Apparent Diffusion Coefficient on Magnetic Resonance Imaging in Pons and in Corona Radiata and Relation with the Neurophysiologic Measurement and the Outcome in Very Preterm Infants

Background: New imaging techniques allow a detailed visualization of the brain and the findings possibly correlate with neurophysiologic measurements and neurosensory and motor outcomes. Postnatal clinical factors known to associate with neurologic disabilities may contribute to brain abnormalities not visible to the naked eye. Objectives: We evaluated whether quantitative measurement of organized water diffusion on MR imaging, apparent diffusion coefficient (ADC), relates to neurophysiologic function and to clinical risk factors and motor outcome in preterm infants. Methods: Diffusion-weighted imaging was successfully performed at term age on 30 infants born <32 weeks of gestation, birth weight <1,000 g. Infants with major destructive brain lesions were excluded from the final analysis (n = 2). ADC was calculated within regions of interest placed in pons and in white matter regions known to contain motor fibers. Brain stem auditory evoked potentials (BAEP) were registered at term age. Gross motor outcome was assessed using Griffiths Scales at 2 years of corrected age. Results: A positive correlation was found between ADC in the pons and the latency of wave III in BAEP (r = 0.619, p = 0.024). Need for inotrope support during the postnatal period and bronchopulmonary dysplasia associated with high ADC values in the pons and in the corona radiata. Infants with poor gross motor outcome had higher ADC in the corona radiata than infants with better outcome (mean = 1.343 vs. 1.197, p = 0.004). Conclusions: This is the first study to report a relationship between ADC and BAEP measurements in the pons. The study may add to the current knowledge about the relation between postnatal clinical factors and diffusion-weighted imaging when evaluating the high-risk infants.