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Tractography of white-matter tracts in very preterm infants: a 2-year follow-up study
Francisca T De Bruïne1, Gerda Van Wezel-Meijler, Lara M Leijser
1Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands. F.T.Wiggers-de_Bruine@lumc.nl
Insights
Diffusion tensor imaging (DTI) tractography can predict neurodevelopmental outcomes in very preterm infants. Specific DTI values at term-equivalent age accurately identified infants at risk for motor delay and cerebral palsy by age two.
Area of Science:
- Neonatal neuroscience
- Developmental neuroscience
- Medical imaging
Background:
- Preterm birth is associated with increased risk of neurodevelopmental impairments.
- Early prediction of neurodevelopmental outcomes is crucial for timely intervention.
- White matter tract development is sensitive to early life insults.
Purpose of the Study:
- To evaluate the predictive value of diffusion tensor imaging (DTI) tractography for neurodevelopmental outcomes in very preterm infants.
- To determine if DTI metrics can independently predict psychomotor delay and cerebral palsy (CP) at 2 years of corrected age.
Main Methods:
- Eighty-four very preterm infants underwent DTI at term-equivalent age.
- Neurodevelopmental assessment using Bayley Scales of Infant Development (3rd ed.) was performed at 2 years.
- Associations between DTI metrics (fractional anisotropy, apparent diffusion coefficient, fiber length) and neurodevelopmental outcomes were analyzed using regression models.
Main Results:
- Lower fractional anisotropy and shorter fiber lengths in the posterior limb of the internal capsule were associated with psychomotor delay and CP.
- Higher apparent diffusion coefficient and shorter fiber lengths in the callosal splenium were linked to psychomotor delay.
- Fractional anisotropy of the posterior internal capsule and ADC of the splenium independently predicted motor delay and CP with high sensitivity and moderate specificity.
Conclusions:
- DTI tractography at term-equivalent age is a valuable tool for predicting neurodevelopmental outcomes in very preterm infants.
- Specific DTI metrics can identify infants at high risk for psychomotor delay and cerebral palsy, enabling early intervention strategies.
Aim:
The aim of this study was to determine whether tractography of white-matter tracts can independently predict neurodevelopmental outcome in very preterm infants.
Method:
Out of 84 very preterm infants admitted to a neonatal intensive care unit, 64 (41 males, 23 females; median gestational age 29.1 weeks [range 25.6-31.9]; birthweight 1163 g [range 585-1960]) underwent follow-up at 2 years. Diffusion tensor imaging (DTI) values obtained around term were associated with a neurological examination and mental and psychomotor developmental index scores at 2 years based on the Bayley Scales of Infant Development (version 3). Univariate and logistic regression analyses tested for associations between DTI values and follow-up parameters. Cut-off values predicting motor delay and cerebral palsy (CP) were determined for fractional anisotropy, apparent diffusion coefficient (ADC), and fibre lengths.
Results:
Infants with psychomotor delay and CP had significantly lower fractional anisotropy values (p=0.002, p=0.04 respectively) and shorter fibre lengths (p=0.02, p=0.02 respectively) of the posterior limb of the internal capsule. Infants with psychomotor delay also had significantly higher ADC values (p=0.03) and shorter fibre lengths (p=0.002) of the callosal splenium. Fractional anisotropy values of the posterior limb of the internal capsule independently predicted motor delay and CP, with sensitivity between 80 and 100% and specificity between 66 and 69%. ADC values of the splenium independently predicted motor delay with sensitivity of 100% and specificity of 65%.
Interpretation:
Diffusion tensor imaging tractography at term-equivalent age independently predicts psychomotor delay at 2 years of age in preterm infants.
