Clinical Implications of MR Imaging Findings in the White Matter in Very Preterm Infants: A 2-year Follow-up Study

Abstract

Purpose:To explore the association between diffuse excessive high signal intensity (DEHSI), punctate white matter (WM) lesions, and ventricular dilatation around term-equivalent age (TEA) and at clinical follow-up at 2 years in very preterm infants and the effect on neurodevelopment. Materials and Methods:Ethical approval for this prospective study was given by the institutional review board, and informed parental consent was obtained. An unselected cohort of 110 preterm infants (gestational age, , 32 weeks) was imaged around or after TEA. Clinical follow-up was performed at a corrected age of 2 years and consisted of a neurologic examination and a mental and developmental assessment (Bayley Scales of Infant Development). Univariate analyses and logistic and linear regression were performed to examine the relationships between variables. Results:DEHSI was found in 58 of 65 (89%) infants imaged around TEA. DEHSI was never detected in infants imaged after postmenstrual age of 50 weeks and showed no association with neurodevelopmental outcome. Punctate WM lesions and ventricular dilatation were signifi cantly associated with mental ( P = .02 for punctate WM lesions) and psychomotor developmental delay ( P , .001 and P = .03, respectively), motor delay ( P = .002 and P = .02, respectively), and cerebral palsy ( P = .01 and P = .03, respectively). Conclusion:Because of its high incidence in preterm infants around TEA, its absence after a postmenstrual age of 50 weeks, and its association with normal neurologic outcome at a corrected age of 2 years, DEHSI should not be considered part of the spectrum of WM injury, but rather a prematurityrelated developmental phenomenon.q RSNA, 2011

Chronic morbidities of premature newborns

“…Az IVH mellett a PVL cisztás formája nagy rizikót jelent a koraszülöttek agyi bénulására [58,59]. A neonatológia fejlődése az utóbbi években csökkentette a PVL incidenciáját [60].…”

“…Marad a rizikófaktorok prevenciója, korai felismerésük esetében eliminálása. A PVL azonban képalkotó módszerekkel jól követhető [58,59,63].…”

“…MR-vizsgálatok fedték fel, hogy a koraszülöttek diffúz fehérállománybeli magas szignálintenzitású eltérése nem tekinthető betegségnek, hanem a koraszülöttek agyfejlődésének egyik állomása mutatja a speciális jelenséget. Azonban a punktált fehérállományi laesio kóros, szoros kapcsolatban van a CP-vel, kiterjedt formája arányosan súlyosabb életmi-nőség-romlással jár [58]. A punktált laesiók valószínűleg izolált microgliaclusterek lehetnek, mikrostrukturális elváltozások, befolyásolják az érintett koraszülöttek agyfejlődését [64].…”

The Role of Diffusion-Tensor Magnetic Resonance Imaging and Tractography in the Diagnosis of Structural Brain Disorders in Children with Cerebral Palsy

“…Высокая частота такого нейрови-зуализационного феномена, как DEHSI (89%), показана также в работе F. T. de Bruine и соавт. : при обследовании 110 новорожденных с низкой массой тела при рождении установлено, что статистически значимым предиктором умственного, психомоторного и моторного развития (при двухлетнем проспективном наблюдении) является нали-чие PWML и вентрикуломегалии [47].…”

Neurodevelopmental Outcomes of VLBW Infants with Diffuse Excessive High Signal Intensity (DEHSI) in the White Matter of the Brain MR Imaging around a Near Term-equivalent Age

“…Abbreviations: MRI, magnetic resonance imaging; DEHSI, diffuse excessive high signal intensity; PVHI, periventricular hemorrhagic infarct. 11,13,16,19,20,32) . …”