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

Department of Radiology and Pediatrics, Subdivision of Neonatology, Leiden University Medical Center, Albinusdreef 2, PO Box 9600, 2300 RC, Leiden, the Netherlands.
Radiology (Impact Factor: 6.87). 12/2011; 261(3):899-906. DOI: 10.1148/radiol.11110797
Source: PubMed


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.
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.
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).
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.

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    • "Kidokoro et al. [4] also found a significant association with cognitive scores but only in preterm infants with WMSA severe enough to render the periventricular crossroads regions invisible. Conversely, others have not observed an association with any impairment [8-11]. Considering its high incidence of up to 75% [3], WMSA may represent a prematurity-related developmental phenomenon. "
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    ABSTRACT: The developmental significance of the frequently encountered white matter signal abnormality (WMSA) findings on MRI around term-equivalent age (TEA) in very preterm infants, remains in question. The use of conventional qualitative analysis methods is subjective, lacks sufficient reliability for producing accurate and reproducible WMSA diagnosis, and possibly contributes to suboptimal neurodevelopmental outcome prediction. The advantages of quantitative over qualitative diagnostic approaches have been widely acknowledged and demonstrated. The purpose of this study is to objectively and accurately quantify WMSA on TEA T2-weighted MRI in very preterm infants and to assess whether such quantifications predict 2-year language and cognitive developmental outcomes. To this end, we constructed a probabilistic brain atlas, exclusively for very preterm infants to embed tissue distributions (i.e. to encode shapes, locations and geometrical proportion of anatomical structures). Guided with this atlas, we then developed a fully automated method for WMSA detection and quantification using T2-weighted images. Computer simulations and experiments using in vivo very preterm data showed very high detection accuracy. WMSA volume, particularly in the centrum semiovale, on TEA MRI was a significant predictor of standardized language and cognitive scores at 2 years of age. Independent validation of our automated WMSA detection algorithm and school age follow-up are important next steps.
    PLoS ONE 12/2013; 8(12):e85475. DOI:10.1371/journal.pone.0085475 · 3.23 Impact Factor
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    ABSTRACT: The aim of this study was to investigate the relationship between diffuse excessive high signal intensity (DEHSI) in the white matter of the brain MRI and neurodevelopmental abnormalities in VLBW infants.
    01/2012; 19(4):212. DOI:10.5385/jksn.2012.19.4.212
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    ABSTRACT: Hyperintense white matter signal abnormalities, also called diffuse excessive high signal intensity (DEHSI), are observed in up to 80% of very preterm infants on T2-weighted MRI scans at term-equivalent age. DEHSI may represent a developmental stage or diffuse microstructural white matter abnormalities. Automated quantitative assessment of DEHSI severity may help resolve this debate and improve neonatal brain tissue segmentation. For T2-weighted sequence without fluid attenuation, the signal intensity distribution of DEHSI greatly overlaps with that of cerebrospinal fluid (CSF) making its detection difficult. Furthermore, signal intensities of T2-weighted images are susceptible to magnetic field inhomogeneity. Increased signal intensities caused by field inhomogeneity may be confused with DEHSI. To overcome these challenges, we propose an algorithm to detect DEHSI using T2 relaxometry, whose reflection of the rapid changes in free water content provides improved distinction between CSF and DEHSI over that of conventional T2-weighted imaging. Moreover, the parametric transverse relaxation time T2 is invulnerable to magnetic field inhomogeneity. We conducted computer simulations to select an optimal detection parameter and to validate the proposed method. We also demonstrated that brain tissue segmentation is further enhanced by incorporating DEHSI detection for both simulated preterm infant brain images and in vivo in very preterm infants imaged at term-equivalent age.
    NeuroImage 09/2012; 64C(1):328-340. DOI:10.1016/j.neuroimage.2012.08.081 · 6.36 Impact Factor
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