1
|
Sex-specific inflammatory and white matter effects of prenatal opioid exposure: a pilot study. Pediatr Res 2023; 93:604-611. [PMID: 36280708 PMCID: PMC9998341 DOI: 10.1038/s41390-022-02357-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 09/01/2022] [Accepted: 10/11/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Preclinical data demonstrate that opioids modulate brain reward signaling through an inflammatory cascade, but this relationship has yet to be studied in opioid-exposed neonates. METHODS Saliva samples of 54 opioid-exposed and sex- and age-matched non-exposed neonates underwent transcriptomic analysis of inflammatory and reward genes. A subset of 22 neonates underwent brain magnetic resonance imaging (MRI) to evaluate white matter injury commonly associated with inflammatory response. Gene expression and brain MRI were compared between opioid- and non-exposed neonates and further stratified by sex and pharmacotherapy need. RESULTS Opioid-exposed females regardless of pharmacotherapy need had higher expression of inflammatory genes than their male counterparts, with notable differences in the expression of CCL2 and CXCL1 in females requiring pharmacotherapy (p = 0.01 and 0.06, respectively). Opioid-exposed males requiring pharmacotherapy had higher expression of DRD2 than exposed females (p = 0.07), validating our prior research. Higher expression of IL1β, IL6, TNFα, and IL10 was seen in opioid-exposed neonates with T1 white matter hyperintensity (WMH) compared to exposed neonates without WMH (p < 0.05). CONCLUSION Prenatal opioid exposure may promote inflammation resulting in changes in reward signaling and white matter injury in the developing brain, with unique sex-specific effects. The actions of opioids through non-neuronal pathways need further investigation. IMPACT Opioid-exposed neonates are at risk for punctate T1 white matter hyperintensity (WMH). Females carry a greater propensity for WMH. Salivary transcriptomic data showed significantly higher expression of inflammatory genes in opioid-exposed neonates with WMH than those without WMH, irrespective of pharmacotherapy need. Adding to prior studies, our findings suggest that prenatal opioid exposure may modulate white matter injury and reward signaling through a pro-inflammatory process that is sex specific. This novel study highlights the short-term molecular and structural effects of prenatal opioids and the need to elucidate the long-term impact of prenatal opioid exposure.
Collapse
|
2
|
Li F, Zhong C, Ouyang X, Zhao Q, Zhang L, Wang B. Developmental characteristics of early electroencephalography in preterm neonates: Differences between twins and singletons. Pediatr Neonatol 2023:S1875-9572(23)00020-7. [PMID: 36764872 DOI: 10.1016/j.pedneo.2022.09.020] [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: 06/20/2022] [Revised: 08/16/2022] [Accepted: 09/15/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND To analyze the early electroencephalography (EEG) development of twins and singleton preterm neonates using 5 measurement indicators. METHODS On the 1st and 7th days after birth, EEG monitoring was performed on 102 preterm neonates (62 males, median gestational age 33.15 weeks, IQR 31.00-35.75). The minimum amplitude, maximum amplitude, maximum interburst intervals (IBI), total duration of trace discontinue (TD), maximum duration of single TD, and the Burdjalov score of amplitude-integrated electroencephalography (aEEG) were used to evaluate EEG recordings. RESULTS The minimum amplitude of EEG increases with gestational age (GA), while the maximum amplitude decreases, the maximum IBI decreases, and the total duration of TD and the maximum duration of single TD decrease (all p < 0.05). Burdjalov score did not differ significantly between the 1st and 7th days (p = 0.075). There is no significant difference between twins and singleton preterm infants in the five EEG measurement indicators (p > 0.05 for all). CONCLUSION The five EEG measurement indicators can better reflect preterm infants' brain maturation than the Burdjalov score in aEEG. There were no statistical differences in brain maturation between twin and singleton preterm infants.
Collapse
Affiliation(s)
- Fangming Li
- Department of Pediatrics, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Chunxia Zhong
- Department of Pediatrics, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Xuejun Ouyang
- Department of Pediatrics, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Qian Zhao
- Department of Pediatrics, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Lijuan Zhang
- Department of Pediatrics, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Bin Wang
- Department of Pediatrics, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China.
| |
Collapse
|
3
|
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
|
4
|
Gire C, Berbis J, Dequin M, Marret S, Muller JB, Saliba E, Tosello B. A correlation between Magnetic Resonance Spectroscopy (1-H MRS) and the neurodevelopment of two-year-olds born preterm in an EPIRMEX cohort study. Front Pediatr 2022; 10:936130. [PMID: 36061395 PMCID: PMC9437452 DOI: 10.3389/fped.2022.936130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 07/18/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Preterm infants are at risk of neurodevelopmental impairments. At present, proton magnetic resonance spectroscopy (1H-MRS) is currently used to evaluate brain metabolites in asphyxiated term infants. The purpose of this study was to identify in the preterm EPIRMEX cohort any correlations between (1H-MRS) metabolites ratio at term equivalent age (TEA) and neurodevelopmental outcomes at 2 years. METHODS Our study included EPIRMEX eligible patients who were very preterm infants (gestational age at birth ≤32 weeks) and who underwent a brain MRI at TEA and 1H-MRS using a monovoxel technique. The volumes of interest (VOI) were periventricular white matter posterior area and basal ganglia. The ratio of N Acetyl Aspartate (NAA) to Cho (Choline), NAA to Cr (creatine), Cho to Cr, and Lac (Lactate) to Cr were measured. Neurodevelopment was assessed at 24 months TEA with ASQ (Ages and Stages Questionnaire). RESULTS A total of 69 very preterm infants had a 1H-MRS at TEA. In white matter there was a significant correlation between a reduction in the NAA/Cho ratio and a total ASQ and/or abnormal communication score, and an increase in the Lac/Cr ratio and an abnormality of fine motor skills. In the gray nuclei there was a trend correlation between the reduction in the NAA/Cho ratio and sociability disorders; and the increase in the Lac/Cr ratio and an anomaly in problem-solving. CONCLUSIONS Using NAA as a biomarker, the vulnerability of immature oligodendrocytes in preterm children at TEA was correlated to neurodevelopment at 2 years. Similarly, the presence of lactate at TEA was associated with abnormal neurodevelopment at 2 years in the preterm brain.
Collapse
Affiliation(s)
- Catherine Gire
- Department of Neonatal Medicine, Assistance Publique Hopitaux de Marseille, Marseille, France.,EA3279, Faculty of Medicine, Self-Perceived Health Assessment Research Unit, Marseille, France
| | - Julie Berbis
- EA3279, Faculty of Medicine, Self-Perceived Health Assessment Research Unit, Marseille, France
| | - Marion Dequin
- Department of Neonatal Pediatrics, Intensive Care, and Neuropediatrics, Rouen University Hospital and Institut National de la Santé et de la Recherche Médicale INSERM U 1245 Team 4 Neovasc, School of Medicine, Normandy University, Rouen, France
| | - Stéphane Marret
- Department of Neonatal Pediatrics, Intensive Care, and Neuropediatrics, Rouen University Hospital and Institut National de la Santé et de la Recherche Médicale INSERM U 1245 Team 4 Neovasc, School of Medicine, Normandy University, Rouen, France
| | | | - Elie Saliba
- UMR 1253, iBrain, Tours University, Institut National de la Santé et de la Recherche Médicale (INSERM), Tours, France
| | - Barthélémy Tosello
- Department of Neonatal Medicine, Assistance Publique Hopitaux de Marseille, Marseille, France.,Aix-Marseille University, CNRS, EFS, ADES, Marseille, France
| |
Collapse
|
5
|
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
|
6
|
Vasung L, Rollins CK, Yun HJ, Velasco-Annis C, Zhang J, Wagstyl K, Evans A, Warfield SK, Feldman HA, Grant PE, Gholipour A. Quantitative In vivo MRI Assessment of Structural Asymmetries and Sexual Dimorphism of Transient Fetal Compartments in the Human Brain. Cereb Cortex 2021; 30:1752-1767. [PMID: 31602456 DOI: 10.1093/cercor/bhz200] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 08/02/2019] [Accepted: 08/05/2019] [Indexed: 12/19/2022] Open
Abstract
Structural asymmetries and sexual dimorphism of the human cerebral cortex have been identified in newborns, infants, children, adolescents, and adults. Some of these findings were linked with cognitive and neuropsychiatric disorders, which have roots in altered prenatal brain development. However, little is known about structural asymmetries or sexual dimorphism of transient fetal compartments that arise in utero. Thus, we aimed to identify structural asymmetries and sexual dimorphism in the volume of transient fetal compartments (cortical plate [CP] and subplate [SP]) across 22 regions. For this purpose, we used in vivo structural T2-weighted MRIs of 42 healthy fetuses (16.43-36.86 gestational weeks old, 15 females). We found significant leftward asymmetry in the volume of the CP and SP in the inferior frontal gyrus. The orbitofrontal cortex showed significant rightward asymmetry in the volume of CP merged with SP. Males had significantly larger volumes in regions belonging to limbic, occipital, and frontal lobes, which were driven by a significantly larger SP. Lastly, we did not observe sexual dimorphism in the growth trajectories of the CP or SP. In conclusion, these results support the hypothesis that structural asymmetries and sexual dimorphism in relative volumes of cortical regions are present during prenatal brain development.
Collapse
Affiliation(s)
- Lana Vasung
- Fetal-Neonatal Neuroimaging & Developmental Science Center (FNNDSC), Boston, MA 02115, USA.,Division of Newborn Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Caitlin K Rollins
- Computational Radiology Laboratory, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA.,Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Hyuk Jin Yun
- Fetal-Neonatal Neuroimaging & Developmental Science Center (FNNDSC), Boston, MA 02115, USA.,Division of Newborn Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Clemente Velasco-Annis
- Computational Radiology Laboratory, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Jennings Zhang
- Fetal-Neonatal Neuroimaging & Developmental Science Center (FNNDSC), Boston, MA 02115, USA.,McGill Centre for Integrative Neuroscience/Montreal Neurological Institute, McGill University, Montreal QC H3A 2B4, Canada
| | | | - Alan Evans
- McGill Centre for Integrative Neuroscience/Montreal Neurological Institute, McGill University, Montreal QC H3A 2B4, Canada
| | - Simon K Warfield
- Computational Radiology Laboratory, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Henry A Feldman
- Division of Newborn Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA.,Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - P Ellen Grant
- Fetal-Neonatal Neuroimaging & Developmental Science Center (FNNDSC), Boston, MA 02115, USA.,Division of Newborn Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Ali Gholipour
- Computational Radiology Laboratory, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| |
Collapse
|
7
|
Structural Changes in the Cortico-Ponto-Cerebellar Axis at Birth are Associated with Abnormal Neurological Outcomes in Childhood. Clin Neuroradiol 2021; 31:1005-1020. [PMID: 33944956 DOI: 10.1007/s00062-021-01017-1] [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: 09/02/2020] [Accepted: 04/04/2021] [Indexed: 10/21/2022]
Abstract
White matter lesions in hypoxic-ischemic encephalopathy (HIE) are considered to be the important substrate of frequent neurological consequences in preterm infants. The aim of the study was to analyze volumes and tractographic parameters of the cortico-ponto-cerebellar axis to assess alterations in the periventricular fiber system and crossroads, corticopontine and corticospinal pathways and prospective transsynaptic changes of the cerebellum.Term infants (control), premature infants without (normotypic) and with perinatal HIE (HIE) underwent brain magnetic resonance imaging at term-equivalent age (TEA) and at 2 years. Cerebrum, cerebellum, brainstem divisions and ventrodorsal compartments volumetric analysis were performed, as well as fractional anisotropy (FA) and apparent diffusion coefficient (ADC) of corticopontine, corticospinal pathways and middle cerebellar peduncles. Amiel-Tison scale at TEA and the Hempel test at 2 years were assessed.Cerebellum, brainstem and its compartments volumes were decreased in normotypic and HIE groups at TEA, while at 2 years volumes were significantly reduced in the HIE group, accompanied by decreased volume and FA and increased ADC of corticopontine and corticospinal pathways. Negative association of the brainstem, cerebellum, mesencephalon, pons, corticopontine volumes and corticospinal pathway FA at TEA with the neurological score at 2 years. Cerebellum and pons volumes presented as potential prognostic indicators of neurological outcomes.Our findings agree that these pathways, as a part of the periventricular fiber system and crossroads, exhibit lesion-induced reaction and vulnerability in HIE. Structural differences between normotypic and HIE group at the 2 years suggest a different developmental structural plasticity.
