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Diffusion-weighted imaging and magnetic resonance proton spectroscopy following preterm birth
A R Hart1, M F Smith2, E H Whitby3
1Department of Paediatric Neurology and Child Development, Ryegate Children's Centre, Sheffield Children's Hospital NHS Foundation Trust, Tapton Crescent Road, Sheffield S10 5DD, UK.
Insights
Magnetic resonance spectroscopy (MRS) revealed altered N-acetyl aspartate (NAA) levels in preterm infants, potentially indicating subtle white matter injury linked to neurodevelopmental difficulties. A patent ductus arteriosus (PDA) was associated with these NAA changes.
Area of Science:
- Neuroimaging
- Neonatal Neurology
- Developmental Pediatrics
Background:
- Preterm birth poses risks for neurodevelopmental impairments.
- Magnetic resonance imaging (MRI) techniques like proton spectroscopy (MRS) and diffusion-weighted imaging (DWI) offer insights into brain development.
- Understanding early brain alterations is crucial for predicting long-term outcomes.
Purpose of the Study:
- To investigate associations between preterm brain MRS and apparent diffusion coefficient (ADC) data with neurodevelopmental outcomes at 18 months corrected age.
- To explore relationships between these imaging biomarkers and clinical variables.
Main Methods:
- Prospective observational cohort study of 67 preterm infants (born before 35 weeks gestational age).
- Brain MRI (MRS and DWI) performed between 37-44 weeks corrected gestational age.
- Developmental assessment conducted around 18 months corrected age.
Main Results:
- No significant associations were found between ADC values and MRS results or developmental outcomes.
- MRS N-acetyl aspartate (NAA) ratios in the posterior white matter correlated with "severe" and "moderate to severe" neurodevelopmental difficulties.
- Lower fine motor scores were observed in infants with a visible lactate doublet in the posterior white matter.
- Patent ductus arteriosus (PDA) was the sole clinical factor associated with NAA ratios.
Conclusions:
- Altered NAA levels in the posterior white matter may indicate subtle white matter injury contributing to neurodevelopmental challenges in preterm infants.
- These findings suggest a potential link between PDA and white matter alterations affecting development.
- Further research is warranted to elucidate the long-term neurodevelopmental implications and the impact of PDAs.
Aim:
To study the associations between magnetic resonance proton spectroscopy (MRS) data and apparent diffusion coefficients (ADC) from the preterm brain with developmental outcome at 18 months corrected age and clinical variables.
Materials And Methods:
A prospective observational cohort study of 67 infants born before 35 weeks gestational age who received both magnetic resonance imaging of the brain between 37 and 44 weeks corrected gestational age and developmental assessment around 18 months corrected age.
Results:
No relationships were found between ADC values and MRS results or outcome. MRS ratios involving N-acetyl aspartate (NAA) from the posterior white matter were associated with "severe" and "moderate to severe" difficulties, and fine motor scores were significantly lower in participants with a visible lactate doublet in the posterior white matter. The presence of a patent ductus arteriosus (PDA) was the only clinical factor related to NAA ratios.
Conclusion:
Altered NAA levels in the posterior white matter may reflect subtle white matter injury associated with neuro-developmental difficulties, which may be related to a PDA. Further work is needed to assess the longer-term neuro-developmental implications of these findings, and to study the effect of PDAs on developmental outcome in later childhood/adolescence.
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