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Schmidbauer VU, Yildirim MS, Dovjak GO, Goeral K, Buchmayer J, Weber M, Kienast P, Diogo MC, Prayer F, Stuempflen M, Kittinger J, Malik J, Nowak NM, Klebermass-Schrehof K, Fuiko R, Berger A, Prayer D, Kasprian G, Giordano V. Quantitative Magnetic Resonance Imaging for Neurodevelopmental Outcome Prediction in Neonates Born Extremely Premature-An Exploratory Study. Clin Neuroradiol 2024; 34:421-429. [PMID: 38289377 PMCID: PMC11129968 DOI: 10.1007/s00062-023-01378-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 12/26/2023] [Indexed: 05/29/2024]
Abstract
PURPOSE Neonates born at < 28 weeks of gestation are at risk for neurodevelopmental delay. The aim of this study was to identify quantitative MR-based metrics for the prediction of neurodevelopmental outcomes in extremely preterm neonates. METHODS T1-/T2-relaxation times (T1R/T2R), ADC, and fractional anisotropy (FA) of the left/right posterior limb of the internal capsule (PLIC) and the brainstem were determined at term-equivalent ages in a sample of extremely preterm infants (n = 33). Scores for cognitive, language, and motor outcomes were collected at one year corrected-age. Pearson's correlation analyses detected relationships between quantitative measures and outcome data. Stepwise regression procedures identified imaging metrics to estimate neurodevelopmental outcomes. RESULTS Cognitive outcomes correlated significantly with T2R (r = 0.412; p = 0.017) and ADC (r = -0.401; p = 0.021) (medulla oblongata). Furthermore, there were significant correlations between motor outcomes and T1R (pontine tegmentum (r = 0.346; p = 0.049), midbrain (r = 0.415; p = 0.016), right PLIC (r = 0.513; p = 0.002), and left PLIC (r = 0.504; p = 0.003)); T2R (right PLIC (r = 0.405; p = 0.019)); ADC (medulla oblongata (r = -0.408; p = 0.018) and pontine tegmentum (r = -0.414; p = 0.017)); and FA (pontine tegmentum (r = -0.352; p = 0.045)). T2R/ADC (medulla oblongata) (cognitive outcomes (R2 = 0.296; p = 0.037)) and T1R (right PLIC)/ADC (medulla oblongata) (motor outcomes (R2 = 0.405; p = 0.009)) revealed predictive potential for neurodevelopmental outcomes. CONCLUSION There are relationships between relaxometry‑/DTI-based metrics determined by neuroimaging near term and neurodevelopmental outcomes collected at one year of age. Both modalities bear prognostic potential for the prediction of cognitive and motor outcomes. Thus, quantitative MRI at term-equivalent ages represents a promising approach with which to estimate neurologic development in extremely preterm infants.
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Affiliation(s)
- Victor U Schmidbauer
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - Mehmet S Yildirim
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Gregor O Dovjak
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Katharina Goeral
- Comprehensive Center for Pediatrics, Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Julia Buchmayer
- Comprehensive Center for Pediatrics, Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Michael Weber
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Patric Kienast
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Mariana C Diogo
- Department of Neuroradiology, Hospital Garcia de Orta, Av. Torrado da Silva, 2805-267 Almada, Portugal
| | - Florian Prayer
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Marlene Stuempflen
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Jakob Kittinger
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Jakob Malik
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Nikolaus M Nowak
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Katrin Klebermass-Schrehof
- Comprehensive Center for Pediatrics, Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Renate Fuiko
- Comprehensive Center for Pediatrics, Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Angelika Berger
- Comprehensive Center for Pediatrics, Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Daniela Prayer
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Gregor Kasprian
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Vito Giordano
- Comprehensive Center for Pediatrics, Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
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Quinones JF, Hildebrandt A, Pavan T, Thiel CM, Heep A. Preterm birth and neonatal white matter microstructure in in-vivo reconstructed fiber tracts among audiovisual integration brain regions. Dev Cogn Neurosci 2023; 60:101202. [PMID: 36731359 PMCID: PMC9894786 DOI: 10.1016/j.dcn.2023.101202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 01/02/2023] [Accepted: 01/25/2023] [Indexed: 01/28/2023] Open
Abstract
Individuals born preterm are at risk of developing a variety of sequelae. Audiovisual integration (AVI) has received little attention despite its facilitating role in the development of socio-cognitive abilities. The present study assessed the association between prematurity and in-vivo reconstructed fiber bundles among brain regions relevant for AVI. We retrieved data from 63 preterm neonates enrolled in the Developing Human Connectome Project (http://www.developingconnectome.org/) and matched them with 63 term-born neonates from the same study by means of propensity score matching. We performed probabilistic tractography, DTI and NODDI analysis on the traced fibers. We found that specific DTI and NODDI metrics are significantly associated with prematurity in neonates matched for postmenstrual age at scan. We investigated the spatial overlap and developmental order of the reconstructed tractograms between preterm and full-term neonates. Permutation-based analysis revealed significant differences in dice similarity coefficients and developmental order between preterm and full term neonates at the group level. Contrarily, no group differences in the amount of interindividual variability of DTI and NODDI metrics were observed. We conclude that microstructural detriment in the reconstructed fiber bundles along with developmental and morphological differences are likely to contribute to disadvantages in AVI in preterm individuals.
