Abnormal Cerebral Microstructure in Premature Neonates with Congenital Heart Disease

Paquette, Lisa; Wisnowski, Jessica L.; Ceschin, Rafael; Pruetz, Jay D.; Detterich, Jon; Castillo, Sylvia Del; Nagasunder, Arabhi; Kim, R.; Painter, Michael J.; Gilles, Floyd H.; Nelson, Marvin D.; Williams, Roberta G.; Blüml, Stefan; Panigrahy, Ashok

doi:10.3174/ajnr.a3528

Cited by 35 publications

(43 citation statements)

References 41 publications

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“…In a DTI study using tract-based spatial statistics in preterm newborns with CHD, widespread microstructural changes were found in the white matter tracts compared to term newborns without CHD. 30 The finding that fractional anisotropy values were higher in all major areas postoperatively, mean of 18(13) days from preoperative MRI, showed that the technique used to analyze the data worked well. 31 It was expected that there would be an increase in fractional anisotropy values from the preoperative to the postoperative periods as the brain matures.…”

Section: Discussionmentioning

confidence: 90%

White Matter Injury in Newborns With Congenital Heart Disease: A Diffusion Tensor Imaging Study

Mulkey

Ramakrishnaiah

et al. 2014

Pediatric Neurology

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BACKGROUND Brain injury is observed on brain magnetic resonance imaging preoperatively in up to 50% of newborns with congenital heart disease. Newer imaging techniques such as diffusion tensor imaging provide sensitive measures of the white matter. The objective of this study was to evaluate the diffusion tensor imaging analysis technique of tract-based spatial statistics in newborns with congenital heart disease. METHODS Term newborns with congenital heart disease that would require surgery at less than one month of age were prospectively enrolled (n = 19). Infants underwent preoperative and postoperative brain magnetic resonance imaging with diffusion tensor imaging. Tract-based spatial statistics, an objective whole brain diffusion tensor imaging analysis technique, was used to determine differences in white matter fractional anisotropy between infant groups. Term control infants were also compared to congenital heart disease infants. Postmenstrual age was equivalent between congenital heart disease infant groups and between congenital heart disease and control infants. RESULTS Ten infants had preoperative brain injury, either infarct or white matter injury, by conventional brain magnetic resonance imaging. The technique of tract-based spatial statistics showed significantly lower fractional anisotropy (P <0.05, corrected) in multiple major white matter tracts in the infants with preoperative brain injury compared to infants without preoperative brain injury. Fractional anisotropy values increased in the white matter tracts from the preoperative to the postoperative brain magnetic resonance imaging correlating with brain maturation. Control infants showed higher fractional anisotropy in multiple white matter tracts compared to infants with congenital heart disease. CONCLUSION Tract-based spatial statistics is a valuable diffusion tensor imaging analysis technique that may have better sensitivity in detecting white matter injury compared to conventional brain magnetic resonance imaging in term newborns with congenital heart disease.

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Section: Discussionmentioning

confidence: 90%

White Matter Injury in Newborns With Congenital Heart Disease: A Diffusion Tensor Imaging Study

Mulkey

Ramakrishnaiah

et al. 2014

Pediatric Neurology

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“…DTI is a promising and sensitive method with which to detect subtle anatomical abnormalities in the neonatal brain (Miller et al, 2007; Mourmans et al, 2006; Neil et al, 2002; Nijman et al, 2013; Oishi et al, 2013; Okumura et al, 2008; Padilla et al, 2014; Panigrahy and Bluml, 2007; Paquette et al, 2013; Parmar et al, 2004; Pogribna et al, 2013; Porter et al, 2010). To further explore the full potential of DTI, a systematic and quantitative assessment of brain abnormalities is essential to enable an evaluation of the anatomical-functional correlation for better diagnosis and prognosis of various types of anatomical abnormalities.…”

Section: Discussionmentioning

confidence: 99%

Probabilistic maps of the white matter tracts with known associated functions on the neonatal brain atlas: Application to evaluate longitudinal developmental trajectories in term-born and preterm-born infants

