrasound, a modality routinely used to assess prognosis. In a high proportion of infants, MRI detects punctate white matter lesions that are not seen on ultrasonography. To determine the relation of punctate lesions to brain development and early neurodevelopmental outcome we used multimodal brain MRI to study a large cohort of preterm infants. Punctate lesions without other focal cerebral or cerebellar lesions were detected at term equivalent age in 123 (24.3%) (59 male) of the 506 infants, predominantly in the centrum semiovale and corona radiata. Infants with lesions had higher gestational age, birth weight, and less chronic lung disease. Punctate lesions showed a dose dependent relation to abnormalities in white matter microstructure, assessed with tract-based spatial statistics, and reduced thalamic volume (p < 0.0001), and predicted unfavourable motor outcome at a median (range) corrected age of 20.2 (18.4–26.3) months with sensitivity (95% confidence intervals) 71 (43–88) and specificity 72 (69–77). Punctate white matter lesions without associated cerebral lesions are common in preterm infants currently not regarded as at highest risk for cerebral injury, and are associated with widespread neuroanatomical abnormalities and adverse early neurodevelopmental outcome.
Collapse
Affiliation(s)
- Nora Tusor
- Centre for the Developing Brain, Perinatal Imaging and Health, Division of Imaging Sciences and Bioengineering, King's College London, St Thomas' Hospital, London, SE1 7EH, United Kingdom.
| | - Manon J Benders
- Department of Neonatology, University Medical Centre Utrecht, Utrecht, The Netherlands; Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, 3584 CX, The Netherlands
| | - Serena J Counsell
- Centre for the Developing Brain, Perinatal Imaging and Health, Division of Imaging Sciences and Bioengineering, King's College London, St Thomas' Hospital, London, SE1 7EH, United Kingdom
| | - Phumza Nongena
- Division of Clinical Sciences, Imperial College London, Hammersmith Hospital, London, W12 0HS, United Kingdom
| | - Moegamad A Ederies
- Division of Clinical Sciences, Imperial College London, Hammersmith Hospital, London, W12 0HS, United Kingdom
| | - Shona Falconer
- Centre for the Developing Brain, Perinatal Imaging and Health, Division of Imaging Sciences and Bioengineering, King's College London, St Thomas' Hospital, London, SE1 7EH, United Kingdom
| | - Andrew Chew
- Centre for the Developing Brain, Perinatal Imaging and Health, Division of Imaging Sciences and Bioengineering, King's College London, St Thomas' Hospital, London, SE1 7EH, United Kingdom
| | - Nuria Gonzalez-Cinca
- Centre for the Developing Brain, Perinatal Imaging and Health, Division of Imaging Sciences and Bioengineering, King's College London, St Thomas' Hospital, London, SE1 7EH, United Kingdom
| | - Joseph V Hajnal
- Centre for the Developing Brain, Perinatal Imaging and Health, Division of Imaging Sciences and Bioengineering, King's College London, St Thomas' Hospital, London, SE1 7EH, United Kingdom
| | - Sunay Gangadharan
- Centre for the Developing Brain, Perinatal Imaging and Health, Division of Imaging Sciences and Bioengineering, King's College London, St Thomas' Hospital, London, SE1 7EH, United Kingdom
| | - Vasiliki Chatzi
- Centre for the Developing Brain, Perinatal Imaging and Health, Division of Imaging Sciences and Bioengineering, King's College London, St Thomas' Hospital, London, SE1 7EH, United Kingdom
| | - Karina J Kersbergen
- Department of Neonatology, University Medical Centre Utrecht, Utrecht, The Netherlands; Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, 3584 CX, The Netherlands
| | - Nigel Kennea
- St. George's, University of London, London, SW17 0QT, United Kingdom
| | - Denis V Azzopardi
- Centre for the Developing Brain, Perinatal Imaging and Health, Division of Imaging Sciences and Bioengineering, King's College London, St Thomas' Hospital, London, SE1 7EH, United Kingdom
| | - A David Edwards
- Centre for the Developing Brain, Perinatal Imaging and Health, Division of Imaging Sciences and Bioengineering, King's College London, St Thomas' Hospital, London, SE1 7EH, United Kingdom
| |
Collapse
|
48
|
Volpe JJ. Confusions in Nomenclature: "Periventricular Leukomalacia" and "White Matter Injury"-Identical, Distinct, or Overlapping? Pediatr Neurol 2017. [PMID: 28648484 DOI: 10.1016/j.pediatrneurol.2017.05.013] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Joseph J Volpe
- Harvard Medical School/Boston Children's Hospital, Boston, Massachusetts.
| |
Collapse
|
49
|
Li X, Gao J, Wang M, Zheng J, Li Y, Hui ES, Wan M, Yang J. Characterization of Extensive Microstructural Variations Associated with Punctate White Matter Lesions in Preterm Neonates. AJNR Am J Neuroradiol 2017; 38:1228-1234. [PMID: 28450434 PMCID: PMC7960104 DOI: 10.3174/ajnr.a5226] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 01/26/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND PURPOSE Punctate white matter lesions are common in preterm neonates. Neurodevelopmental outcomes of the neonates are related to the degree of extension. This study aimed to characterize the extent of microstructural variations for different punctate white matter lesion grades. MATERIALS AND METHODS Preterm neonates with punctate white matter lesions were divided into 3 grades (from mild to severe: grades I-III). DTI-derived fractional anisotropy, axial diffusivity, and radial diffusivity between patients with punctate white matter lesions and controls were compared with Tract-Based Spatial Statistics and tract-quantification methods. RESULTS Thirty-three preterm neonates with punctate white matter lesions and 33 matched controls were enrolled. There were 15, 9, and 9 patients, respectively, in grades I, II, and III. Punctate white matter lesions were mainly located in white matter adjacent to the lateral ventricles, especially regions lateral to the trigone, posterior horns, and centrum semiovale and/or corona radiata. Extensive microstructural changes were observed in neonates with grade III punctate white matter lesions, while no significant changes in DTI metrics were found for grades I and II. A pattern of increased axial diffusivity, increased radial diffusivity, and reduced/unchanged fractional anisotropy was found in regions adjacent to punctate white matter lesion sites seen on T1WI and T2WI. Unchanged axial diffusivity, increased radial diffusivity, and reduced/unchanged fractional anisotropy were observed in regions distant from punctate white matter lesion sites. CONCLUSIONS White matter microstructural variations were different across punctate white matter lesion grades. Extensive change patterns varied according to the distance to the lesion sites in neonates with severe punctate white matter lesions. These findings may help in determining the outcomes of punctate white matter lesions and selecting treatment strategies.
