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[Exploring the clinical significance of continuously measuring apparent diffusion coefficient values in the preterm
Xin Tong1, Xindong Xue1, Jianhua Fu1
1Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang 110004, China.
Objective:
To observe the dynamic changes of MRI in the preterm infants with punctate white matter damage (PWMD), and to explore the clinical significance of apparent diffusion coefficient (ADC) values by continuously measuring the lesions and surrounding region by applying diffusion weighted imaging (DWI).
Method:
MRI, using conventional and diffusion weighted imaging, was performed in 151 preterm infants within 7 days after birth between October 2010 to June 2011 in NICU. Twenty-four preterm infants with PWMD and 24 controls were obtained according to their MRI results. The control group infants were those with normal MRI results and at the same gestational age as those with PWMDs. The ADC value was measured for the lesions and their surrounding regions, and for the same sites of the controls. All the PWMD were followed up for 2-5 weeks, and apparent diffusion coefficients were measured at the same regions. The variation of magnetic resonance imaging was observed and the apparent diffusion coefficients were compared.
Result:
The first MRI scanning: in the 24 cases with PWMD, high signals on DWI were seen in all patients (100%), increased signal intensity on T1-weighted images were seen in 19 (79.2%) patients, increased signal intensity on T1-weighted images and decreased signal intensity on T2-weighted images were seen in 4 (16.6%) patients. The second MRI scanning: in the 24 cases with PWMD, The high signal on DWI vanished in all patients (100%), the increased signal intensity on T1-weighted images vanished in 9 (39.1%) patients, the increased signal intensity on T1-weighted images did not vanish but was smaller than before in 14 (60.9%) patients. The measurement of ADC values: the mean ADC value of the lesions in the group of PWMD was (942 ± 170)×10(-3)mm(2)/s, significantly lower than the area surrounding (1 554 ± 116)×10(-3)mm(2)/s and the same area of the control group (1 524 ± 116)×10(-3)mm(2)/s ( P < 0.05). The second MRI scanning: the mean ADC of the lesions in the PWMD group was up to (1 468 ± 195)×10(-3)mm(2)/s, which is significantly higher than before, but still lower than the areas surrounding the lesion (1 586 ± 97)×10(-3)mm(2)/s (P < 0.05).
Conclusion:
Continuous measurement of ADC values in the lesions and surrounding areas is important to describe the micro-change of PWMD.
Insights
Diffusion weighted imaging (DWI) and apparent diffusion coefficient (ADC) values reveal dynamic changes in preterm infants with punctate white matter damage (PWMD). Continuous ADC measurement aids in understanding micro-changes in PWMD lesions over time.
Area of Science:
- Neuroimaging
- Pediatric Neurology
- Radiology
Context:
- Preterm infants are susceptible to brain injury, including punctate white matter damage (PWMD).
- Early detection and monitoring of PWMD are crucial for predicting neurodevelopmental outcomes.
- Diffusion weighted imaging (DWI) and apparent diffusion coefficient (ADC) mapping are advanced MRI techniques for assessing brain tissue microstructure.
Purpose:
- To dynamically observe MRI changes in preterm infants diagnosed with PWMD.
- To investigate the clinical significance of ADC values in PWMD lesions and surrounding areas.
- To track the evolution of PWMD using serial ADC measurements.
Summary:
- Initial MRI in preterm infants with PWMD showed high DWI signals. Lesion ADC values were significantly lower than controls and surrounding white matter.
- Follow-up MRI revealed resolution of DWI abnormalities and normalization of ADC values over 2-5 weeks, though still lower than surrounding areas.
- These findings highlight the dynamic nature of PWMD and the utility of serial ADC measurements in characterizing microstructural changes.
Impact:
- Provides insights into the natural history and microstructural evolution of PWMD in preterm neonates.
- Establishes the value of continuous ADC monitoring for assessing treatment response and prognosis in PWMD.
- Enhances the understanding of white matter injury in preterm infants, potentially guiding therapeutic strategies.