et al. 2016

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Diffusion tensor imaging (DTI) has been widely used to investigate the development of the neonatal and infant brain, and deviations related to various diseases or medical conditions like preterm birth. In this study, we created a probabilistic map of fiber pathways with known associated functions, on a published neonatal multimodal atlas. The pathways-of-interest include the superficial white matter (SWM) fibers just beneath the specific cytoarchitectonically defined cortical areas, which were difficult to evaluate with existing DTI analysis methods. The Jülich cytoarchitectonic atlas was applied to define cortical areas related to specific brain functions, and the Dynamic Programming (DP) method was applied to delineate the white matter pathways traversing through the SWM. Probabilistic maps were created for pathways related to motor, somatosensory, auditory, visual, and limbic functions, as well as major white matter tracts, such as the corpus callosum, the inferior fronto-occipital fasciculus, and the middle cerebellar peduncle, by delineating these structures in eleven healthy term-born neonates. In order to characterize maturation-related changes in diffusivity measures of these pathways, the probabilistic maps were then applied to DTIs of 49 healthy infants who were longitudinally scanned at three time-points, approximately five weeks apart. First, we investigated the normal developmental pattern based on 19 term-born infants. Next, we analyzed 30 preterm-born infants to identify developmental patterns related to preterm birth. Last, we investigated the difference in diffusion measures between these groups to evaluate the effects of preterm birth on the development of these functional pathways. Term-born and preterm-born infants both demonstrated a time-dependent decrease in diffusivity, indicating postnatal maturation in these pathways, with laterality seen in the corticospinal tract and the optic radiation. The comparison between term- and preterm-born infants indicated higher diffusivity in the preterm-born infants than in the term-born infants in three of these pathways: the body of the corpus callosum; the left inferior longitudinal fasciculus; and the pathway connecting the left primary/ secondary visual cortices and the motion-sensitive area in the occipitotemporal visual cortex (V5/MT+). Probabilistic maps provided an opportunity to investigate developmental changes of each white matter pathway. Whether alterations in white matter pathways can predict functional outcomes will be further investigated in a follow-up study.

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“…In addition, conventional T1-weighted, T2-weighted, and diffusion-weighted images were acquired and reviewed by 2 pediatric neuroradiologists for evidence of punctate white matter lesion, acute focal infarction, and hemorrhage as described previously. 23 …”

Section: Methodsmentioning

confidence: 99%

Clinical Factors Associated with Cerebral Metabolism in Term Neonates with Congenital Heart Disease

Harbison

Votava‐Smith

Castillo

et al. 2017

The Journal of Pediatrics

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Objective To determine associations between patient and clinical factors with postnatal brain metabolism in term neonates with congenital heart disease (CHD) via the use of quantitative magnetic resonance spectroscopy. Study design Neonates with CHD were enrolled prospectively to undergo pre- and postoperative 3T brain magnetic resonance imaging. Short-echo single-voxel magnetic resonance spectroscopy of parietal white matter was used to quantify metabolites related to brain maturation (n-acetyl aspartate, choline, myo-inositol), neurotransmitters (glutamate and gamma-aminobutyric acid), energy metabolism (glutamine, citrate, glucose, and phosphocreatine), and injury/apoptosis (lactate and lipids). Multivariable regression was performed to search for associations between (1) patient-specific/prenatal/preoperative factors with concurrent brain metabolism and (2) intraoperative and postoperative factors with postoperative brain metabolism. Results A total of 83 magnetic resonance images were obtained on 55 subjects. No patient-specific, prenatal, or preoperative factors associated with concurrent metabolic brain dysmaturation or elevated lactate could be identified. Chromosome 22q11 microdeletion and age at surgery were predictive of altered concurrent white matter phosphocreatine (P < .0055). The only significant intraoperative association found was increased deep hypothermic circulatory arrest time with reduced postoperative white matter glutamate and gamma-aminobutyric acid (P < .0072). Multiple postoperative factors, including increased number of extracorporeal membrane oxygenation days (P < .0067), intensive care unit, length of stay (P < .0047), seizures in the intensive care unit (P < .0009), and home antiepileptic use (P < .0002), were associated with reduced postoperative white matter n-acetyl aspartate. Conclusion Multiple postoperative factors were found to be associated with altered brain metabolism in term infants with CHD. Interventions in the perioperative period might have the potential to improve neurodevelopmental outcomes in term CHD.

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Abnormal Cerebral Microstructure in Premature Neonates with Congenital Heart Disease

Cited by 35 publications

References 41 publications

White Matter Injury in Newborns With Congenital Heart Disease: A Diffusion Tensor Imaging Study

White Matter Injury in Newborns With Congenital Heart Disease: A Diffusion Tensor Imaging Study

Probabilistic maps of the white matter tracts with known associated functions on the neonatal brain atlas: Application to evaluate longitudinal developmental trajectories in term-born and preterm-born infants

Clinical Factors Associated with Cerebral Metabolism in Term Neonates with Congenital Heart Disease

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