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Perinatal clinical antecedents of white matter microstructural abnormalities on diffusion tensor imaging in extremely preterm infants.

Pogribna U, Yu X, Burson K, Zhou Y, Lasky RE, Narayana PA, Parikh NA - PLoS ONE (2013)

Bottom Line: Conversely, antenatal steroids, female sex, longer duration of caffeine therapy, and greater duration of human milk use were independent favorable factors.White matter injury on cranial ultrasound was associated with a five weeks or greater delayed maturation of the corpus callosum; every additional 10 days of human milk use were associated with a three weeks or greater advanced maturation of the corpus callosum.In our cohort, it also aided identification of several previously known or suspected perinatal clinical antecedents of brain injury, aberrant development, and neurodevelopmental impairments.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatrics, Division of Neonatology, University of Texas Health Science Center, Houston, Texas, USA.

ABSTRACT

Objective: To identify perinatal clinical antecedents of white matter microstructural abnormalities in extremely preterm infants.

Methods: A prospective cohort of extremely preterm infants (N = 86) and healthy term controls (N = 16) underwent diffusion tensor imaging (DTI) at term equivalent age. Region of interest-based measures of white matter microstructure - fractional anisotropy and mean diffusivity - were quantified in seven vulnerable cerebral regions and group differences assessed. In the preterm cohort, multivariable linear regression analyses were conducted to identify independent clinical factors associated with microstructural abnormalities.

Results: Preterm infants had a mean (standard deviation) gestational age of 26.1 (1.7) weeks and birth weight of 824 (182) grams. Compared to term controls, the preterm cohort exhibited widespread microstructural abnormalities in 9 of 14 regional measures. Chorioamnionitis, necrotizing enterocolitis, white matter injury on cranial ultrasound, and increasing duration of mechanical ventilation were adversely correlated with regional microstructure. Conversely, antenatal steroids, female sex, longer duration of caffeine therapy, and greater duration of human milk use were independent favorable factors. White matter injury on cranial ultrasound was associated with a five weeks or greater delayed maturation of the corpus callosum; every additional 10 days of human milk use were associated with a three weeks or greater advanced maturation of the corpus callosum.

Conclusions: Diffusion tensor imaging is sensitive in detecting the widespread cerebral delayed maturation and/or damage increasingly observed in extremely preterm infants. In our cohort, it also aided identification of several previously known or suspected perinatal clinical antecedents of brain injury, aberrant development, and neurodevelopmental impairments.

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Related in: MedlinePlus

Study and control region of interest templates and placements shown on FA maps.Panel A: 1) Anterior limb of internal capsule, 2) Posterior limb of internal capsule, 3) Frontal periventricular zone, 4) Occipital periventricular zone, 5a–b) Centrum semiovale at two consecutive levels, 6 a–b) Genu and splenium of corpus callosum, and 7) Subventricular zone. Panel B: 1) External capsule, 2) Middle cerebellar peduncles. Same templates were utilized for all scans.
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pone-0072974-g001: Study and control region of interest templates and placements shown on FA maps.Panel A: 1) Anterior limb of internal capsule, 2) Posterior limb of internal capsule, 3) Frontal periventricular zone, 4) Occipital periventricular zone, 5a–b) Centrum semiovale at two consecutive levels, 6 a–b) Genu and splenium of corpus callosum, and 7) Subventricular zone. Panel B: 1) External capsule, 2) Middle cerebellar peduncles. Same templates were utilized for all scans.

Mentions: DTI Studio software, Version 3.0.3 (Johns Hopkins University, Baltimore, MD, http://cmrm.med.jhmi.edu) [15] was utilized for analyzing the DTI data. All DTI analyses were performed blinded to the results of cranial ultrasound, anatomical MRI, and clinical variables. Seven vulnerable study and two control regions of interest (ROI) were selected based on prior published data [16], [17]. The seven study white matter ROIs were: anterior and posterior limbs of internal capsule, frontal and occipital periventricular zones, centrum semiovale, genu and splenium of corpus callosum, and the subventricular zone. External capsule and middle cerebellar peduncles were selected as control ROIs. To minimize variability in the ROI placement, ImageJ, Version 1.44p (National Institutes of Health, http://imagej.nih.gov/ij) was utilized for development and placement of ROI templates (one for each ROI) in the native space for fractional anisotropy (FA) and mean diffusivity (MD) measurements (Figure 1). Standardized ROI templates were utilized with manual verification/correction of placement by a trained investigator. The same templates were applied to each DTI scan, minimizing measurement variability between different subjects. All ROI placements were small and centrally placed, minimizing capture of outside non-tract regions. The subventricular zone was only measured in the right hemisphere and the genu and splenium of the corpus callosum were measured centrally. All other regions were measured bilaterally.