Collapse
|
8
|
Kostović I, Radoš M, Kostović-Srzentić M, Krsnik Ž. Fundamentals of the Development of Connectivity in the Human Fetal Brain in Late Gestation: From 24 Weeks Gestational Age to Term. J Neuropathol Exp Neurol 2021; 80:393-414. [PMID: 33823016 PMCID: PMC8054138 DOI: 10.1093/jnen/nlab024] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
During the second half of gestation, the human cerebrum undergoes pivotal histogenetic events that underlie functional connectivity. These include the growth, guidance, selection of axonal pathways, and their first engagement in neuronal networks. Here, we characterize the spatiotemporal patterns of cerebral connectivity in extremely preterm (EPT), very preterm (VPT), preterm and term babies, focusing on magnetic resonance imaging (MRI) and histological data. In the EPT and VPT babies, thalamocortical axons enter into the cortical plate creating the electrical synapses. Additionally, the subplate zone gradually resolves in the preterm and term brain in conjunction with the growth of associative pathways leading to the activation of large-scale neural networks. We demonstrate that specific classes of axonal pathways within cerebral compartments are selectively vulnerable to temporally nested pathogenic factors. In particular, the radial distribution of axonal lesions, that is, radial vulnerability, is a robust predictor of clinical outcome. Furthermore, the subplate tangential nexus that we can visualize using MRI could be an additional marker as pivotal in the development of cortical connectivity. We suggest to direct future research toward the identification of sensitive markers of earlier lesions, the elucidation of genetic mechanisms underlying pathogenesis, and better long-term follow-up using structural and functional MRI.
Collapse
Affiliation(s)
- Ivica Kostović
- From the Croatian Institute for Brain Research, School of Medicine, University of Zagreb, Scientific Centre of Excellence for Basic, Clinical and Translational Neuroscience, Zagreb, Croatia
| | - Milan Radoš
- From the Croatian Institute for Brain Research, School of Medicine, University of Zagreb, Scientific Centre of Excellence for Basic, Clinical and Translational Neuroscience, Zagreb, Croatia.,Polyclinic "Neuron", Zagreb, Croatia
| | - Mirna Kostović-Srzentić
- From the Croatian Institute for Brain Research, School of Medicine, University of Zagreb, Scientific Centre of Excellence for Basic, Clinical and Translational Neuroscience, Zagreb, Croatia.,Department of Health Psychology, University of Applied Health Sciences, Zagreb, Croatia.,Croatian Institute for Brain Research, Center of Research Excellence for Basic, Clinical and Translational Neuroscience, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Željka Krsnik
- From the Croatian Institute for Brain Research, School of Medicine, University of Zagreb, Scientific Centre of Excellence for Basic, Clinical and Translational Neuroscience, Zagreb, Croatia
| |
Collapse
|
9
|
Radhakrishnan R, Grecco G, Stolze K, Atwood B, Jennings SG, Lien IZ, Saykin AJ, Sadhasivam S. Neuroimaging in infants with prenatal opioid exposure: Current evidence, recent developments and targets for future research. J Neuroradiol 2021; 48:112-120. [PMID: 33065196 PMCID: PMC7979441 DOI: 10.1016/j.neurad.2020.09.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 09/28/2020] [Accepted: 09/29/2020] [Indexed: 12/29/2022]
Abstract
Prenatal opioid exposure (POE) has shown to be a risk factor for adverse long-term cognitive and behavioral outcomes in offspring. However, the neural mechanisms of these outcomes remain poorly understood. While preclinical and human studies suggest that these outcomes may be due to opioid-mediated changes in the fetal and early postnatal brain, other maternal, social, and environmental factors are also shown to play a role. Recent neuroimaging studies reveal brain alterations in children with POE. Early neuroimaging and novel methodology could provide an in vivo mechanistic understanding of opioid mediated alterations in developing brain. However, this is an area of ongoing research. In this review we explore recent imaging developments in POE, with emphasis on the neonatal and infant brain, and highlight some of the challenges of imaging the developing brain in this population. We also highlight evidence from animal models and imaging in older children and youth to understand areas where future research may be targeted in infants with POE.
Collapse
Affiliation(s)
- Rupa Radhakrishnan
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Indiana, USA.
| | - Gregory Grecco
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | | | - Brady Atwood
- Department of Pharmacology and Toxicology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Samuel G Jennings
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Izlin Z Lien
- Department of Pediatrics, Division of Neonatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Andrew J Saykin
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | | |
Collapse
|
10
|
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
|
11
|
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
|
12
|
Antecedents of Objectively Diagnosed Diffuse White Matter Abnormality in Very Preterm Infants. Pediatr Neurol 2020; 106:56-62. [PMID: 32139164 PMCID: PMC7500641 DOI: 10.1016/j.pediatrneurol.2020.01.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 01/22/2020] [Accepted: 01/26/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Diffuse white matter abnormality (diffuse excessive high signal intensity) is the most common finding on structural brain magnetic resonance imaging (MRI) at term-equivalent age in very preterm infants. Yet, there remains a large gap in our understanding of the etiology of diffuse white matter abnormality. Our objective was to evaluate perinatal and neonatal inflammation-associated antecedents of diffuse white matter abnormality on MRI. METHODS We prospectively enrolled 110 very preterm infants born at ≤31 weeks gestational age and collected data on multiple perinatal/neonatal exposures, especially inflammation initiating-illnesses. We performed structural MRI at term-equivalent age and quantified the volume of diffuse white matter abnormality objectively. Multivariable regression was used to identify clinical antecedents of diffuse white matter abnormality. RESULTS The mean (S.D.) birth gestational age of the final study sample of 98 very preterm infants was 28.3 (2.5) weeks. Multiple inflammation initiating-illnesses were associated with diffuse white matter abnormality in univariate analyses. In multivariable linear regression analyses controlling for gestational age, severe retinopathy of prematurity (P < 0.001) and bronchopulmonary dysplasia (P = 0.006) were independent risk factors, whereas maternal treatment with 17-hydroxyprogesterone (P < 0.001) was protective of later development of objectively quantified diffuse white matter abnormality. CONCLUSIONS We identified several perinatal and neonatal antecedent clinical factors associated with diffuse white matter abnormality. Although we found some support for inflammation as a common underlying mechanism, larger studies are needed to validate inflammation as a potential common pathway to the development of diffuse white matter abnormality in very preterm infants.
Collapse
|
13
|
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
|
14
|
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
|
15
|
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
|
16
|
Smyser CD, Wheelock MD, Limbrick DD, Neil JJ. Neonatal brain injury and aberrant connectivity. Neuroimage 2019; 185:609-623. [PMID: 30059733 PMCID: PMC6289815 DOI: 10.1016/j.neuroimage.2018.07.057] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 06/21/2018] [Accepted: 07/24/2018] [Indexed: 12/12/2022] Open
Abstract
Brain injury sustained during the neonatal period may disrupt development of critical structural and functional connectivity networks leading to subsequent neurodevelopmental impairment in affected children. These networks can be characterized using structural (via diffusion MRI) and functional (via resting state-functional MRI) neuroimaging techniques. Advances in neuroimaging have led to expanded application of these approaches to study term- and prematurely-born infants, providing improved understanding of cerebral development and the deleterious effects of early brain injury. Across both modalities, neuroimaging data are conducive to analyses ranging from characterization of individual white matter tracts and/or resting state networks through advanced 'connectome-style' approaches capable of identifying highly connected network hubs and investigating metrics of network topology such as modularity and small-worldness. We begin this review by summarizing the literature detailing structural and functional connectivity findings in healthy term and preterm infants without brain injury during the postnatal period, including discussion of early connectome development. We then detail common forms of brain injury in term- and prematurely-born infants. In this context, we next review the emerging body of literature detailing studies employing diffusion MRI, resting state-functional MRI and other complementary neuroimaging modalities to characterize structural and functional connectivity development in infants with brain injury. We conclude by reviewing technical challenges associated with neonatal neuroimaging, highlighting those most relevant to studying infants with brain injury and emphasizing the need for further targeted study in this high-risk population.
Collapse
Affiliation(s)
- Christopher D Smyser
- Departments of Neurology, Pediatrics and Radiology, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8111, St. Louis, MO, 63110, USA.
| | - Muriah D Wheelock
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8134, St. Louis, MO, 63110, USA.
| | - David D Limbrick
- Departments of Neurosurgery and Pediatrics, Washington University School of Medicine, One Children's Place, Suite S20, St. Louis, MO, 63110, USA.
| | - Jeffrey J Neil
- Department of Pediatric Neurology, Boston Children's Hospital, 300 Longwood Avenue, BCH3443, Boston, MA, 02115, USA.
| |
Collapse
|
17
|
Abstract
Despite the advances in neonatal intensive care, the preterm brain remains vulnerable to white matter injury (WMI) and disruption of normal brain development (i.e., dysmaturation). Compared to severe cystic WMI encountered in the past decades, contemporary cohorts of preterm neonates experience milder WMIs. More than destructive lesions, disruption of the normal developmental trajectory of cellular elements of the white and the gray matter occurs. In the acute phase, in response to hypoxia-ischemia and/or infection and inflammation, multifocal areas of necrosis within the periventricular white matter involve all cellular elements. Later, chronic WMI is characterized by diffuse WMI with aberrant regeneration of oligodendrocytes, which fail to mature to myelinating oligodendrocytes, leading to myelination disturbances. Complete neuronal degeneration classically accompanies necrotic white matter lesions, while altered neurogenesis, represented by a reduction of the dendritic arbor and synapse formation, is observed in response to diffuse WMI. Neuroimaging studies now provide more insight in assessing both injury and dysmaturation of both gray and white matter. Preterm brain injury remains an important cause of neurodevelopmental disabilities, which are still observed in up to 50% of the preterm survivors and take the form of a complex combination of motor, cognitive, and behavioral concerns.