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Affiliation(s)
- Juan F. Quinones
- Psychological Methods and Statistics, Department of Psychology, School of Medicine and Health Sciences, Carl von Ossietzky Universität Oldenburg, Oldenburg, Germany,Cluster of Excellence Hearing4all, Carl von Ossietzky Universität Oldenburg, Oldenburg, Germany,Correspondence to: Carl von Ossietzky Universität Oldenburg, Department of Psychology, Ammerländer Heerstr., 114-11, 826129 Oldenburg, Germany.
| | - Andrea Hildebrandt
- Psychological Methods and Statistics, Department of Psychology, School of Medicine and Health Sciences, Carl von Ossietzky Universität Oldenburg, Oldenburg, Germany,Cluster of Excellence Hearing4all, Carl von Ossietzky Universität Oldenburg, Oldenburg, Germany,Research Center Neurosensory Science, Carl von Ossietzky Universität Oldenburg, Germany,Correspondence to: Carl von Ossietzky Universität Oldenburg, Department of Psychology, Ammerländer Heerstr., 114-11, 826129 Oldenburg, Germany.
| | - Tommaso Pavan
- Department of Radiology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Christiane M. Thiel
- Cluster of Excellence Hearing4all, Carl von Ossietzky Universität Oldenburg, Oldenburg, Germany,Research Center Neurosensory Science, Carl von Ossietzky Universität Oldenburg, Germany,Biological Psychology, Department of Psychology, School of Medicine and Health Sciences, Carl von Ossietzky Universität Oldenburg, Oldenburg, Germany
| | - Axel Heep
- Research Center Neurosensory Science, Carl von Ossietzky Universität Oldenburg, Germany,Klinik für Neonatologie, Intensivmedizin und Kinderkardiologie, Oldenburg, Germany
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Saiote C, Sutter E, Xenopoulos-Oddsson A, Rao R, Georgieff M, Rudser K, Peyton C, Dean D, McAdams RM, Gillick B. Study Protocol: Multimodal Longitudinal Assessment of Infant Brain Organization and Recovery in Perinatal Brain Injury. Pediatr Phys Ther 2022; 34:268-276. [PMID: 35385465 PMCID: PMC9200232 DOI: 10.1097/pep.0000000000000886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Perinatal brain injury is a primary cause of cerebral palsy, a condition resulting in lifelong motor impairment. Infancy is an important period of motor system development, including development of the corticospinal tract (CST), the primary pathway for cortical movement control. The interaction between perinatal stroke recovery, CST organization, and resultant motor outcome in infants is not well understood. METHODS Here, we present a protocol for multimodal longitudinal assessment of brain development and motor function following perinatal brain injury using transcranial magnetic stimulation and magnetic resonance imaging to noninvasively measure CST functional and structural integrity across multiple time points in infants 3 to 24 months of age. We will further assess the association between cortical excitability, integrity, and motor function. DISCUSSION This protocol will identify bioindicators of motor outcome and neuroplasticity and subsequently inform early detection, diagnosis, and intervention strategies for infants with perinatal stroke, brain bleeds, and related diagnoses.