Perinatal clinical antecedents of white matter microstructural abnormalities on diffusion tensor imaging in extremely preterm infants.

Pogribna U, Yu X, Burson K, Zhou Y, Lasky RE, Narayana PA, Parikh NA - PLoS ONE (2013)

Study and control region of interest templates and placements shown on FA maps.Panel A: 1) Anterior limb of internal capsule, 2) Posterior limb of internal capsule, 3) Frontal periventricular zone, 4) Occipital periventricular zone, 5a–b) Centrum semiovale at two consecutive levels, 6 a–b) Genu and splenium of corpus callosum, and 7) Subventricular zone. Panel B: 1) External capsule, 2) Middle cerebellar peduncles. Same templates were utilized for all scans.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3756943&req=5

pone-0072974-g001: Study and control region of interest templates and placements shown on FA maps.Panel A: 1) Anterior limb of internal capsule, 2) Posterior limb of internal capsule, 3) Frontal periventricular zone, 4) Occipital periventricular zone, 5a–b) Centrum semiovale at two consecutive levels, 6 a–b) Genu and splenium of corpus callosum, and 7) Subventricular zone. Panel B: 1) External capsule, 2) Middle cerebellar peduncles. Same templates were utilized for all scans.
Mentions: DTI Studio software, Version 3.0.3 (Johns Hopkins University, Baltimore, MD, http://cmrm.med.jhmi.edu) [15] was utilized for analyzing the DTI data. All DTI analyses were performed blinded to the results of cranial ultrasound, anatomical MRI, and clinical variables. Seven vulnerable study and two control regions of interest (ROI) were selected based on prior published data [16], [17]. The seven study white matter ROIs were: anterior and posterior limbs of internal capsule, frontal and occipital periventricular zones, centrum semiovale, genu and splenium of corpus callosum, and the subventricular zone. External capsule and middle cerebellar peduncles were selected as control ROIs. To minimize variability in the ROI placement, ImageJ, Version 1.44p (National Institutes of Health, http://imagej.nih.gov/ij) was utilized for development and placement of ROI templates (one for each ROI) in the native space for fractional anisotropy (FA) and mean diffusivity (MD) measurements (Figure 1). Standardized ROI templates were utilized with manual verification/correction of placement by a trained investigator. The same templates were applied to each DTI scan, minimizing measurement variability between different subjects. All ROI placements were small and centrally placed, minimizing capture of outside non-tract regions. The subventricular zone was only measured in the right hemisphere and the genu and splenium of the corpus callosum were measured centrally. All other regions were measured bilaterally.

Bottom Line: Conversely, antenatal steroids, female sex, longer duration of caffeine therapy, and greater duration of human milk use were independent favorable factors.White matter injury on cranial ultrasound was associated with a five weeks or greater delayed maturation of the corpus callosum; every additional 10 days of human milk use were associated with a three weeks or greater advanced maturation of the corpus callosum.In our cohort, it also aided identification of several previously known or suspected perinatal clinical antecedents of brain injury, aberrant development, and neurodevelopmental impairments.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatrics, Division of Neonatology, University of Texas Health Science Center, Houston, Texas, USA.

ABSTRACT

Objective: To identify perinatal clinical antecedents of white matter microstructural abnormalities in extremely preterm infants.

Methods: A prospective cohort of extremely preterm infants (N = 86) and healthy term controls (N = 16) underwent diffusion tensor imaging (DTI) at term equivalent age. Region of interest-based measures of white matter microstructure - fractional anisotropy and mean diffusivity - were quantified in seven vulnerable cerebral regions and group differences assessed. In the preterm cohort, multivariable linear regression analyses were conducted to identify independent clinical factors associated with microstructural abnormalities.

Results: Preterm infants had a mean (standard deviation) gestational age of 26.1 (1.7) weeks and birth weight of 824 (182) grams. Compared to term controls, the preterm cohort exhibited widespread microstructural abnormalities in 9 of 14 regional measures. Chorioamnionitis, necrotizing enterocolitis, white matter injury on cranial ultrasound, and increasing duration of mechanical ventilation were adversely correlated with regional microstructure. Conversely, antenatal steroids, female sex, longer duration of caffeine therapy, and greater duration of human milk use were independent favorable factors. White matter injury on cranial ultrasound was associated with a five weeks or greater delayed maturation of the corpus callosum; every additional 10 days of human milk use were associated with a three weeks or greater advanced maturation of the corpus callosum.

Conclusions: Diffusion tensor imaging is sensitive in detecting the widespread cerebral delayed maturation and/or damage increasingly observed in extremely preterm infants. In our cohort, it also aided identification of several previously known or suspected perinatal clinical antecedents of brain injury, aberrant development, and neurodevelopmental impairments.

Show MeSH
Related in: MedlinePlus