Collapse
Affiliation(s)
- Juliane Schneider
- Department of Woman-Mother-Child, Clinic of Neonatology, University Hospital Center and University of Lausanne, Lausanne, Switzerland
| | - Steven P Miller
- Division of Neurology and Centre for Brain and Mental Health, Hospital for Sick Children, Toronto, ON, Canada.
| |
Collapse
|
18
|
Developmental Disorders Among Very Preterm Children. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2018. [DOI: 10.1007/s40474-018-0151-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
19
|
Žunić Išasegi I, Radoš M, Krsnik Ž, Radoš M, Benjak V, Kostović I. Interactive histogenesis of axonal strata and proliferative zones in the human fetal cerebral wall. Brain Struct Funct 2018; 223:3919-3943. [PMID: 30094607 PMCID: PMC6267252 DOI: 10.1007/s00429-018-1721-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 07/18/2018] [Indexed: 12/17/2022]
Abstract
Development of the cerebral wall is characterized by partially overlapping histogenetic events. However, little is known with regards to when, where, and how growing axonal pathways interact with progenitor cell lineages in the proliferative zones of the human fetal cerebrum. We analyzed the developmental continuity and spatial distribution of the axonal sagittal strata (SS) and their relationship with proliferative zones in a series of human brains (8-40 post-conceptional weeks; PCW) by comparing histological, histochemical, and immunocytochemical data with magnetic resonance imaging (MRI). Between 8.5 and 11 PCW, thalamocortical fibers from the intermediate zone (IZ) were initially dispersed throughout the subventricular zone (SVZ), while sizeable axonal "invasion" occurred between 12.5 and 15 PCW followed by callosal fibers which "delaminated" the ventricular zone-inner SVZ from the outer SVZ (OSVZ). During midgestation, the SS extensively invaded the OSVZ, separating cell bands, and a new multilaminar axonal-cellular compartment (MACC) was formed. Preterm period reveals increased complexity of the MACC in terms of glial architecture and the thinning of proliferative bands. The addition of associative fibers and the formation of the centrum semiovale separated the SS from the subplate. In vivo MRI of the occipital SS indicates a "triplet" structure of alternating hypointense and hyperintense bands. Our results highlighted the developmental continuity of sagittally oriented "corridors" of projection, commissural and associative fibers, and histogenetic interaction with progenitors, neurons, and glia. Histogenetical changes in the MACC, and consequently, delineation of the SS on MRI, may serve as a relevant indicator of white matter microstructural integrity in the developing brain.
Collapse
Affiliation(s)
- Iris Žunić Išasegi
- Croatian Institute for Brain Research, Centar of Research Excellence for Basic, Clinical and Translational Neuroscience, University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Milan Radoš
- Croatian Institute for Brain Research, Centar of Research Excellence for Basic, Clinical and Translational Neuroscience, University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Željka Krsnik
- Croatian Institute for Brain Research, Centar of Research Excellence for Basic, Clinical and Translational Neuroscience, University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Marko Radoš
- Department of Radiology, Clinical Hospital Center Zagreb, University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Vesna Benjak
- Department of Pediatrics, Clinical Hospital Center Zagreb, University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Ivica Kostović
- Croatian Institute for Brain Research, Centar of Research Excellence for Basic, Clinical and Translational Neuroscience, University of Zagreb, School of Medicine, Zagreb, Croatia.
| |
Collapse
|
20
|
Abstract
Predicting neurodevelopmental outcomes in high-risk neonates remains challenging despite advances in neonatal care. Early and accurate characterization of infants at risk for neurodevelopmental delays is necessary to best identify those who may benefit from existing early interventions and novel therapies that become available. Although neuroimaging is a promising biomarker in the prediction of neurodevelopmental outcomes in high-risk infants, it requires additional resources and expertise. Despite many advances in neonatal neuroimaging, there remain limitations in relating early neuroimaging findings with long-term outcomes; further studies are necessary to determine the optimal protocols to best identify high-risk patients and improve neurodevelopmental outcome prediction.
Collapse
|
21
|
Ball G, Aljabar P, Nongena P, Kennea N, Gonzalez-Cinca N, Falconer S, Chew ATM, Harper N, Wurie J, Rutherford MA, Counsell SJ, Edwards AD. Multimodal image analysis of clinical influences on preterm brain development. Ann Neurol 2017; 82:233-246. [PMID: 28719076 PMCID: PMC5601217 DOI: 10.1002/ana.24995] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 07/11/2017] [Accepted: 07/12/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Premature birth is associated with numerous complex abnormalities of white and gray matter and a high incidence of long-term neurocognitive impairment. An integrated understanding of these abnormalities and their association with clinical events is lacking. The aim of this study was to identify specific patterns of abnormal cerebral development and their antenatal and postnatal antecedents. METHODS In a prospective cohort of 449 infants (226 male), we performed a multivariate and data-driven analysis combining multiple imaging modalities. Using canonical correlation analysis, we sought separable multimodal imaging markers associated with specific clinical and environmental factors and correlated to neurodevelopmental outcome at 2 years. RESULTS We found five independent patterns of neuroanatomical variation that related to clinical factors including age, prematurity, sex, intrauterine complications, and postnatal adversity. We also confirmed the association between imaging markers of neuroanatomical abnormality and poor cognitive and motor outcomes at 2 years. INTERPRETATION This data-driven approach defined novel and clinically relevant imaging markers of cerebral maldevelopment, which offer new insights into the nature of preterm brain injury. Ann Neurol 2017;82:233-246.
Collapse
Affiliation(s)
- Gareth Ball
- Centre for the Developing Brain, King's College London, St Thomas' Hospital, London, United Kingdom.,Developmental Imaging, Murdoch Childrens Research Institute, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Paul Aljabar
- Centre for the Developing Brain, King's College London, St Thomas' Hospital, London, United Kingdom
| | - Phumza Nongena
- Centre for the Developing Brain, King's College London, St Thomas' Hospital, London, United Kingdom
| | - Nigel Kennea
- St Georges, University of London, St Georges Hospital, London, United Kingdom
| | - Nuria Gonzalez-Cinca
- Centre for the Developing Brain, King's College London, St Thomas' Hospital, London, United Kingdom
| | - Shona Falconer
- Centre for the Developing Brain, King's College London, St Thomas' Hospital, London, United Kingdom
| | - Andrew T M Chew
- Centre for the Developing Brain, King's College London, St Thomas' Hospital, London, United Kingdom
| | - Nicholas Harper
- Centre for the Developing Brain, King's College London, St Thomas' Hospital, London, United Kingdom
| | - Julia Wurie
- Centre for the Developing Brain, King's College London, St Thomas' Hospital, London, United Kingdom
| | - Mary A Rutherford
- Centre for the Developing Brain, King's College London, St Thomas' Hospital, London, United Kingdom
| | - Serena J Counsell
- Centre for the Developing Brain, King's College London, St Thomas' Hospital, London, United Kingdom
| | - A David Edwards
- Centre for the Developing Brain, King's College London, St Thomas' Hospital, London, United Kingdom
| |
Collapse
|
22
|
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
|
23
|
Krsnik Ž, Majić V, Vasung L, Huang H, Kostović I. Growth of Thalamocortical Fibers to the Somatosensory Cortex in the Human Fetal Brain. Front Neurosci 2017; 11:233. [PMID: 28496398 PMCID: PMC5406414 DOI: 10.3389/fnins.2017.00233] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 04/07/2017] [Indexed: 01/17/2023] Open
Abstract
Thalamocortical (TH-C) fiber growth begins during the embryonic period and is completed by the third trimester of gestation in humans. Here we determined the timing and trajectories of somatosensory TH-C fibers in the developing human brain. We analyzed the periods of TH-C fiber outgrowth, path-finding, "waiting" in the subplate (SP), target selection, and ingrowth in the cortical plate (CP) using histological sections from post-mortem fetal brain [from 7 to 34 postconceptional weeks (PCW)] that were processed with acetylcholinesterase (AChE) histochemistry and immunohistochemical methods. Images were compared with post mortem diffusion tensor imaging (DTI)-based fiber tractography (code No NO1-HD-4-3368). The results showed TH-C axon outgrowth occurs as early as 7.5 PCW in the ventrolateral part of the thalamic anlage. Between 8 and 9.5 PCW, TH-C axons form massive bundles that traverse the diencephalic-telencephalic boundary. From 9.5 to 11 PCW, thalamocortical axons pass the periventricular area at the pallial-subpallial boundary and enter intermediate zone in radiating fashion. Between 12 and 14 PCW, the TH-C axons, aligned along the fibers from the basal forebrain, continue to grow for a short distance within the deep intermediate zone and enter the deep CP, parallel with SP expansion. Between 14 and 18 PCW, the TH-C interdigitate with callosal fibers, running shortly in the sagittal stratum and spreading through the deep SP ("waiting" phase). From 19 to 22 PCW, TH-C axons accumulate in the superficial SP below the somatosensory cortical area; this occurs 2 weeks earlier than in the frontal and occipital cortices. Between 23 and 24 PCW, AChE-reactive TH-C axons penetrate the CP concomitantly with its initial lamination. Between 25 and 34 PCW, AChE reactivity of the CP exhibits an uneven pattern suggestive of vertical banding, showing a basic 6-layer pattern. In conclusion, human thalamocortical axons show prolonged growth (4 months), and somatosensory fibers precede the ingrowth of fibers destined for frontal and occipital areas. The major features of growing TH-C somatosensory fiber trajectories are fan-like radiation, short runs in the sagittal strata, and interdigitation with the callosal system. These results support our hypothesis that TH-C axons are early factors in SP and CP morphogenesis and synaptogenesis and may regulate cortical somatosensory system maturation.
Collapse
Affiliation(s)
- Željka Krsnik
- Department of Neuroscience, Croatian Institute for Brain Research, School of Medicine, University of ZagrebZagreb, Croatia
| | - Visnja Majić
- Department of Neuroscience, Croatian Institute for Brain Research, School of Medicine, University of ZagrebZagreb, Croatia
| | - Lana Vasung
- Harvard Medical School, Boston Children's HospitalBoston, MA, USA
| | - Hao Huang
- Laboratory of Neural MRI and Brain Connectivity, School of Medicine and Children's Hospital of Philadelphia, University of Pennsylvania PerelmanPhiladelphia, PA, USA
| | - Ivica Kostović
- Department of Neuroscience, Croatian Institute for Brain Research, School of Medicine, University of ZagrebZagreb, Croatia
| |
Collapse
|
24
|
Langham A. MRI for premature neonatal brain injury: a case report. J Med Radiat Sci 2017; 64:152-155. [PMID: 28263044 PMCID: PMC5454326 DOI: 10.1002/jmrs.226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 12/05/2016] [Accepted: 01/27/2017] [Indexed: 01/12/2023] Open
Abstract
This case report aims to extend analytical thinking and clinical reasoning of clinicians and radiographers when presented with diagnosing premature neonatal brain injuries (PNBI). The report considers the uses and merit of magnetic resonance imaging (MRI) in the primary assessment of PNBI. The traditional technique of cranial ultrasound as the first modality of choice can have several limitations, which includes a lower temporal resolution in its ability to differentiate grey-white matter distribution patterns, lower spatial resolution in its ability to accurately map white matter fibre tracts and distribution patterns which are critical in white matter injury pathological events. In this specific case report, MRI was useful for the assessment of haemorrhagic brain injury post partum.Therefore, should MRI be considered, the primary imaging modality in these cases when the concerns about PNBI is presented? This case study explores the current trends in MRI neonatal brain imaging and advancements being made in this field.
Collapse
|
25
|
Lodygensky GA, Thompson DK. Toward quantitative MRI analysis: A smart approach to characterize neonatal white matter injury. Neurology 2017; 88:610-611. [PMID: 28100729 DOI: 10.1212/wnl.0000000000003621] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Gregory A Lodygensky
- From the Department of Pediatrics and Pharmacology (G.A.L), CHU Research Center, University of Montréal; Montreal Heart Institute (G.A.L), Canada; Murdoch Childrens Research Institute (D.K.T); Florey Institute of Neuroscience and Mental Health (D.K.T), Parkville; and Department of Paediatrics (D.K.T), University of Melbourne, Australia.
| | - Deanne K Thompson
- From the Department of Pediatrics and Pharmacology (G.A.L), CHU Research Center, University of Montréal; Montreal Heart Institute (G.A.L), Canada; Murdoch Childrens Research Institute (D.K.T); Florey Institute of Neuroscience and Mental Health (D.K.T), Parkville; and Department of Paediatrics (D.K.T), University of Melbourne, Australia
| |
Collapse
|
26
|
Parikh NA, Pierson CR, Rusin JA. Neuropathology Associated With Diffuse Excessive High Signal Intensity Abnormalities on Magnetic Resonance Imaging in Very Preterm Infants. Pediatr Neurol 2016; 65:78-85. [PMID: 27567289 DOI: 10.1016/j.pediatrneurol.2016.07.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 07/11/2016] [Accepted: 07/14/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Diffuse excessive high signal intensity abnormality is the most common finding on term-equivalent age magnetic resonance imaging in extremely preterm infants. Yet its clinical significance remains a matter of debate, in part because of a lack of prior imaging-pathology correlational studies. PATIENT PRESENTATIONS We present two 24-week-gestation infants with complicated clinical courses who died at 33 and 46 weeks postmenstrual age with magnetic resonance imaging evidence of diffuse excessive high signal intensity. Two patients with periventricular leukomalacia and two without injury were examined for comparison. Immunohistochemistry characterized the presence of reactive astrocytes, microglia, myelin, and axons. Infants with periventricular leukomalacia demonstrated the typical microscopic necrosis with spheroids, gliosis/microgliosis with reduction in stainable myelin and axons. Infants with diffuse excessive high signal intensity showed vacuolated regions with increased reactive astrocytes and microglia and fewer oligodendroglial cell bodies/processes and dramatic reduction in axon number. CONCLUSION These two individuals with diffuse excessive high signal intensity exhibited pathologic characteristics that were overlapping but distinct from those of periventricular leukomalacia.