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Affiliation(s)
- Catarina Saiote
- Waisman Center (Drs Saiote, Sutter, Dean, and Gillick), Department of Pediatrics (Drs Dean, McAdams, and Gillick), and Department of Medical Physics (Dr Dean), University of Wisconsin-Madison, Madison, Wisconsin; Department of Rehabilitation Medicine (Dr Sutter and Ms Xenopoulos-Oddsson), Department of Pediatrics (Drs Rao and Georgieff), and Division of Biostatistics (Dr Rudser), University of Minnesota, Minneapolis, Minnesota; Department of Physical Therapy and Human Movement Sciences, Department of Pediatrics (Dr Peyton), Northwestern University, Chicago, Illinois
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Longitudinal Cognitive Assessment in Low-Risk Very Preterm Infants. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58010133. [PMID: 35056441 PMCID: PMC8778540 DOI: 10.3390/medicina58010133] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 01/10/2022] [Accepted: 01/12/2022] [Indexed: 11/17/2022]
Abstract
Background and Objectives: Preterm infants are at higher risk of neurodevelopmental impairment both at preschool and school ages, even in the absence of major neurological deficits. The early identification of children at risk is essential for early intervention with rehabilitation to optimize potential outcomes during school years. The aim of our study is to assess cognitive outcomes at preschool age in a cohort of low-risk very preterm infants, previously studied at 12 and 24 months using the Griffiths scales. Materials and Methods: Sixty-six low-risk very preterm infants born at a gestational age of <32 weeks were assessed at 12 and 24 months corrected age using the Griffiths Mental Development Scales (second edition) and at preschool age with the Wechsler Preschool and Primary Scales of Intelligence (third edition) (WPPSI-III). Results: At 12 and 24 months and at preschool age, low-risk very preterm infants showed scores within normal ranges with similar scores in males and females. A statistically significant correlation was observed in the general developmental quotient between 12 and 24 months; a further significant correlation was observed between the early cognitive assessments and those performed at preschool age, with a better correlation using the assessments at 24 months. Conclusion: The present study showed a favourable trajectory of cognitive development in low-risk very preterm infants, from 12 months to preschool age.
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Tortora D, Severino M, Di Biase C, Malova M, Parodi A, Minghetti D, Traggiai C, Uccella S, Boeri L, Morana G, Rossi A, Ramenghi LA. Early Pain Exposure Influences Functional Brain Connectivity in Very Preterm Neonates. Front Neurosci 2019; 13:899. [PMID: 31507370 PMCID: PMC6716476 DOI: 10.3389/fnins.2019.00899] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 08/12/2019] [Indexed: 11/13/2022] Open
Abstract
Background Early exposure to nociceptive events may cause brain structural alterations in preterm neonates, with long-lasting consequences on neurodevelopmental outcome. Little is known on the extent to which early pain may affect brain connectivity. We aim to evaluate brain functional connectivity changes in preterm neonate that underwent multiple invasive procedures during the postnatal period, and to correlate them with the neurodevelopmental outcome at 24 months. Methods In this prospective case-control study, we collected information about exposure to painful events during the early postnatal period and resting-state BOLD-fMRI data at term equivalent age from two groups of preterm neonate: 33 subjected to painful procedures during the neonatal intensive care (mean gestational age 27.9 ± 1.8 weeks) and 13 who did not require invasive procedures (average gestational age 31.2 ± 2.1 weeks). A data-driven principal-component-based multivariate pattern analysis (MVPA) was used to investigate the effect of early pain exposure on brain functional connectivity, and the relationship between connectivity changes and neurodevelopmental outcome at 24 months, assessed with Griffiths, Developmental Scale-Revised: 0-2. Results Early pain was associated with decreased functional connectivity between thalami and bilateral somatosensory cortex, and between the right insular cortex and ipsilateral amygdala and hippocampal regions, with a more evident effect in preterm neonate undergoing more invasive procedures. Functional connectivity of the right thalamocortical pathway was related to neuromotor outcome at 24 months (P = 0.003). Conclusion Early exposure to pain is associated with abnormal functional connectivity of developing networks involved in the modulation of noxious stimuli in preterm neonate, contributing to the neurodevelopmental consequence of preterm birth.
