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Magnetic resonance imaging of white matter diseases of prematurity
Mary A Rutherford1, Veena Supramaniam, Ashraf Ederies
1MRC Clinical Sciences Centre, Imperial College, Hammersmith Hospital, London, UK. m.rutherford@imperial.ac.uk
Insights
Periventricular leucomalacia (PVL) and new white matter brain injuries are common in preterm infants. Magnetic resonance imaging helps understand these conditions and their impact on neurodevelopment.
Area of Science:
- Neonatal neurology
- Neuroimaging
- Developmental neuroscience
Background:
- Periventricular leucomalacia (PVL) and parenchymal venous infarction are established white matter diseases in preterm infants, linked to cerebral palsy.
- Recent magnetic resonance imaging (MRI) studies identify punctate white matter lesions and diffuse excessive high signal intensity (DEHSI) as additional white matter abnormalities in prematurity.
Purpose of the Study:
- To review the role of MRI in understanding the etiology, pathology, and outcomes of PVL, punctate white matter lesions, and DEHSI.
- To explore the potential continuum between these white matter disorders of prematurity.
Main Methods:
- Review of recent magnetic resonance imaging studies on preterm brain development.
- Analysis of etiological, pathological, and outcome data for white matter diseases in preterm infants.
Main Results:
- PVL and parenchymal venous infarction are significant causes of cerebral palsy in preterm survivors.
- Punctate white matter lesions and DEHSI are increasingly recognized, potentially more common than PVL but with less immediate neurodevelopmental impact.
- These newer lesions may be associated with later cognitive and behavioral issues.
Conclusions:
- MRI is crucial for characterizing white matter diseases in preterm infants, including PVL, punctate lesions, and DEHSI.
- Further research is needed to determine if these conditions represent a spectrum of injury from a common process.
- Understanding these conditions is vital for predicting and managing neurodevelopmental outcomes in preterm infants.
Abstract:
Periventricular leucomalacia (PVL) and parenchymal venous infarction complicating germinal matrix/intraventricular haemorrhage have long been recognised as the two significant white matter diseases responsible for the majority of cases of cerebral palsy in survivors of preterm birth. However, more recent studies using magnetic resonance imaging to assess the preterm brain have documented two new appearances, adding to the spectrum of white matter disease of prematurity: punctate white matter lesions, and diffuse excessive high signal intensity (DEHSI). These appear to be more common than PVL but less significant in terms of their impact on individual neurodevelopment. They may, however, be associated with later cognitive and behavioural disorders known to be common following preterm birth. It remains unclear whether PVL, punctate lesions, and DEHSI represent a continuum of disorders occurring as a result of a similar injurious process to the developing white matter. This review discusses the role of MR imaging in investigating these three disorders in terms of aetiology, pathology, and outcome.
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