Collapse
Affiliation(s)
- Nehal A Parikh
- Cincinnati Children's Hospital, The Perinatal Institute, Cincinnati, Ohio; Department of Pediatrics, Ohio State University College of Medicine, Columbus, Ohio.
| | - Christopher R Pierson
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, Ohio; Department of Pathology, Division of Anatomy, The Ohio State University College of Medicine, Columbus, Ohio
| | - Jerome A Rusin
- Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio
| |
Collapse
|
27
|
Parikh NA. Advanced neuroimaging and its role in predicting neurodevelopmental outcomes in very preterm infants. Semin Perinatol 2016; 40:530-541. [PMID: 27863706 PMCID: PMC5951398 DOI: 10.1053/j.semperi.2016.09.005] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Up to 35% of very preterm infants survive with neurodevelopmental impairments (NDI) such as cognitive deficits, cerebral palsy, and attention deficit disorder. Advanced MRI quantitative tools such as brain morphometry, diffusion MRI, magnetic resonance spectroscopy, and functional MRI at term-equivalent age are ideally suited to improve current efforts to predict later development of disabilities. This would facilitate application of targeted early intervention therapies during the first few years of life when neuroplasticity is optimal. A systematic search and review identified 47 published studies of advanced MRI to predict NDI. Diffusion MRI and morphometry studies were the most commonly studied modalities. Despite several limitations, studies clearly showed that brain structural and metabolite biomarkers are promising independent predictors of NDI. Large representative multicenter studies are needed to validate these studies.
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,Correspondence address: Cincinnati Children’s Hospital, Perinatal Institute, 3333 Burnet Ave., MLC 7009, Cincinnati, OH.
| |
Collapse
|
28
|
Bekiesińska-Figatowska M, Helwich E, Rutkowska M, Stankiewicz J, Terczyńska I. Magnetic resonance imaging of neonates in the magnetic resonance compatible incubator. Arch Med Sci 2016; 12:1064-1070. [PMID: 27695498 PMCID: PMC5016588 DOI: 10.5114/aoms.2016.61913] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 06/14/2014] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The authors present the first experience in neonatal magnetic resonance imaging (MRI) examinations using an MR compatible incubator (INC) at the Institute of Mother and Child. MATERIAL AND METHODS Forty-nine examinations of 47 newborns (20 girls, 27 boys) were performed using the GE Signa HDxt 1.5T system and INC Nomag IC 1.5. Demographic data, anesthetic methods and MRI findings in the INC in comparison with previously performed imaging were analyzed. RESULTS Thirty-two neonates were prematurely born (68.1%) at gestational age 23-37 weeks, mean: 29.9 weeks. They were examined at 26 weeks postmenstrual age to 1 month corrected age, mean: 37.5 weeks. Body weight of newborns on the study day was 600-4300 g, mean: 2724 g. Seventeen (34.7%) children were examined in physiological sleep, 32 (65.3%) anesthetized. In none of them did anesthesiological complications or disease worsening occur. In 43 (91.5%) children brain MRI was performed, in 4 (8.5%) MRI of the spinal cord and canal and of the abdomen/pelvis. In children prenatally examined by MRI, the INC provided new diagnostic information in 5 (83.3%) cases, in neonates studied after birth by ultrasound in 32 (82%). Magnetic resonance imaging in the INC did not entail additional knowledge in 9 (18.7%) cases. CONCLUSIONS The INC enables MRI in preterm newborns and those with low/extremely low body weight. These studies are necessary to assess the extent of changes in the central nervous system and other organs. Incubator coils, designed specifically for neonates, allow more accurate diagnosis than previously used coils for adults. MRI results allow one to determine prognosis, for more accurate planning of diagnostics, helping to make appropriate therapeutic decisions.
Collapse
Affiliation(s)
| | - Ewa Helwich
- Clinic of Neonatology and Neonatal Intensive Care, Institute of Mother and Child, Warsaw, Poland
| | - Magdalena Rutkowska
- Clinic of Neonatology and Neonatal Intensive Care, Institute of Mother and Child, Warsaw, Poland
| | - Joanna Stankiewicz
- Intensive Care and Anesthesiology Clinic, Institute of Mother and Child, Warsaw, Poland
| | - Iwona Terczyńska
- Clinic of Neurology of Children and Adolescents, Institute of Mother and Child, Warsaw, Poland
| |
Collapse
|
29
|
Koob M, Viola A, Le Fur Y, Viout P, Ratiney H, Confort-Gouny S, Cozzone PJ, Girard N. Creatine, Glutamine plus Glutamate, and Macromolecules Are Decreased in the Central White Matter of Premature Neonates around Term. PLoS One 2016; 11:e0160990. [PMID: 27547969 PMCID: PMC4993494 DOI: 10.1371/journal.pone.0160990] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 07/28/2016] [Indexed: 11/18/2022] Open
Abstract
Preterm birth represents a high risk of neurodevelopmental disabilities when associated with white-matter damage. Recent studies have reported cognitive deficits in children born preterm without brain injury on MRI at term-equivalent age. Understanding the microstructural and metabolic underpinnings of these deficits is essential for their early detection. Here, we used diffusion-weighted imaging and single-voxel 1H magnetic resonance spectroscopy (MRS) to compare brain maturation at term-equivalent age in premature neonates with no evidence of white matter injury on conventional MRI except diffuse excessive high-signal intensity, and normal term neonates. Thirty-two infants, 16 term neonates (mean post-conceptional age at scan: 39.8±1 weeks) and 16 premature neonates (mean gestational age at birth: 29.1±2 weeks, mean post-conceptional age at scan: 39.2±1 weeks) were investigated. The MRI/MRS protocol performed at 1.5T involved diffusion-weighted MRI and localized 1H-MRS with the Point RESolved Spectroscopy (PRESS) sequence. Preterm neonates showed significantly higher ADC values in the temporal white matter (P<0.05), the occipital white matter (P<0.005) and the thalamus (P<0.05). The proton spectrum of the centrum semiovale was characterized by significantly lower taurine/H2O and macromolecules/H2O ratios (P<0.05) at a TE of 30 ms, and reduced (creatine+phosphocreatine)/H2O and (glutamine+glutamate)/H2O ratios (P<0.05) at a TE of 135 ms in the preterm neonates than in full-term neonates. Our findings indicate that premature neonates with normal conventional MRI present a delay in brain maturation affecting the white matter and the thalamus. Their brain metabolic profile is characterized by lower levels of creatine, glutamine plus glutamate, and macromolecules in the centrum semiovale, a finding suggesting altered energy metabolism and protein synthesis.
Collapse
Affiliation(s)
- Meriam Koob
- Service de Neuroradiologie, AP-HM Timone, Aix-Marseille Université, Marseille, France
- Service de Radiopédiatrie-Imagerie 2, CHU de Strasbourg, Hôpital de Hautepierre, Strasbourg, France
- Laboratoire ICube, UMR 7357, FMTS, Université de Strasbourg-CNRS, Strasbourg, France
| | - Angèle Viola
- Aix-Marseille Université, CNRS, Centre de Résonance Magnétique Biologique et Médicale, UMR 7339, Faculté de Médecine la Timone, Marseille, France
- * E-mail: (NG); (AV)
| | - Yann Le Fur
- Aix-Marseille Université, CNRS, Centre de Résonance Magnétique Biologique et Médicale, UMR 7339, Faculté de Médecine la Timone, Marseille, France
| | - Patrick Viout
- Aix-Marseille Université, CNRS, Centre de Résonance Magnétique Biologique et Médicale, UMR 7339, Faculté de Médecine la Timone, Marseille, France
| | - Hélène Ratiney
- Laboratoire CREATIS, CNRS UMR 5220, Inserm U1044, Université Claude Bernard Lyon I, INSA-Lyon, Lyon, France
| | - Sylviane Confort-Gouny
- Aix-Marseille Université, CNRS, Centre de Résonance Magnétique Biologique et Médicale, UMR 7339, Faculté de Médecine la Timone, Marseille, France
| | - Patrick J. Cozzone
- Aix-Marseille Université, CNRS, Centre de Résonance Magnétique Biologique et Médicale, UMR 7339, Faculté de Médecine la Timone, Marseille, France
| | - Nadine Girard
- Service de Neuroradiologie, AP-HM Timone, Aix-Marseille Université, Marseille, France
- Aix-Marseille Université, CNRS, Centre de Résonance Magnétique Biologique et Médicale, UMR 7339, Faculté de Médecine la Timone, Marseille, France
- * E-mail: (NG); (AV)
| |
Collapse
|
30
|
Differentiating T2 hyperintensity in neonatal white matter by two-compartment model of diffusional kurtosis imaging. Sci Rep 2016; 6:24473. [PMID: 27075248 PMCID: PMC4830988 DOI: 10.1038/srep24473] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 03/30/2016] [Indexed: 12/18/2022] Open
Abstract
In conventional neonatal MRI, the T2 hyperintensity (T2h) in cerebral white matter (WM) at term-equivalent age due to immaturity or impairment is still difficult to identify. To clarify such issue, this study used the metrics derived from a two-compartment WM model of diffusional kurtosis imaging (WM-DKI), including intra-axonal, extra-axonal axial and radial diffusivities (Da, De,// and De,⊥), to compare WM differences between the simple T2h and normal control for both preterm and full-term neonates, and between simple T2h and complex T2h with hypoxic-ischemic encephalopathy (HIE). Results indicated that compared with control, the simple T2h showed significantly increased De,// and De,⊥, but no significant change in Da in multiple premyelination regions, indicative of expanding extra-axonal diffusion microenvironment; while myelinated regions showed no changes. However, compared with simple T2h, the complex T2h with HIE had decreased Da, increased De,⊥ in both premyelination and myelinated regions, indicative of both intra- and extra-axonal diffusion alterations. While diffusion tensor imaging (DTI) failed to distinguish simple T2h from complex T2h with HIE. In conclusion, superior to DTI-metrics, WM-DKI metrics showed more specificity for WM microstructural changes to distinguish simple T2h from complex T2h with HIE.