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Affiliation(s)
- Domenico Tortora
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | | | - Carlo Di Biase
- Neonatal Intensive Care Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Maryia Malova
- Neonatal Intensive Care 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
| | - Cristina Traggiai
- Neonatal Intensive Care Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Sara Uccella
- Child Neuropsychiatry Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Luca Boeri
- Child Neuropsychiatry Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Giovanni Morana
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Andrea Rossi
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
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Tortora D, Martinetti C, Severino M, Uccella S, Malova M, Parodi A, Brera F, Morana G, Ramenghi LA, Rossi A. The effects of mild germinal matrix-intraventricular haemorrhage on the developmental white matter microstructure of preterm neonates: a DTI study. Eur Radiol 2017; 28:1157-1166. [PMID: 28956133 DOI: 10.1007/s00330-017-5060-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 07/31/2017] [Accepted: 09/05/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To evaluate white matter (WM) microstructural changes in preterm neonates (PN) with mild germinal matrix-intraventricular haemorrhage (mGMH-IVH) (grades I and II) and no other associated MRI abnormalities, and correlate them with gestational age (GA) and neurodevelopmental outcome. METHODS Tract-based spatial-statistics (TBSS) was performed on DTI of 103 patients studied at term-equivalent age, to compare diffusional parameters (fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD), axial diffusivity (AD)) between mGMH-IVH neonates (24/103) and controls matched by GA at birth and sex. The relationship between DTI abnormalities, GA and neurodevelopmental outcome assessed with Griffiths' Developmental Scale-Revised:0-2 was explored using TBSS and Spearman-correlation analysis (p < .05). RESULTS Affected neonates had lower FA, higher RD and MD of the corpus callosum, limbic pathways and cerebellar tracts. Extremely preterm neonates (GA < 29 weeks) presented more severe microstructural impairment (higher RD and MD) in periventricular regions. Neonates of GA ≥ 29 weeks had milder WM alterations (lower FA), also in subcortical WM. DTI abnormalities were associated with poorer locomotor, eye-hand coordination and performance outcomes at 24 months. CONCLUSIONS WM microstructural changes occur in PN with mGMH-IVH with a GA-dependent selective vulnerability of WM regions, and correlate with adverse neurodevelopmental outcome at 24 months. KEY POINTS • DTI-TBSS analysis identifies WM microstructural changes in preterm neonates with mGMH-IVH. • Extremely preterm neonates with mGMH-IVH presented more severe impairment of WM microstructure. • Extremely preterm neonates with mGMH-IVH presented microstructural impairment of periventricular WM. • mGMH-IVH affects subcortical WM in preterm neonates with gestational age ≥ 29 weeks. • WM microstructural alterations are related to neurodevelopmental impairments at 24 months.
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Affiliation(s)
- Domenico Tortora
- Neuroradiology Unit, Istituto Giannina Gaslini, Via Gerolamo Gaslini, 5, 16147, Genoa, Italy
| | - Carola Martinetti
- Neuroradiology Unit, Istituto Giannina Gaslini, Via Gerolamo Gaslini, 5, 16147, Genoa, Italy
| | - Mariasavina Severino
- Neuroradiology Unit, Istituto Giannina Gaslini, Via Gerolamo Gaslini, 5, 16147, Genoa, Italy.
