Neonatal DTI early after birth predicts motor outcome in preterm infants with periventricular hemorrhagic infarction

Abstract

Background:To determine the association between early neonatal diffusion tensor imaging (DTI) and the development of unilateral spastic cerebral palsy (USCP) in preterm infants with periventricular hemorrhagic infarction (PVHI). Methods: Preterm infants with PVHI were assessed with early (≤4 wk after birth) and term-equivalent age MRI-DTI. Involvement of corticospinal tracts was assessed by visual assessment of the posterior limb of the internal capsule (PLIC) on DTI (classified asymmetrical, equivocal, or symmetrical) and by an atlas-based approach calculating fractional anisotropy asymmetry index in the PLIC. Motor outcome was assessed at ≥15 mo corrected age. results: Seven out of 23 infants with PVHI developed USCP. Their PLIC was visually scored as asymmetrical in 6 and equivocal in 1 on the early DTI. Thirteen out of 16 infants with a symmetrical motor development had a symmetrical PLIC on early DTI, the remaining 3 were equivocal. All infants with USCP had a fractional anisotropy asymmetry index of >0.05 (optimal cut-off value) on early DTI. In infants with a symmetrical motor development (n = 16), 14 had an asymmetry index ≤0.05 while 2 had an index >0.05. conclusion: DTI in preterm infants with PVHI within a few weeks after birth is associated with later motor development. P eriventricular hemorrhagic infarction (PVHI) is a serioustype of brain injury that occurs in around 1-3% of preterm infants with a gestational age below 37 wk (1-3). It is a complication of a germinal matrix hemorrhage that develops due to impaired venous drainage of the medullary veins in the periventricular white matter and may have an adverse effect on corticospinal tract (CST) development (4). PVHI leads in about 50-85% of infants to, mainly unilateral, spastic cerebral palsy (USCP) (2,3,5). The diagnosis is made with cranial ultrasound (cUS) and prediction of cerebral palsy is possible in most but not all infants taken the site and size of the lesion into account (5).MRI studies performed at term-equivalent age (TEA) will reliably predict motor outcome with asymmetry in myelination of the posterior limb of the internal capsule (PLIC) due to Wallerian degeneration being almost invariably associated with the development of USCP (6).Diffusion tensor imaging (DTI) allows the study of microstructural properties of the white matter (7). To the best of our knowledge, it has not yet been studied whether early disturbances in CST integrity shortly after the onset of PVHI relate to later development of USCP. In addition, the prognostic value of DTI for early prediction of USCP in infants with PVHI is still unknown.The aim of this study was to determine the association between MRI-DTI within 4 wk after birth and the development of USCP in preterm infants with PVHI. RESULTS PatientsThe clinical characteristics and motor outcome of the study group (n = 23) are summarized in Table 1. The infants who developed cerebral palsy (n = 7, 30%) all had USCP. Cranial Ultrasound FindingsIn 16 infants with a normal motor development, the cUS on which t...

Neonatal diffusion tensor brain imaging predicts later motor outcome in preterm neonates with white matter abnormalities

“…De Bruïne et al [28] confirmed a strong correlation between those low FA values of the posterior limb of the internal capsule at term-equivalent age and subsequent psychomotor delay at the age of 2 years in very preterm infants. Roze et al [29] determined the association between later development of spastic CP and early perturbation of DTI values. They showed that asymmetries in FA within 4 weeks after birth were predictive of unilateral spastic CP in preterm infants with periventricular hemorrhagic infarction.…”

Weak functional connectivity in the human fetal brain prior to preterm birth

“…These studies report diminished coherence of activity measured across brain circuits, indicative of weaker connectivity in individuals born preterm from infancy1112 through adulthood1314. Given the robust linkage between child neurological disorders and atypical large-scale neural connectivity1516 (see also refs 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37), theory has evolved that neurodevelopmental impairment following preterm birth may stem from alterations in neural connectivity38, and recent evidence provides nascent support for this claim1039.…”

Diagnostic accuracy of early magnetic resonance imaging to determine motor outcomes in infants born preterm: a systematic review and meta‐analysis

“…Cohorts with low prevalence of adverse motor outcomes frequently excluded infants with destructive brain lesions in recruitment . Studies with a high prevalence of CP chose study participants based on the presence of defined brain lesions …”

“…Seventeen studies from nine distinct cohorts acquired early diffusion MRI data . Sensitivity and specificity of diffusion MRI findings to determine later motor outcomes and/or CP in individual studies are presented in Table .…”

“…Diffusion biomarkers, regions evaluated, and associations with motor outcomes are presented in Table SIII (online supporting information). Three diffusion MRI studies reported diagnostic accuracy of their methods, although the data were not suitable to be combined in a meta‐analysis . Asymmetry of the PLIC on visual inspection of diffusion images, detected cases of hemiplegic CP with a sensitivity of 86% and a specificity of 100% .…”