Collapse
|
31
|
Broström L, Bolk J, Padilla N, Skiöld B, Eklöf E, Mårtensson G, Vollmer B, Ådén U. Clinical Implications of Diffuse Excessive High Signal Intensity (DEHSI) on Neonatal MRI in School Age Children Born Extremely Preterm. PLoS One 2016; 11:e0149578. [PMID: 26886451 PMCID: PMC4757441 DOI: 10.1371/journal.pone.0149578] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 02/01/2016] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Magnetic resonance imaging (MRI) of the brain carried out during the neonatal period shows that 55-80% of extremely preterm infants display white matter diffuse excessive high signal intensity (DEHSI). Our aim was to study differences in developmental outcome at the age of 6.5 years in children born extremely preterm with and without DEHSI. STUDY DESIGN This was a prospective cohort study of 83 children who were born in Stockholm, Sweden, between 2004 and 2007, born at gestational age of < 27 weeks + 0 days and who underwent an MRI scan of their brain at term equivalent age. The outcome measures at 6.5 years included testing 66 children with the modified Touwen neurology examination, the Movement Assessment Battery for Children 2, the Wechsler Intelligence Scale for Children-Fourth Edition, Beery Visual-motor Integration test-Sixth Edition, and the Strengths and Difficulties Questionnaire. Group-wise comparisons were done between children with and without DEHSI using Student t-test, Mann Whitney U test, Chi square test and regression analysis. RESULTS DEHSI was detected in 39 (59%) of the 66 children who were assessed at 6.5 years. The presence of DEHSI was not associated with mild neurological dysfunction, scores on M-ABC assessment, cognition, visual-motor integration, or behavior at 6.5 years. CONCLUSION The presence of qualitatively defined DEHSI on neonatal MRI did not prove to be a useful predictor of long-term impairment in children born extremely preterm.
Collapse
Affiliation(s)
- Lina Broström
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
| | - Jenny Bolk
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Neonatal Unit, Sachs’ Children and Youth Hospital, Stockholm, Sweden
| | - Nelly Padilla
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Béatrice Skiöld
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Neonatal Unit, Karolinska University Hospital, Stockholm, Sweden
| | - Eva Eklöf
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Gustaf Mårtensson
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Brigitte Vollmer
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Clinical Neurosciences, Clinical and Experimental Sciences, University of Southampton, Southampton, United Kingdom
| | - Ulrika Ådén
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Neonatal Unit, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
32
|
Neonatal brain microstructure correlates of neurodevelopment and gait in preterm children 18-22 mo of age: an MRI and DTI study. Pediatr Res 2015; 78:700-8. [PMID: 26322412 DOI: 10.1038/pr.2015.157] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 05/18/2015] [Indexed: 11/09/2022]
Abstract
BACKGROUND Near-term brain structure was examined in preterm infants in relation to neurodevelopment. We hypothesized that near-term macrostructural brain abnormalities identified using conventional magnetic resonance imaging (MRI), and white matter (WM) microstructure detected using diffusion tensor imaging (DTI), would correlate with lower cognitive and motor development and slower, less-stable gait at 18-22 mo of age. METHODS One hundred and two very-low-birth-weight preterm infants (≤1,500 g birth weight; ≤32 wk gestational age) were recruited prior to routine near-term brain MRI at 36.6 ± 1.8 wk postmenstrual age. Cerebellar and WM macrostructure was assessed on conventional structural MRI. DTI was obtained in 66 out of 102 and WM microstructure was assessed using fractional anisotropy and mean diffusivity (MD) in six subcortical brain regions defined by DiffeoMap neonatal atlas. Neurodevelopment was assessed with Bayley-Scales-of-Infant-Toddler-Development, 3rd-Edition (BSID-III); gait was assessed using an instrumented mat. RESULTS Neonates with cerebellar abnormalities identified using MRI demonstrated lower mean BSID-III cognitive composite scores (89.0 ± 10.1 vs. 97.8 ± 12.4; P = 0.002) at 18-22 mo. Neonates with higher DTI-derived left posterior limb of internal capsule (PLIC) MD demonstrated lower cognitive and motor composite scores (r = -0.368; P = 0.004; r = -0.354; P = 0.006) at 18-22 mo; neonates with higher genu MD demonstrated slower gait velocity (r = -0.374; P = 0.007). Multivariate linear regression significantly predicted cognitive (adjusted r(2) = 0.247; P = 0.002) and motor score (adjusted r(2) = 0.131; P = 0.017). CONCLUSION Near-term cerebellar macrostructure and PLIC and genu microstructure were predictive of early neurodevelopment and gait.
Collapse
|
33
|
He L, Parikh NA. Aberrant Executive and Frontoparietal Functional Connectivity in Very Preterm Infants With Diffuse White Matter Abnormalities. Pediatr Neurol 2015. [PMID: 26216502 DOI: 10.1016/j.pediatrneurol.2015.05.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Diffuse white matter abnormalities are identified in up to 80% of very preterm infants on magnetic resonance imaging at 40 weeks' postmenstrual age. Several studies have observed an association between diffuse white matter abnormalities and cognitive deficits. We hypothesized that very preterm infants (gestational age ≤32 weeks) with diffuse white matter abnormalities will exhibit reduced executive control and frontoparietal functional connectivity compared with infants without diffuse white matter abnormalities measured using resting state functional magnetic resonance imaging at term-equivalent age. METHODS We quantified diffuse white matter abnormality volume objectively using an automated segmentation approach and defined diffuse white matter abnormality severity as no-mild (volume ≤50th percentile; N = 13) and moderate-severe (N = 14). Resting state networks of interests were identified using probabilistic independent component analysis. Within network functional connectivity was calculated between the different pair of nodes in a given network using partial correlation coefficients. RESULTS We studied 27 very preterm infants born at a mean (standard deviation) gestational age of 26.9 (2.0) weeks and imaged at 39.6 (1.4) weeks' postmenstrual age. Within-network connectivity was significantly reduced in the moderate-severe diffuse white matter abnormalities group than in the no-mild diffuse white matter abnormalities group for the executive control (P < 0.001) and frontoparietal (P = 0.02) networks. As expected, connectivity in three control resting state networks was similar: visual (P = 0.17), motor (P = 0.89), and somatosensory (P = 0.69) networks. CONCLUSIONS Very preterm infants with moderate or severe diffuse white matter abnormalities exhibited reduced functional connectivity in important cognitive and attention networks. This aberrant connectivity may be the early life antecedent to the cognitive deficits reported at 2 years of age or later in such infants.
Collapse
Affiliation(s)
- Lili He
- Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio.
| | - Nehal A Parikh
- Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio; The Department of Pediatrics, Ohio State University College of Medicine, Columbus, Ohio.
| |
Collapse
|
34
|
Van't Hooft J, van der Lee JH, Opmeer BC, Aarnoudse-Moens CSH, Leenders AGE, Mol BWJ, de Haan TR. Predicting developmental outcomes in premature infants by term equivalent MRI: systematic review and meta-analysis. Syst Rev 2015; 4:71. [PMID: 25982565 PMCID: PMC4438620 DOI: 10.1186/s13643-015-0058-7] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 05/05/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study aims to determine the prognostic accuracy of term MRI in very preterm born (≤32 weeks) or low-birth-weight (≤1500 g) infants for long-term (>18 months) developmental outcomes. METHODS We performed a systematic review searching Central, Medline, Embase, and PsycInfo. Two independent reviewers performed study selection, data extraction, and quality assessment. We documented sensitivity and specificity for three different MRI findings (white matter abnormalities (WMA), brain abnormality (BA), and diffuse excessive high signal intensity (DEHSI)), related to developmental outcomes including cerebral palsy (CP), visual and/or hearing problems, motor, neurocognitive, and behavioral function. Using bivariate meta-analysis, we estimated pooled sensitivity and specificity and plotted summary receiver operating characteristic (sROC) curves for different cut-offs of MRI. RESULTS We included 20 papers published between 2000 and 2013. Quality of included studies varied. Pooled sensitivity and specificity values (95 % confidence interval (CI)) for prediction of CP combining the three different MRI findings (using normal/mild vs. moderate/severe cut-off) were 77 % (53 to 91 %) and 79 % (51 to 93 %), respectively. For prediction of motor function, the values were 72 % (52 to 86 %) and 62 % (29 to 87 %), respectively. Prognostic accuracy for visual and/or hearing problems, neurocognitive, and/or behavioral function was poor. sROC curves of the individual MRI findings showed that presence of WMA provided the best prognostic accuracy whereas DEHSI did not show any potential prognostic accuracy. CONCLUSIONS This study shows that presence of moderate/severe WMA on MRI around term equivalent age can predict CP and motor function in very preterm or low-birth-weight infants with moderate sensitivity and specificity. Its ability to predict other long-term outcomes such as neurocognitive and behavioral impairments is limited. Also, other white matter related tests as BA and DEHSI demonstrated limited prognostic value. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42013006362.
Collapse
Affiliation(s)
- Janneke Van't Hooft
- Department of Obstetrics and Gynecology, Academic Medical Center, PO Box 22660, 1100 DD, Amsterdam, The Netherlands.
| | - Johanna H van der Lee
- Pediatric Clinical Research Office, Emma Children's Hospital, Academic Medical Center, PO Box 22660, 1100 DD, Amsterdam, The Netherlands.
| | - Brent C Opmeer
- Clinical Research Unit, Academic Medical Center, PO Box 22660, 1100 DD, Amsterdam, The Netherlands.
| | - Cornelieke S H Aarnoudse-Moens
- Pediatric Psychosocial Department, Emma Children's Hospital, Academic Medical Center, PO Box 22660, 1100 DD, Amsterdam, The Netherlands.
| | - Arnold G E Leenders
- Medical Library, Academic Medical Center, PO Box 22660, 1100 DD, Amsterdam, The Netherlands.
| | - Ben Willem J Mol
- Robinson Research Institute, School of Pediatrics and Reproductive Health, University of Adelaide, Adelaide, 5000, SA, Australia.
| | - Timo R de Haan
- Department of Neonatology (H3-147), Emma Children's Hospital, Academical Medical Center, PO Box 22660, 1100 DD, Amsterdam, The Netherlands.
| |
Collapse
|
35
|
Calloni SF, Cinnante CM, Bassi L, Avignone S, Fumagalli M, Bonello L, Consonni D, Picciolini O, Mosca F, Triulzi F. Neurodevelopmental outcome at 36 months in very low birth weight premature infants with MR diffuse excessive high signal intensity (DEHSI) of cerebral white matter. Radiol Med 2015; 120:1056-63. [PMID: 25903560 DOI: 10.1007/s11547-015-0540-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 04/08/2015] [Indexed: 11/30/2022]
Abstract
PURPOSE To understand the meaning of diffuse excessive high signal intensity (DEHSI) of white matter (WM), a frequently observed finding on MR in VLBW infants at a corrected term age. METHODS This is a retrospective study. Qualitative visual assessment of cerebral WM signal intensity on T2WI was performed by two readers on 78 VLBW infants, scanned on a 1.5 T-MRI at term equivalent age. ADC values were then measured in six regions of interest: four in frontal and parietal periventricular and two in parietal subcortical WM. Mean ADC values were then compared with qualitative visual assessment and with mean ADC values obtained ten term healthy babies. Both periventricular and subcortical mean ADC values were correlated with the neurological follow-up, evaluated with the Griffith's mental developmental scale at 36 months. RESULTS There was no agreement between the visual qualitative assessment of white matter DEHSI and corresponding ADC values (P values = 0.42 for periventricular WM; P values = 0.18 for subcortical WM). Mean ADC values were higher in preterms than in term babies (P values <0.001). No significant correlation was found between ADC values and the developmental quotient at 36 months (P values >0.05). CONCLUSIONS DEHSI in VLBW infants is a MR finding poorly defined with conventional T2 MRI. The presence of T2 hyperintensities weakly correlates with ADC, and ADC values are not associated with the neurological long-term outcome at 3 years, demonstrating that DEHSI should not be considered as a WM disease.
