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Magnetic resonance diffusion tractography of the preterm infant brain: a systematic review
Kerstin Pannek1, Simon M Scheck, Paul B Colditz
1School of Medicine, The University of Queensland, Brisbane, Qld;, Australia.
Insights
Diffusion magnetic resonance imaging (dMRI) tractography studies show potential for assessing white matter development in preterm infants. Further research is needed to establish its predictive utility for neurodevelopmental outcomes.
Area of Science:
- Neuroimaging
- Developmental Neuroscience
- Pediatric Radiology
Background:
- Preterm birth increases the risk of adverse neurodevelopmental outcomes.
- Diffusion magnetic resonance imaging (dMRI) with tractography offers non-invasive assessment of white matter microstructure and brain development in preterm infants.
- This review focuses on tractography studies conducted up to term-equivalent age.
Purpose of the Study:
- To systematically review current evidence from dMRI tractography studies of preterm infants.
- To evaluate the assessment of white matter microstructure and brain development.
- To explore the utility of tractography as a predictive tool for neurodevelopmental outcomes.
Main Methods:
- Systematic literature search of dMRI tractography studies involving preterm infants.
- Assessment of 22 relevant studies.
- Identification of frequently and infrequently assessed white matter tracts.
Main Results:
- The corticospinal tract, corpus callosum, and optic radiations were most commonly studied.
- Evidence suggests a relationship between diffusion metrics and postmenstrual age.
- Conflicting evidence exists regarding the effects of gestational age at birth and white matter injury; sex and laterality may be important factors.
Conclusions:
- More studies across all gestational ages are needed to clarify the relationship between gestational age and diffusion metrics.
- Establishing tractography's predictive value requires further investigation.
- Improved acquisition and analysis methods are necessary for accurate assessment of white matter pathway development.
Aim:
Preterm birth is associated with an increased risk of adverse neurodevelopmental outcomes. Diffusion magnetic resonance imaging (dMRI) combined with tractography can be used to assess non-invasively white matter microstructure and brain development in preterm infants. Our aim was to conduct a systematic review of the current evidence obtained from tractography studies of preterm infants in whom MRI was performed up to term-equivalent age.
Method:
Databases were searched for dMRI tractography studies of preterm infants.
Results:
Twenty-two studies were assessed. The most frequently assessed tracts included the corticospinal tract, the corpus callosum, and the optic radiations. The superior longitudinal fasciculus, and the anterior and superior thalamic radiations were investigated less frequently. A clear relationship exists between diffusion metrics and postmenstrual age at the time of scanning, although the evidence of an effect of gestational age at birth and white matter injury is conflicting. Sex and laterality may play an important role in the relationship between diffusion metrics, early clinical assessment, and outcomes.
Interpretation:
Studies involving infants of all gestational ages are required to elucidate the relationship between gestational age and diffusion metrics, and to establish the utility of tractography as a predictive tool. There is a need for more robust acquisition and analysis methods to improve the accuracy of assessing development of white matter pathways.
