Serial Diffusion Tensor Imaging Detects White Matter Changes That Correlate with Motor Outcome in Premature Infants

Abstract

The objective of the study was to assess predictive value of serial diffusion tensor MRI (DTI) for the white matter injury and neurodevelopmental outcome in a cohort of premature infants. Twenty-four infants less than 32 weeks’ gestation were stratified to a control group (n = 11), mild brain injury with grades 1–2 of intraventricular hemorrhage (n = 6) and severe brain injury with grades 3–4 intraventricular hemorrhage (n = 4). Serial DTI studies were performed at around 30 and 36 weeks’ gestation. Fractional anisotropy (FA) and apparent diffusion coefficient were calculated. Twelve infants were followed up for developmental outcome. Developmental testing was performed with the Bayley Scales of Infant Development to obtain psychomotor index (Performance Developmental Index). Apparent diffusion coefficient was higher in the severe injury group at the second MRI in the central and occipital white matter, and corona radiata; FA was lower in optic radiation compared to controls. Performance Developmental Indexscore correlated with FA on the scan taken at the 30th week and inversely with the change of FA between scans in internal capsule and occipital white matter. A low value of FA at 30 weeks and a higher change of FA predicted less favorable motor outcome at 2 years and suggests that early subtle white matter injury can be detected in premature infants even without obvious signs of injury.

MRI Predicts Efficacy of Constraint-Induced Movement Therapy in Children With Brain Injury

“…This is in agreement with our results, which showed that only average lesion FA was able to predict functional improvement at the end of treatment, while lesion volume and DTI indexes of the affected CST were not. The notion that measuring lesion FA may be a rewarding exercise for predicting clinical outcome and assessing the efficacy of interventions is supported by 2 studies of infants with motor dysfunction in whom baseline FA values of affected areas predicted functional outcome after 2 [32] and 3 [16] years of follow up. An enhancement of the cortical representation of upper limb movement is believed to be among the factors contributing to the efficacy of CIMT [33].…”

The predictive validity of neonatal MRI for neurodevelopmental outcome in very preterm children

“…72,48,73 Serial DWI in the neonatal period enables developmental changes in diffusion to be studied and related to outcome. Drobyshevsky et al 74 scanned VP infants at 30 and 36 weeks and found lower FA at 30 weeks and a higher change in FA predicted poorer motor development. In another study in which VP infants had DWI shortly after birth and at TEA, FA was lower within the major white matter tracts in those with motor or language delay, a slower increase in FA within the major white matter tracts and superior white matter was observed in those with poorer cognitive development, and slower increase in FA within the superior white matter was observed in those with poorer language outcomes.…”

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

“…Nevertheless, few studies have been conducted to evaluate the correlations between WM connectivity as revealed by DTI and motor neurodevelopment of extremely low birth weight (ELBW; <1000 g) infants with WM abnormalities [7, 8]. Therefore, this study aimed to determine the diffusion tensor characteristics of WM regions associated with motor outcome among preterm infants with or without WM abnormalities and/or cerebral palsy (CP).…”