Collapse
Affiliation(s)
| | - Claudia Maria Cinnante
- Department of Neuroradiology, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Laura Bassi
- Neonatal Intensive Care Unit, Department of Clinical Science and Community Health, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Sabrina Avignone
- Department of Neuroradiology, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Monica Fumagalli
- Neonatal Intensive Care Unit, Department of Clinical Science and Community Health, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Luke Bonello
- School of Medicine, University of Milan, Via Festa del Perdono, 7, 20122, Milan, Italy
| | - Dario Consonni
- Department of Epidemiology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Odoardo Picciolini
- Neonatal Intensive Care Unit, Department of Clinical Science and Community Health, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Fabio Mosca
- Neonatal Intensive Care Unit, Department of Clinical Science and Community Health, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Fabio Triulzi
- Department of Neuroradiology, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| |
Collapse
|
36
|
Anderson PJ, Cheong JLY, Thompson DK. The predictive validity of neonatal MRI for neurodevelopmental outcome in very preterm children. Semin Perinatol 2015; 39:147-58. [PMID: 25724792 DOI: 10.1053/j.semperi.2015.01.008] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Very preterm children are at a high risk for neurodevelopmental impairments, but there is variability in the pattern and severity of outcome. Neonatal magnetic resonance imaging (MRI) enhances the capacity to detect brain injury and altered brain development and assists in the prediction of high-risk children who warrant surveillance and early intervention. This review describes the application of conventional and advanced MRI with very preterm neonates, specifically focusing on the relationship between neonatal MRI findings and later neurodevelopmental outcome. Research demonstrates that conventional MRI is strongly associated with neurodevelopmental outcome in childhood. Further studies are needed to examine the role of advanced MRI techniques in predicting outcome in very preterm children, but early research findings are promising. In conclusion, neonatal MRI is predictive of later neurodevelopment but is dependent on appropriately trained specialists and should be interpreted in conjunction with other clinical and social information.
Collapse
Affiliation(s)
- Peter J Anderson
- Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Australia.
| | - Jeanie L Y Cheong
- Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Australia; Neonatal Services, Royal Women׳s Hospital, Melbourne, Australia; Department of Obstetrics & Gynaecology, University of Melbourne, Melbourne, Australia
| | - Deanne K Thompson
- Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| |
Collapse
|
37
|
Wisnowski JL, Ceschin RC, Choi SY, Schmithorst VJ, Painter MJ, Nelson MD, Blüml S, Panigrahy A. Reduced thalamic volume in preterm infants is associated with abnormal white matter metabolism independent of injury. Neuroradiology 2015; 57:515-25. [PMID: 25666231 DOI: 10.1007/s00234-015-1495-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 01/21/2015] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Altered thalamocortical development is hypothesized to be a key substrate underlying neurodevelopmental disabilities in preterm infants. However, the pathogenesis of this abnormality is not well-understood. We combined magnetic resonance spectroscopy of the parietal white matter and morphometric analyses of the thalamus to investigate the association between white matter metabolism and thalamic volume and tested the hypothesis that thalamic volume would be associated with diminished N-acetyl-aspartate (NAA), a measure of neuronal/axonal maturation, independent of white matter injury. METHODS Data from 106 preterm infants (mean gestational age at birth: 31.0 weeks ± 4.3; range 23-36 weeks) who underwent MR examinations under clinical indications were included in this study. RESULTS Linear regression analyses demonstrated a significant association between parietal white matter NAA concentration and thalamic volume. This effect was above and beyond the effect of white matter injury and age at MRI and remained significant even when preterm infants with punctate white matter lesions (pWMLs) were excluded from the analysis. Furthermore, choline, and among the preterm infants without pWMLs, lactate concentrations were also associated with thalamic volume. Of note, the associations between NAA and choline concentration and thalamic volume remained significant even when the sample was restricted to neonates who were term-equivalent age or older. CONCLUSION These observations provide convergent evidence of a neuroimaging phenotype characterized by widespread abnormal thalamocortical development and suggest that the pathogenesis may involve impaired axonal maturation.
Collapse
Affiliation(s)
- Jessica L Wisnowski
- Department of Radiology, Children's Hospital Los Angeles, 4650 Sunset Blvd., MS #81, Los Angeles, CA, 90027, USA,
| | | | | | | | | | | | | | | |
Collapse
|
38
|
Brouwer MJ, van Kooij BJM, van Haastert IC, Koopman-Esseboom C, Groenendaal F, de Vries LS, Benders MJNL. Sequential cranial ultrasound and cerebellar diffusion weighted imaging contribute to the early prognosis of neurodevelopmental outcome in preterm infants. PLoS One 2014; 9:e109556. [PMID: 25329772 PMCID: PMC4203729 DOI: 10.1371/journal.pone.0109556] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 09/01/2014] [Indexed: 11/22/2022] Open
Abstract
Objective To evaluate the contribution of sequential cranial ultrasound (cUS) and term-equivalent age magnetic resonance imaging (TEA-MRI) including diffusion weighted imaging (DWI) to the early prognosis of neurodevelopmental outcome in a cohort of very preterm infants (gestational age [GA] <31 weeks). Study design In total, 93 preterm infants (median [range] GA in weeks: 28.3 [25.0–30.9]) were enrolled in this prospective cohort study and underwent early and term cUS as well as TEA-MRI including DWI. Early cUS abnormalities were classified as normal, mild, moderate or severe. Term cUS was evaluated for ex-vacuo ventriculomegaly (VM) and enlargement of the extracerebral cerebrospinal fluid (eCSF) space. Abnormalities on T1- and T2-weighted TEA-MRI were scored according to Kidokoro et al. Using DWI at TEA, apparent diffusion coefficients (ADCs) were measured in four white matter regions bilaterally and both cerebellar hemispheres. Neurodevelopmental outcome was assessed at two years’ corrected age (CA) using the Bayley Scales of Infant and Toddler Development, third edition. Linear regression analysis was conducted to explore the correlation between the different neuroimaging modalities and outcome. Results Moderate/severe abnormalities on early cUS, ex-vacuo VM and enlargement of the eCSF space on term cUS and increased cerebellar ADC values on term DWI were independently associated with worse motor outcome (p<.05). Ex-vacuo VM on term cUS was also related to worse cognitive performance at two years’ CA (p<.01). Conclusion These data support the clinical value of sequential cUS and recommend repeating cUS at TEA. In particular, assessment of moderate/severe early cUS abnormalities and ex-vacuo VM on term cUS provides important prognostic information. Cerebellar ADC values may further aid in the prognostication of gross motor function.
Collapse
Affiliation(s)
- Margaretha J. Brouwer
- Department of Neonatology, Wilhelmina Children’s Hospital/University Medical Center Utrecht, Utrecht, The Netherlands
| | - Britt J. M. van Kooij
- Department of Neonatology, Wilhelmina Children’s Hospital/University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ingrid C. van Haastert
- Department of Neonatology, Wilhelmina Children’s Hospital/University Medical Center Utrecht, Utrecht, The Netherlands
| | - Corine Koopman-Esseboom
- Department of Neonatology, Wilhelmina Children’s Hospital/University Medical Center Utrecht, Utrecht, The Netherlands
| | - Floris Groenendaal
- Department of Neonatology, Wilhelmina Children’s Hospital/University Medical Center Utrecht, Utrecht, The Netherlands
| | - Linda S. de Vries
- Department of Neonatology, Wilhelmina Children’s Hospital/University Medical Center Utrecht, Utrecht, The Netherlands
| | - Manon J. N. L. Benders
- Department of Neonatology, Wilhelmina Children’s Hospital/University Medical Center Utrecht, Utrecht, The Netherlands
- Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, King's College London, St Thomas' Hospital, London, United Kingdom
- * E-mail:
| |
Collapse
|
39
|
Kostović I, Kostović-Srzentić M, Benjak V, Jovanov-Milošević N, Radoš M. Developmental dynamics of radial vulnerability in the cerebral compartments in preterm infants and neonates. Front Neurol 2014; 5:139. [PMID: 25120530 PMCID: PMC4114264 DOI: 10.3389/fneur.2014.00139] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Accepted: 07/14/2014] [Indexed: 01/06/2023] Open
Abstract
The developmental vulnerability of different classes of axonal pathways in preterm white matter is not known. We propose that laminar compartments of the developing cerebral wall serve as spatial framework for axonal growth and evaluate potential of anatomical landmarks for understanding reorganization of the cerebral wall after perinatal lesions. The 3-T MRI (in vivo) and histological analysis were performed in a series of cases ranging from 22 postconceptional weeks to 3 years. For the follow-up scans, three groups of children (control, normotypic, and preterms with lesions) were examined at the term equivalent age and after the first year of life. MRI and histological abnormalities were analyzed in the following compartments: (a) periventricular, with periventricular fiber system; (b) intermediate, with periventricular crossroads, sagittal strata, and centrum semiovale; (c) superficial, composed of gyral white matter, subplate, and cortical plate. Vulnerability of thalamocortical pathways within the crossroads and sagittal strata seems to be characteristic for early preterms, while vulnerability of long association pathways in the centrum semiovale seems to be predominant feature of late preterms. The structural indicator of the lesion of the long association pathways is the loss of delineation between centrum semiovale and subplate remnant, which is possible substrate of the diffuse periventricular leukomalacia. The enhanced difference in MR signal intensity of centrum semiovale and subplate remnant, observed in damaged children after first year, we interpret as structural plasticity of intact short cortico-cortical fibers, which grow postnatally through U-zones and enter the cortex through the subplate remnant. Our findings indicate that radial distribution of MRI signal abnormalities in the cerebral compartments may be related to lesion of different classes of axonal pathways and have prognostic value for predicting the likely outcome of prenatal and perinatal lesions.
Collapse
Affiliation(s)
- Ivica Kostović
- Croatian Institute for Brain Research, University of Zagreb School of Medicine , Zagreb , Croatia
| | | | - Vesna Benjak
- Department of Pediatrics, Clinical Hospital Center Zagreb, University of Zagreb School of Medicine , Zagreb , Croatia
| | - Nataša Jovanov-Milošević
- Croatian Institute for Brain Research, University of Zagreb School of Medicine , Zagreb , Croatia
| | - Milan Radoš
- Croatian Institute for Brain Research, University of Zagreb School of Medicine , Zagreb , Croatia
| |
Collapse
|
40
|
Hart AR, Smith MF, Whitby EH, Alladi S, Wilkinson S, Paley MN, Griffiths PD. Diffusion-weighted imaging and magnetic resonance proton spectroscopy following preterm birth. Clin Radiol 2014; 69:870-9. [PMID: 24935906 DOI: 10.1016/j.crad.2014.04.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Accepted: 04/03/2014] [Indexed: 10/25/2022]
Abstract
AIM To study the associations between magnetic resonance proton spectroscopy (MRS) data and apparent diffusion coefficients (ADC) from the preterm brain with developmental outcome at 18 months corrected age and clinical variables. MATERIALS AND METHODS A prospective observational cohort study of 67 infants born before 35 weeks gestational age who received both magnetic resonance imaging of the brain between 37 and 44 weeks corrected gestational age and developmental assessment around 18 months corrected age. RESULTS No relationships were found between ADC values and MRS results or outcome. MRS ratios involving N-acetyl aspartate (NAA) from the posterior white matter were associated with "severe" and "moderate to severe" difficulties, and fine motor scores were significantly lower in participants with a visible lactate doublet in the posterior white matter. The presence of a patent ductus arteriosus (PDA) was the only clinical factor related to NAA ratios. CONCLUSION Altered NAA levels in the posterior white matter may reflect subtle white matter injury associated with neuro-developmental difficulties, which may be related to a PDA. Further work is needed to assess the longer-term neuro-developmental implications of these findings, and to study the effect of PDAs on developmental outcome in later childhood/adolescence.