| | - Sara Uccella
- Neuropsychiatry Unit, Istituto Giannina Gaslini, Genoa, Italy
| | - Mariya Malova
- Neonatal Intensive Care Unit, Istituto Giannina Gaslini, Genoa, Italy
| | - Alessandro Parodi
- Neonatal Intensive Care Unit, Istituto Giannina Gaslini, Genoa, Italy
| | - Fabia Brera
- Neuropsychiatry Unit, Istituto Giannina Gaslini, Genoa, Italy
| | - Giovanni Morana
- Neuroradiology Unit, Istituto Giannina Gaslini, Via Gerolamo Gaslini, 5, 16147, Genoa, Italy
| | | | - Andrea Rossi
- Neuroradiology Unit, Istituto Giannina Gaslini, Via Gerolamo Gaslini, 5, 16147, Genoa, Italy
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Tortora D, Mattei PA, Navarra R, Panara V, Salomone R, Rossi A, Detre JA, Caulo M. Prematurity and brain perfusion: Arterial spin labeling MRI. NEUROIMAGE-CLINICAL 2017; 15:401-407. [PMID: 28603687 PMCID: PMC5454138 DOI: 10.1016/j.nicl.2017.05.023] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 05/07/2017] [Accepted: 05/25/2017] [Indexed: 12/02/2022]
Abstract
Purpose Abnormal brain perfusion is a critical mechanism in neonatal brain injury. The aim of the present study was to compare Cerebral Blood Flow (CBF) evaluated with ASL MRI in three groups of neonates: preterms without brain lesions on MRI (PN), preterms with periventricular white matter lesions (PNp) and term neonates with normal MRI (TN). The correlation between CBF and clinical outcome was explored. Materials and methods The institutional review board approved this prospective study and waived informed consent. The perfusion ASL data from 49 consecutive preterm neonates (PN) studied at term-equivalent age and 15 TN were evaluated. Statistically significant differences in gray matter CBF were evaluated by using a linear mixed-model analysis and Mann-Whitney U test. Logistic regression analysis was used to assess the relation between CBF and neuromotor outcome at 12 months. Results Comparison of means indicated that the CBF of the whole brain were significantly higher in PN compared to TN (P = 0.011). This difference remained significant when considering the frontal (P = 0.038), parietal (P = 0.002), temporal (P = 0.030), occipital (P = 0.041) and cerebellar (P = 0.010) gray matter. In the PN group, lower CBF in basal ganglia was associated with a worse neuromotor outcome (P = 0.012). Conclusions ASL MRI demonstrated differences in brain perfusion of the basal ganglia between PN and TN. In PN, a positive correlation between CBF and neuromotor outcome was demonstrated in this area. Different ASL cerebral perfusion between preterm and term neonates Global reduction of CBF values in preterm neonates with white matter lesions ASL identifies preterm neonates at higher risk for sub-optimal neuromotor development. Worst 12-months neuromotor outcome in preterm neonates with lower CBF of basal ganglia
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Affiliation(s)
- Domenico Tortora
- ITAB-Institute of Advanced Biomedical Technologies, University "G. d'Annunzio", Via Luigi Polacchi 11, 66100 Chieti, Italy; Neuroradiology Unit, Istituto Giannina Gaslini, Via Gerolamo Gaslini 5, 16147 Genoa, Italy.
| | - Peter Angelo Mattei
- Ophthalmology Clinic, Department of Medicine and Aging Sciences, University "G. d'Annunzio", Via dei Vestini, 66100 Chieti, Italy.
| | - Riccardo Navarra
- ITAB-Institute of Advanced Biomedical Technologies, University "G. d'Annunzio", Via Luigi Polacchi 11, 66100 Chieti, Italy; Department of Neuroscience and Imaging, University "G. d'Annunzio", Via dei Vestini, 66100 Chieti, Italy.
| | - Valentina Panara
- ITAB-Institute of Advanced Biomedical Technologies, University "G. d'Annunzio", Via Luigi Polacchi 11, 66100 Chieti, Italy; Department of Neuroscience and Imaging, University "G. d'Annunzio", Via dei Vestini, 66100 Chieti, Italy.
| | - Rita Salomone
- Department of Paediatrics, Neonatology and Neonatal Intensive Care Unit, University Hospital of Chieti, Via dei Vestini, 66100 Chieti, Italy.
| | - Andrea Rossi
- Neuroradiology Unit, Istituto Giannina Gaslini, Via Gerolamo Gaslini 5, 16147 Genoa, Italy.
| | - John A Detre
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, 3400 Spruce Street, Philadelphia, PA 19104, USA.
| | - Massimo Caulo
- ITAB-Institute of Advanced Biomedical Technologies, University "G. d'Annunzio", Via Luigi Polacchi 11, 66100 Chieti, Italy; Department of Neuroscience and Imaging, University "G. d'Annunzio", Via dei Vestini, 66100 Chieti, Italy.
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