Clinical implications of MR imaging findings in the white matter in very preterm infants: a 2-year follow-up study.

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 significantly 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 prematurity-related developmental phenomenon.

[1]  F. Walther,et al.  Brain imaging findings in very preterm infants throughout the neonatal period: part II. Relation with perinatal clinical data. , 2009, Early human development.

[2]  A. Albanese,et al.  Excessively High Magnetic Resonance Signal in Preterm Infants and Neuropsychobehavioural Follow-up at 2 Years , 2005, International journal of immunopathology and pharmacology.

[3]  F. Groenendaal,et al.  Complications affecting preterm neonates from 1991 to 2006: what have we gained? , 2010, Acta paediatrica.

[4]  G M Bydder,et al.  Relationship between MR imaging and histopathologic findings of the brain in extremely sick preterm infants. , 1999, AJNR. American journal of neuroradiology.

[5]  L. Papile.  Cerebellar Injury in Preterm Infants: Incidence and Findings on US and MR Images , 2010 .

[6]  F. Walther,et al.  Brain imaging findings in very preterm infants throughout the neonatal period: part I. Incidences and evolution of lesions, comparison between ultrasound and MRI. , 2009, Early human development.

[7]  Paul D Griffiths,et al.  Magnetic resonance imaging and developmental outcome following preterm birth: review of current evidence , 2008, Developmental medicine and child neurology.

[8]  F. Walther,et al.  Is sequential cranial ultrasound reliable for detection of white matter injury in very preterm infants? , 2010, Neuroradiology.

[9]  Fabio Mosca,et al.  Probabilistic diffusion tractography of the optic radiations and visual function in preterm infants at term equivalent age. , 2008, Brain : a journal of neurology.

[10]  A. Bos,et al.  Risk Factors for Adverse Outcome in Preterm Infants With Periventricular Hemorrhagic Infarction , 2008, Pediatrics.

[11]  L. D. de Vries,et al.  Ultrasound abnormalities preceding cerebral palsy in high-risk preterm infants. , 2004, The Journal of pediatrics.

[12]  Steven P. Miller,et al.  From selective vulnerability to connectivity: insights from newborn brain imaging , 2009, Trends in Neurosciences.

[13]  J. Allsop,et al.  Relationship Between White Matter Apparent Diffusion Coefficients in Preterm Infants at Term-Equivalent Age and Developmental Outcome at 2 Years , 2007, Pediatrics.

[14]  L. Ment,et al.  Imaging biomarkers of outcome in the developing preterm brain , 2009, The Lancet Neurology.

[15]  P. Raina,et al.  Validation of a model of gross motor function for children with cerebral palsy. , 2000, Physical therapy.

[16]  T. Achenbach,et al.  The Child Behavior Checklist and related forms for assessing behavioral/emotional problems and competencies. , 2000, Pediatrics in review.

[17]  S. Back,et al.  Maturation-Dependent Vulnerability of Perinatal White Matter in Premature Birth , 2007, Stroke.

[18]  Serena J. Counsell,et al.  Structural linear measurements in the newborn brain: accuracy of cranial ultrasound compared to MRI , 2007, Pediatric Radiology.

[19]  A. Chew,et al.  Magnetic resonance imaging of white matter diseases of prematurity , 2010, Neuroradiology.

[20]  Serena Counsell,et al.  MRI of perinatal brain injury , 2010, Pediatric Radiology.

[21]  T. Inder.  Early Brain Injury in Premature Newborns Detected With Magnetic Resonance Imaging Is Associated With Adverse Early Neurodevelopmental Outcome , 2007 .

[22]  Joseph Hajnal,et al.  Natural History of Brain Lesions in Extremely Preterm Infants Studied With Serial Magnetic Resonance Imaging From Birth and Neurodevelopmental Assessment , 2006, Pediatrics.

[23]  Deanne K. Thompson,et al.  Abnormal White Matter Signal on MR Imaging Is Related to Abnormal Tissue Microstructure , 2009, American Journal of Neuroradiology.

[24]  J. Volpe.  Brain injury in premature infants: a complex amalgam of destructive and developmental disturbances , 2009, The Lancet Neurology.

[25]  T. Inder,et al.  Neonatal MRI to predict neurodevelopmental outcomes in preterm infants. , 2006, The New England journal of medicine.

[26]  David J Larkman,et al.  Diffusion-weighted imaging of the brain in preterm infants with focal and diffuse white matter abnormality. , 2003, Pediatrics.

[27]  G. Bydder,et al.  Origin and timing of brain lesions in term infants with neonatal encephalopathy , 2003 .

[28]  Tomoki Arichi,et al.  Diffusion Tensor Imaging in Preterm Infants With Punctate White Matter Lesions , 2011, Pediatric Research.

[29]  M. Paley,et al.  Diffusion‐weighted imaging of cerebral white matter and the cerebellum following preterm birth , 2010, Developmental medicine and child neurology.

[30]  L. Cornette,et al.  Magnetic resonance imaging of the infant brain: anatomical characteristics and clinical significance of punctate lesions , 2002, Archives of disease in childhood. Fetal and neonatal edition.

[31]  F. Walther,et al.  Cerebellar injury in preterm infants: incidence and findings on US and MR images. , 2009, Radiology.

[32]  Elspeth H. Whitby,et al.  Appearances of diffuse excessive high signal intensity (DEHSI) on MR imaging following preterm birth , 2010, Pediatric Radiology.

[33]  L. D. de Vries,et al.  Decreasing incidence and severity of cerebral palsy in prematurely born children. , 2011, The Journal of pediatrics.

[34]  D. Larkman,et al.  Axial and Radial Diffusivity in Preterm Infants Who Have Diffuse White Matter Changes on Magnetic Resonance Imaging at Term-Equivalent Age , 2006, Pediatrics.

[35]  Terrie E Inder,et al.  Understanding brain injury and neurodevelopmental disabilities in the preterm infant: the evolving role of advanced magnetic resonance imaging. , 2010, Seminars in perinatology.

[36]  Fabio Mosca,et al.  Magnetic resonance imaging assessment of brain maturation in preterm neonates with punctate white matter lesions , 2007, Neuroradiology.

[37]  Jeroen van der Grond,et al.  Magnetic resonance imaging of the brain in newborn infants: practical aspects. , 2009, Early human development.

[38]  L. Lehtonen,et al.  Ventricular dilatation in relation to outcome at 2 years of age in very preterm infants: a prospective Finnish cohort study , 2011, Developmental medicine and child neurology.

[39]  M A Rutherford,et al.  Magnetic resonance imaging of the brain in a cohort of extremely preterm infants. , 1999, The Journal of pediatrics.

[40]  T. Inder,et al.  Defining the nature of the cerebral abnormalities in the premature infant: a qualitative magnetic resonance imaging study. , 2003, Jornal de Pediatria.