Collapse
Affiliation(s)
- A R Hart
- Department of Paediatric Neurology and Child Development, Ryegate Children's Centre, Sheffield Children's Hospital NHS Foundation Trust, Tapton Crescent Road, Sheffield S10 5DD, UK.
| | - M F Smith
- Department of Neonatology, Jessop Wing, Sheffield Teaching Hospitals NHS, Foundation Trust, Tree Root Walk, Sheffield S10 2SF, UK
| | - E H Whitby
- Academic Unit of Radiology, University of Sheffield, Floor C, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK
| | - S Alladi
- Department of Paediatric Neurology and Child Development, Ryegate Children's Centre, Sheffield Children's Hospital NHS Foundation Trust, Tapton Crescent Road, Sheffield S10 5DD, UK
| | - S Wilkinson
- Department of Neonatology, Jessop Wing, Sheffield Teaching Hospitals NHS, Foundation Trust, Tree Root Walk, Sheffield S10 2SF, UK
| | - M N Paley
- Academic Unit of Radiology, University of Sheffield, Floor C, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK
| | - P D Griffiths
- Academic Unit of Radiology, University of Sheffield, Floor C, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK
| |
Collapse
|
41
|
Magnetic resonance spectroscopy markers of axons and astrogliosis in relation to specific features of white matter injury in preterm infants. Neuroradiology 2014; 56:771-9. [DOI: 10.1007/s00234-014-1380-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 05/08/2014] [Indexed: 01/13/2023]
|
42
|
Rose J, Vassar R, Cahill-Rowley K, Stecher Guzman X, Hintz SR, Stevenson DK, Barnea-Goraly N. Neonatal physiological correlates of near-term brain development on MRI and DTI in very-low-birth-weight preterm infants. NEUROIMAGE-CLINICAL 2014; 5:169-77. [PMID: 25068107 PMCID: PMC4110350 DOI: 10.1016/j.nicl.2014.05.013] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Revised: 05/09/2014] [Accepted: 05/21/2014] [Indexed: 12/01/2022]
Abstract
Structural brain abnormalities identified at near-term age have been recognized as potential predictors of neurodevelopment in children born preterm. The aim of this study was to examine the relationship between neonatal physiological risk factors and early brain structure in very-low-birth-weight (VLBW) preterm infants using structural MRI and diffusion tensor imaging (DTI) at near-term age. Structural brain MRI, diffusion-weighted scans, and neonatal physiological risk factors were analyzed in a cross-sectional sample of 102 VLBW preterm infants (BW ≤ 1500 g, gestational age (GA) ≤ 32 weeks), who were admitted to the Lucile Packard Children's Hospital, Stanford NICU and recruited to participate prior to routine near-term brain MRI conducted at 36.6 ± 1.8 weeks postmenstrual age (PMA) from 2010 to 2011; 66/102 also underwent a diffusion-weighted scan. Brain abnormalities were assessed qualitatively on structural MRI, and white matter (WM) microstructure was analyzed quantitatively on DTI in six subcortical regions defined by DiffeoMap neonatal brain atlas. Specific regions of interest included the genu and splenium of the corpus callosum, anterior and posterior limbs of the internal capsule, the thalamus, and the globus pallidus. Regional fractional anisotropy (FA) and mean diffusivity (MD) were calculated using DTI data and examined in relation to neonatal physiological risk factors including gestational age (GA), bronchopulmonary dysplasia (BPD), necrotizing enterocolitis (NEC), retinopathy of prematurity (ROP), and sepsis, as well as serum levels of C-reactive protein (CRP), glucose, albumin, and total bilirubin. Brain abnormalities were observed on structural MRI in 38/102 infants including 35% of females and 40% of males. Infants with brain abnormalities observed on MRI had higher incidence of BPD (42% vs. 25%) and sepsis (21% vs. 6%) and higher mean and peak serum CRP levels, respectively, (0.64 vs. 0.34 mg/dL, p = .008; 1.57 vs. 0.67 mg/dL, p= .006) compared to those without. The number of signal abnormalities observed on structural MRI correlated to mean and peak CRP (rho = .316, p = .002; rho = .318, p= .002). The number of signal abnormalities observed on MRI correlated with thalamus MD (left: r= .382, p= .002; right: r= .400, p= .001), controlling for PMA-at-scan. Thalamus WM microstructure demonstrated the strongest associations with neonatal risk factors. Higher thalamus MD on the left and right, respectively, was associated with lower GA (r = −.322, p = .009; r= −.381, p= .002), lower mean albumin (r = −.276, p= .029; r= −.385, p= .002), and lower mean bilirubin (r = −.293, p= .020; r= −.337 p= .007). Results suggest that at near-term age, thalamus WM microstructure may be particularly vulnerable to certain neonatal risk factors. Interactions between albumin, bilirubin, phototherapy, and brain development warrant further investigation. Identification of physiological risk factors associated with selective vulnerability of certain brain regions at near-term age may clarify the etiology of neurodevelopmental impairment and inform neuroprotective treatment for VLBW preterm infants. Biomarkers of inflammation in preterm infants correlated with brain abnormalities detected on near-term structural MRI. Biomarkers of inflammation in preterm infants correlated with near-term WM microstructure assessed on DTI. Signal abnormalities observed on near-term structural MRI correlated with increased thalamus MD.
Collapse
Key Words
- ALIC, anterior limb of the internal capsule
- Brain development
- CC, corpus callosum
- DTI, diffusion tensor imaging
- Diffusion tensor imaging
- FA, fractional anisotropy
- GA, gestational age
- GloP, globus pallidus
- IC, internal capsule
- MD, mean diffusivity
- MRI
- PLIC, posterior limb of the internal capsule
- PMA, post-menstrual age
- Preterm infants
- Risk factors
- VLBW, very-low-birth-weight
- White matter microstructure
Collapse
Affiliation(s)
- Jessica Rose
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, USA ; Motion Analysis Lab, Lucile Packard Children's Hospital, Stanford, CA, USA
| | - Rachel Vassar
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Katelyn Cahill-Rowley
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, USA ; Motion Analysis Lab, Lucile Packard Children's Hospital, Stanford, CA, USA ; Department of Bioengineering, Stanford University, Stanford, CA, USA
| | - Ximena Stecher Guzman
- Radiology Department, Universidad del Desarrollo, Facultad de Medicina Clínica Alemana, Chile
| | - Susan R Hintz
- Division of Neonatology and Developmental Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - David K Stevenson
- Division of Neonatology and Developmental Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Naama Barnea-Goraly
- Center for Interdisciplinary Brain Sciences Research, Stanford University School of Medicine, Stanford, CA, USA
| |
Collapse
|
43
|
Weinstein M, Ben Bashat D, Gross-Tsur V, Leitner Y, Berger I, Marom R, Geva R, Uliel S, Ben-Sira L. Isolated mild white matter signal changes in preterm infants: a regional approach for comparison of cranial ultrasound and MRI findings. J Perinatol 2014; 34:476-82. [PMID: 24651736 DOI: 10.1038/jp.2014.33] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2013] [Revised: 01/20/2014] [Accepted: 01/27/2014] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To compare echogenicity detected using cranial ultrasound (cUS) and diffuse excessive high signal intensity (DEHSI) detected using magnetic resonance imaging (MRI) by identical region-based scoring criteria in preterm infants. To explore the association between these white matter (WM) signal changes with early neurobehavior. STUDY DESIGN Forty-nine pre-selected premature infants with only echogenicity on a first routine cUS1 underwent MRI and a repeated cUS2 at term equivalent age. Echogenicity and DEHSI were graded in various brain areas and diffusivity values were calculated. Neurobehavior was assessed using the Rapid Neonatal Neurobehavioral Assessment Procedure. RESULT WM signal changes were significantly higher on cUS1 than cUS2; and higher in MRI than cUS2 in posterior regions. Infants with DEHSI demonstrated reduced tissue integrity. Imaging findings were not correlated with early neurobehavior. CONCLUSION Echogenicity and DEHSI likely represent the same phenomenon. Reduction of over-interpretation of WM signal changes may help define criteria for the judicious use of imaging in routine follow-up of premature infants.
Collapse
Affiliation(s)
- M Weinstein
- 1] Functional Brain Center, Wohl Institute for Advanced Imaging, Tel-Aviv Sourasky Medical Center (TASMC), Tel-Aviv, Israel [2] Department of Psychology, Gonda Multidisciplinary Brain Research Center, Bar Ilan University, Ramat-Gan, Israel
| | - D Ben Bashat
- 1] Functional Brain Center, Wohl Institute for Advanced Imaging, Tel-Aviv Sourasky Medical Center (TASMC), Tel-Aviv, Israel [2] Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel [3] Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
| | - V Gross-Tsur
- Department of Pediatric Neurology, Shaare-Zedek Medical Center, Jerusalem, Israel
| | - Y Leitner
- 1] Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel [2] Department of Pediatrics, Child Development Center, TASMC, Tel-Aviv, Israel
| | - I Berger
- 1] Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel [2] Department of Neonatology, Lis Maternity Hospital, TASMC, Tel-Aviv, Israel
| | - R Marom
- 1] Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel [2] Department of Neonatology, Lis Maternity Hospital, TASMC, Tel-Aviv, Israel
| | - R Geva
- Department of Psychology, Gonda Multidisciplinary Brain Research Center, Bar Ilan University, Ramat-Gan, Israel
| | - S Uliel
- Department of Pediatrics, Child Development Center, TASMC, Tel-Aviv, Israel
| | - L Ben-Sira
- 1] Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel [2] Department of Radiology, TASMC, Tel-Aviv, Israel
| |
Collapse
|
44
|
Leitner Y, Weinstein M, Myers V, Uliel S, Geva K, Berger I, Marom R, Bashat DB, Ben-Sira L, Geva R, Gross-Tsur V. Diffuse excessive high signal intensity in low-risk preterm infants at term-equivalent age does not predict outcome at 1 year: a prospective study. Neuroradiology 2014; 56:669-78. [PMID: 24823447 DOI: 10.1007/s00234-014-1373-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 04/17/2014] [Indexed: 10/25/2022]
Abstract
INTRODUCTION The outcome of premature infants with only diffuse excessive high signal intensity (DEHSI) is not clear. We explored the relationship between DEHSI, white matter (WM) diffusion characteristics, perinatal characteristics, and neurobehavioral outcome at 1 year in a homogenous group of preterm infants without major brain abnormalities. METHODS Fifty-eight preterm infants, gestational age 29 ± 2.6 weeks, underwent an MRI at term-equivalent age (TEA). Griffiths Mental Developmental Scales, neurological assessment, and Parental Stress Index (PSI) were performed at 1 year corrected age. These measures were compared between preterm infants according to DEHSI classification (none, mild, moderate). Diffusion tensor imaging was used in major WM volumes of interest to objectively measure the degree of WM maturation. RESULTS No significant differences were detected in the perinatal risk characteristics, neurobehavioral outcome, and PSI at 1 year between infants with different DEHSI classifications. In infants with DEHSI, increased axial and radial diffusivities were detected in the optic radiations, centrum semiovale, and posterior limb of the internal capsule, indicating less advanced maturation of the WM. Significant correlations were detected between the time interval from birth to MRI and the WM microstructure in infants without DEHSI. CONCLUSION DEHSI in premature infants is neither a predictive measure for short-term adverse neurobehavioral outcome nor related to perinatal risk characteristics. Extrauterine exposure time had a differential effect on WM maturational trajectories in infants with DEHSI compared to those without. We suggest DEHSI may represent an alteration in WM maturational characteristics. Further follow-up studies may verify later consequences of DEHSI in premature infants.
Collapse
Affiliation(s)
- Yael Leitner
- Child Development Centre, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Centre, Weizman 6, 64239, Tel Aviv, Israel,
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Abstract
Magnetic resonance imaging (MRI) is a safe and high-resolution neuroimaging modality that is increasingly used in the neonatal population to assess brain injury and its consequences on brain development. It is superior to cranial ultrasound for the definition of patterns of both white and gray matter maturation and injury and therefore has the potential to provide prognostic information on the neurodevelopmental outcomes of the preterm population. Furthermore, the development of sophisticated MRI strategies, including diffusion tensor imaging, resting state functional connectivity, and magnetic resonance spectroscopy, may increase the prognostic value, helping to guide parental counseling and allocate early intervention services.
