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Cerebral Perfusion Is Perturbed by Preterm Birth and Brain Injury
E S Mahdi1, M Bouyssi-Kobar1,2, M B Jacobs3
1From the Developing Brain Research Program (E.S.M., M.B.-K., J.M., C.L.), Department of Diagnostic Imaging and Radiology.
Insights
Preterm infants with brain injury show altered cerebral blood flow (CBF), particularly in the thalamus and pons. These early hemodynamic disturbances highlight regional vulnerabilities in the developing brain.
Area of Science:
- Neuroscience
- Neonatal Medicine
- Medical Imaging
Background:
- Systemic and cerebral hemodynamic disturbances are implicated in prematurity-related brain injury.
- The precise impact of preterm birth on cerebral blood flow (CBF) remains incompletely understood.
Purpose of the Study:
- To compare global and regional CBF in preterm infants with and without brain injury using arterial spin-labeling (ASL) MRI.
- To investigate the relationship between clinical risk factors and CBF in this population.
Main Methods:
- ASL MRI was performed on preterm infants (<32 weeks gestational age, <1500 g).
- Global and regional CBF were quantified in specific brain regions (cerebral cortex, thalami, pons, cerebellum).
- Infants were stratified by the presence and severity of brain injury.
Main Results:
- Lower global CBF trended in preterm infants with brain injury (P = 0.07).
- Regional CBF was significantly reduced in the right thalamus and midpons (P < 0.05) and trended lower in other regions in infants with brain injury.
- Moderate-severe brain injury was associated with lower regional CBF in the midpons, right cerebellar hemisphere, and dentate nuclei compared to mild injury.
- Lower regional CBF correlated with ventilation, sepsis, and cesarean delivery.
Conclusions:
- Early disturbances in global and regional CBF are evident in preterm infants with brain injury.
- Alterations in thalamic and pontine perfusion suggest regional vulnerability in developing cerebro-cerebellar circuitry.
- ASL MRI can detect early hemodynamic changes associated with brain injury in preterm neonates.
Background And Purpose:
Early disturbances in systemic and cerebral hemodynamics are thought to mediate prematurity-related brain injury. However, the extent to which CBF is perturbed by preterm birth is unknown. Our aim was to compare global and regional CBF in preterm infants with and without brain injury on conventional MR imaging using arterial spin-labeling during the third trimester of ex utero life and to examine the relationship between clinical risk factors and CBF.
Materials And Methods:
We prospectively enrolled preterm infants younger than 32 weeks' gestational age and <1500 g and performed arterial spin-labeling MR imaging studies. Global and regional CBF in the cerebral cortex, thalami, pons, and cerebellum was quantified. Preterm infants were stratified into those with and without structural brain injury. We further categorized preterm infants by brain injury severity: moderate-severe and mild.
Results:
We studied 78 preterm infants: 31 without brain injury and 47 with brain injury (29 with mild and 18 with moderate-severe injury). Global CBF showed a borderline significant increase with increasing gestational age at birth (P = .05) and trended lower in preterm infants with brain injury (P = .07). Similarly, regional CBF was significantly lower in the right thalamus and midpons (P < .05) and trended lower in the midtemporal, left thalamus, and anterior vermis regions (P < .1) in preterm infants with brain injury. Regional CBF in preterm infants with moderate-severe brain injury trended lower in the midpons, right cerebellar hemisphere, and dentate nuclei compared with mild brain injury (P < .1). In addition, a significant, lower regional CBF was associated with ventilation, sepsis, and cesarean delivery (P < .05).
Conclusions:
We report early disturbances in global and regional CBF in preterm infants following brain injury. Regional cerebral perfusion alterations were evident in the thalamus and pons, suggesting regional vulnerability of the developing cerebro-cerebellar circuitry.
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