Collapse
Affiliation(s)
- X Li
- From the Department of Radiology (X.L., J.G., M. Wang, Y.L., J.Y.)
- Department of Biomedical Engineering (X.L., M. Wan, J.Y.), the Key Laboratory of Biomedical Information Engineering of the Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
| | - J Gao
- From the Department of Radiology (X.L., J.G., M. Wang, Y.L., J.Y.)
| | - M Wang
- From the Department of Radiology (X.L., J.G., M. Wang, Y.L., J.Y.)
| | - J Zheng
- Clinical Research Center (J.Z.), the First Affiliated Hospital, Xi'an, Shaanxi, China
| | - Y Li
- From the Department of Radiology (X.L., J.G., M. Wang, Y.L., J.Y.)
| | - E S Hui
- Department of Diagnostic Radiology (E.S.H.), University of Hong Kong, Hong Kong, China
| | - M Wan
- Department of Biomedical Engineering (X.L., M. Wan, J.Y.), the Key Laboratory of Biomedical Information Engineering of the Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
| | - J Yang
- From the Department of Radiology (X.L., J.G., M. Wang, Y.L., J.Y.)
- Department of Biomedical Engineering (X.L., M. Wan, J.Y.), the Key Laboratory of Biomedical Information Engineering of the Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
| |
Collapse
|
50
|
Brouwer MJ, Kersbergen KJ, van Kooij BJM, Benders MJNL, van Haastert IC, Koopman-Esseboom C, Neil JJ, de Vries LS, Kidokoro H, Inder TE, Groenendaal F. Preterm brain injury on term-equivalent age MRI in relation to perinatal factors and neurodevelopmental outcome at two years. PLoS One 2017; 12:e0177128. [PMID: 28486543 PMCID: PMC5423624 DOI: 10.1371/journal.pone.0177128] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 04/21/2017] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES First, to apply a recently extended scoring system for preterm brain injury at term-equivalent age (TEA-)MRI in a regional extremely preterm cohort; second, to identify independent perinatal factors associated with this score; and third, to assess the prognostic value of this TEA-MRI score with respect to early neurodevelopmental outcome. STUDY DESIGN 239 extremely preterm infants (median gestational age [range] in weeks: 26.6 [24.3-27.9]), admitted to the Wilhelmina Children's Hospital between 2006 and 2012 were included. Brain abnormalities in white matter, cortical and deep grey matter and cerebellum and brain growth were scored on T1- and T2-weighted TEA-MRI using the Kidokoro scoring system. Neurodevelopmental outcome was assessed at two years corrected age using the Bayley Scales of Infant and Toddler Development, third edition. The association between TEA-MRI and perinatal factors as well as neurodevelopmental outcome was evaluated using multivariable regression analysis. RESULTS The distribution of brain abnormalities and brain metrics in the Utrecht cohort differed from the original St. Louis cohort (p < .05). Mechanical ventilation >7 days (β [95% confidence interval, CI]: 1.3 [.5; 2.0]) and parenteral nutrition >21 days (2.2 [1.2; 3.2]) were independently associated with higher global brain abnormality scores (p < .001). Global brain abnormality scores were inversely associated with cognitive (β in composite scores [95% CI]: -.7 [-1.2; -.2], p = .004), fine motor (β in scaled scores [95% CI]: -.1 [-.3; -.0], p = .007) and gross motor outcome (β in scaled scores [95% CI]: -.2 [-.3; -.1], p < .001) at two years corrected age, although the explained variances were low (R2 ≤.219). CONCLUSION Patterns of brain injury differed between cohorts. Prolonged mechanical ventilation and parenteral nutrition were identified as independent perinatal risk factors. The prognostic value of the TEA-MRI score was rather limited in this well-performing cohort.
Collapse
Affiliation(s)
- Margaretha J. Brouwer
- Department of Perinatology, Wilhelmina Children’s Hospital and Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Karina J. Kersbergen
- Department of Perinatology, Wilhelmina Children’s Hospital and Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Britt J. M. van Kooij
- Department of Perinatology, Wilhelmina Children’s Hospital and Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Manon J. N. L. Benders
- Department of Perinatology, Wilhelmina Children’s Hospital and Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ingrid C. van Haastert
- Department of Perinatology, Wilhelmina Children’s Hospital and Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Corine Koopman-Esseboom
- Department of Perinatology, Wilhelmina Children’s Hospital and Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jeffrey J. Neil
- Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts, United States of America
| | - Linda S. de Vries
- Department of Perinatology, Wilhelmina Children’s Hospital and Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Hiroyuki Kidokoro
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Brain & Mind Research Center, Nagoya University, Nagoya, Japan
| | - Terrie E. Inder
- Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Floris Groenendaal
- Department of Perinatology, Wilhelmina Children’s Hospital and Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| |
Collapse
|