Collapse
|
46
|
Atlas-guided quantification of white matter signal abnormalities on term-equivalent age MRI in very preterm infants: findings predict language and cognitive development at two years of age. PLoS One 2013; 8:e85475. [PMID: 24392012 PMCID: PMC3877364 DOI: 10.1371/journal.pone.0085475] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 11/27/2013] [Indexed: 11/19/2022] Open
Abstract
The developmental significance of the frequently encountered white matter signal abnormality (WMSA) findings on MRI around term-equivalent age (TEA) in very preterm infants, remains in question. The use of conventional qualitative analysis methods is subjective, lacks sufficient reliability for producing accurate and reproducible WMSA diagnosis, and possibly contributes to suboptimal neurodevelopmental outcome prediction. The advantages of quantitative over qualitative diagnostic approaches have been widely acknowledged and demonstrated. The purpose of this study is to objectively and accurately quantify WMSA on TEA T2-weighted MRI in very preterm infants and to assess whether such quantifications predict 2-year language and cognitive developmental outcomes. To this end, we constructed a probabilistic brain atlas, exclusively for very preterm infants to embed tissue distributions (i.e. to encode shapes, locations and geometrical proportion of anatomical structures). Guided with this atlas, we then developed a fully automated method for WMSA detection and quantification using T2-weighted images. Computer simulations and experiments using in vivo very preterm data showed very high detection accuracy. WMSA volume, particularly in the centrum semiovale, on TEA MRI was a significant predictor of standardized language and cognitive scores at 2 years of age. Independent validation of our automated WMSA detection algorithm and school age follow-up are important next steps.
Collapse
|
47
|
Parikh NA, He L, Bonfante-Mejia E, Hochhauser L, Wilder PE, Burson K, Kaur S. Automatically quantified diffuse excessive high signal intensity on MRI predicts cognitive development in preterm infants. Pediatr Neurol 2013; 49:424-30. [PMID: 24138952 PMCID: PMC3957176 DOI: 10.1016/j.pediatrneurol.2013.08.026] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 08/15/2013] [Accepted: 08/20/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cognitive and language impairments constitute the majority of disabilities observed in preterm infants. It remains unclear if diffuse excessive high signal intensity on magnetic resonance imaging at term represents delayed white matter maturation or pathology. METHODS We hypothesized that diffusion tensor imaging-based objectively quantified diffuse excessive high signal intensity measures at term will be strong predictors of cognitive and language development at 2 years in a cohort of 41 extremely low birth weight (≤1000 g) infants. Using an automated probabilistic atlas, mean diffusivity maps were used to objectively segment and quantify diffuse excessive high signal intensity volume and mean, axial, and radial diffusivity measures. Standardized neurodevelopment was assessed at 2 years of age using the Bayley Scales of Infant Development, third edition. RESULTS Thirty-six of the 41 infants (88%) had complete developmental data at follow-up. Objectively quantified diffuse excessive high signal intensity volume correlated significantly with cognitive and language scores at 2 years (P < 0.001 for both). The sum values of the three diffusivity measures in detected diffuse excessive high signal intensity regions also correlated significantly with the Bayley scores (r(2) 34.7%; P < 0.001 for each). Infants in the highest quartile for diffuse excessive high signal intensity volumes had scores between 19 and 24 points lower than infants in the lowest quartile (P < 0.01). When diagnosed subjectively by neuroradiologists however, Bayley scores were not significantly lower in infants with extensive diffuse excessive high signal intensity. CONCLUSIONS These findings lend further evidence that diffuse excessive high signal intensity is pathologic and that objectively quantified diffusion-based diffuse excessive high signal intensity volume at term is associated with cognitive and language impairments. Our approach could be used for risk stratification and early intervention for such high-risk extremely preterm infants.
Collapse
Affiliation(s)
- Nehal A. Parikh
- Center for Perinatal Research, The Research Institute at Nationwide Children’s Hospital, Columbus, OH, United States,The Department of Pediatrics, Ohio State University College of Medicine, Columbus, OH, United States,Department of Pediatrics, Division of Neonatology, University of Texas Health Science Center, Houston, TX
| | - Lili He
- Center for Perinatal Research, The Research Institute at Nationwide Children’s Hospital, Columbus, OH, United States
| | | | - Leo Hochhauser
- Department of Radiology, University of Texas Health Science Center, Houston, TX
| | - Patricia Evans Wilder
- Department of Pediatrics, Division of Neonatology, University of Texas Health Science Center, Houston, TX
| | - Katrina Burson
- Department of Pediatrics, Division of Neonatology, University of Texas Health Science Center, Houston, TX
| | - Supreet Kaur
- Center for Perinatal Research, The Research Institute at Nationwide Children’s Hospital, Columbus, OH, United States
| |
Collapse
|
48
|
Rose J, Vassar R, Cahill-Rowley K, Guzman XS, Stevenson DK, Barnea-Goraly N. Brain microstructural development at near-term age in very-low-birth-weight preterm infants: an atlas-based diffusion imaging study. Neuroimage 2013; 86:244-56. [PMID: 24091089 DOI: 10.1016/j.neuroimage.2013.09.053] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2013] [Revised: 08/19/2013] [Accepted: 09/22/2013] [Indexed: 10/26/2022] Open
Abstract
At near-term age the brain undergoes rapid growth and development. Abnormalities identified during this period have been recognized as potential predictors of neurodevelopment in children born preterm. This study used diffusion tensor imaging (DTI) to examine white matter (WM) microstructure in very-low-birth-weight (VLBW) preterm infants to better understand regional WM developmental trajectories at near-term age. DTI scans were analyzed in a cross-sectional sample of 45 VLBW preterm infants (BW≤1500g, GA≤32weeks) within a cohort of 102 neonates admitted to the NICU and recruited to participate prior to standard-of-care MRI, from 2010 to 2011, 66/102 also had DTI. For inclusion in this analysis, 45 infants had DTI, no evidence of brain abnormality on MRI, and were scanned at PMA ≤40weeks (34.7-38.6). White matter microstructure was analyzed in 19 subcortical regions defined by DiffeoMap neonatal brain atlas, using threshold values of trace <0.006mm(2)s(-1) and FA >0.15. Regional fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) were calculated and temporal-spatial trajectories of development were examined in relation to PMA and brain region location. Posterior regions within the corona radiata (CR), corpus callosum (CC), and internal capsule (IC) demonstrated significantly higher mean FA values compared to anterior regions. Posterior regions of the CR and IC demonstrated significantly lower RD values compared to anterior regions. Centrally located projection fibers demonstrated higher mean FA and lower RD values than peripheral regions including the posterior limb of the internal capsule (PLIC), cerebral peduncle, retrolenticular part of the IC, posterior thalamic radiation, and sagittal stratum. Centrally located association fibers of the external capsule had higher FA and lower RD than the more peripherally-located superior longitudinal fasciculus (SLF). A significant relationship between PMA-at-scan and FA, MD, and RD was demonstrated by a majority of regions, the strongest correlations were observed in the anterior limb of the internal capsule, a region undergoing early stages of myelination at near-term age, in which FA increased (r=.433, p=.003) and MD (r=-.545, p=.000) and RD (r=-.540, p=.000) decreased with PMA-at-scan. No correlation with PMA-at-scan was observed in the CC or SLF, regions that myelinate later in infancy. Regional patterns of higher FA and lower RD were observed at this near-term age, suggestive of more advanced microstructural development in posterior compared to anterior regions within the CR, CC, and IC and in central compared to peripheral WM structures. Evidence of region-specific rates of microstructural development was observed. Temporal-spatial patterns of WM microstructure development at near-term age have important implications for interpretation of near-term DTI and for identification of aberrations in typical developmental trajectories that may signal future impairment.
Collapse
Affiliation(s)
- Jessica Rose
- Department of Orthopaedic Surgery, Stanford University School of Medicine, USA; Motion Analysis Lab, Lucile Packard Children's Hospital, USA.
| | - Rachel Vassar
- Department of Orthopaedic Surgery, Stanford University School of Medicine, USA
| | - Katelyn Cahill-Rowley
- Motion Analysis Lab, Lucile Packard Children's Hospital, USA; Department of BioEngineering, Stanford, CA, USA
| | - Ximena Stecher Guzman
- Radiology Department, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Chile
| | - David K Stevenson
- Division of Neonatology and Developmental Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Naama Barnea-Goraly
- Center for Interdisciplinary Brain Sciences Research, Stanford University School of Medicine, USA
| |
Collapse
|
49
|
de Vries LS, Benders MJNL, Groenendaal F. Imaging the premature brain: ultrasound or MRI? Neuroradiology 2013; 55 Suppl 2:13-22. [PMID: 23839652 DOI: 10.1007/s00234-013-1233-y] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 06/27/2013] [Indexed: 12/12/2022]
Abstract
Neuroimaging of preterm infants has become part of routine clinical care, but the question is often raised on how often cranial ultrasound should be done and whether every high risk preterm infant should at least have one MRI during the neonatal period. An increasing number of centres perform an MRI either at discharge or around term equivalent age, and a few centres have access to a magnet in or adjacent to the neonatal intensive care unit and are doing sequential MRIs. In this review, we try to discuss when best to perform these two neuroimaging techniques and the additional information each technique may provide.
Collapse
Affiliation(s)
- Linda S de Vries
- Department of Neonatology, Wilhelmina Children's Hospital, UMC Utrecht, Utrecht, The Netherlands.
| | | | | |
Collapse
|
50
|
Parikh NA, Lasky RE, Kennedy KA, McDavid G, Tyson JE. Perinatal factors and regional brain volume abnormalities at term in a cohort of extremely low birth weight infants. PLoS One 2013; 8:e62804. [PMID: 23671636 PMCID: PMC3650008 DOI: 10.1371/journal.pone.0062804] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 03/26/2013] [Indexed: 11/19/2022] Open
Abstract
Our objective was to investigate diverse clinical antecedents of total and regional brain volume abnormalities and white matter hyperintensity volume on term MRI in extremely low birth weight (birth weight ≤1000 g) survivors. A consecutive cohort of extremely low birth weight infants who survived to 38 weeks postmenstrual age (n = 122) and a control group of 16 healthy term newborns underwent brain MRI at term-equivalent age. Brain volumes were measured using semi-automated and manual segmentation methods. Using multivariable linear regression, clinical antecedents were correlated with volumes of total brain tissue, white matter hyperintensities, and regional tissues/structures, adjusted for age at MRI, total cranial volume, and total tissue volume. Regional brain volumes were markedly reduced in extremely low birth weight infants as compared to term newborns (relative difference range: -11.0%, -35.9%). Significant adverse clinical associations for total brain tissue volume included: small for gestational age, seizures, caffeine therapy/apnea of prematurity, duration of parenteral nutrition, pulmonary hemorrhage, and white matter injury (p<0.01 for each; relative difference range: -1.4% to -15.0%). Surgery for retinopathy of prematurity and surgery for necrotizing enterocolitis or spontaneous intestinal perforation were significantly associated with increasing volume of white matter hyperintensities. Regional brain volumes are sensitive to multiple perinatal factors and neonatal morbidities or interventions. Brain growth measurements in extremely low birth weight infants can advance our understanding of perinatal brain injury and development.
Collapse
Affiliation(s)
- Nehal A Parikh
- Department of Pediatrics, University of Texas Medical School at Houston and Children's Memorial Hermann Hospital, Houston, Texas, USA.
| | | | | | | | | |
Collapse
|