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Characterisation of brain volume and microstructure at term-equivalent age in infants born across the gestational age
Deanne K Thompson1, Claire E Kelly2, Jian Chen3
1Murdoch Children's Research Institute, Melbourne, VIC, Australia; Florey Institute of Neuroscience and Mental Health, Melbourne, VIC, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia.
Insights
Brain structure differs in preterm infants, with very preterm infants showing the most significant differences in brain volume and white matter microstructure compared to full-term infants.
Area of Science:
- Neonatal neuroscience
- Developmental neuroimaging
- Pediatric neurology
Background:
- Morbidity risks vary across preterm (VP, MP, LP) and full-term (FT) infant groups.
- Brain structure at term-equivalent age (TEA) is not fully characterized across all gestational age (GA) groups.
Purpose of the Study:
- Compare global and regional brain volumes in VP, MP, LP, and FT infants at TEA.
- Assess regional white matter microstructure differences across GA groups at TEA.
- Determine the magnitude and location of brain structure differences between GA groups.
Main Methods:
- Structural MRI scans of 328 infants (VP, MP, LP, FT) were segmented.
- Global and regional brain volumes (grey matter, white matter, CSF) were analyzed using voxel-based morphometry.
- Tract-Based Spatial Statistics analyzed white matter microstructure (FA, MD, AD, RD) in 361 infants.
Main Results:
- All preterm groups had larger CSF volumes than FT infants.
- Preterm infants showed smaller temporal grey and white matter volumes and corpus callosum.
- Lower FA and higher RD/MD in white matter were observed in all preterm groups compared to FT.
- Brain structure differences were most pronounced in VP, followed by MP, then LP infants.
Conclusions:
- All preterm infants exhibit atypical brain volume and microstructure at TEA.
- A gradient of brain structure differences exists, with very preterm infants being most vulnerable.
- Specific regions like CSF, temporal lobes, and corpus callosum are particularly affected by preterm birth.
Background:
Risk of morbidity differs between very preterm (VP; <32 weeks' gestational age (GA)), moderate preterm (MP; 32-33 weeks' GA), late preterm (LP; 34-36 weeks' GA), and full-term (FT; ≥37 weeks' GA) infants. However, brain structure at term-equivalent age (TEA; 38-44 weeks) remains to be characterised in all clinically important GA groups. We aimed to compare global and regional brain volumes, and regional white matter microstructure, between VP, MP, LP and FT groups at TEA, in order to establish the magnitude and anatomical locations of between-group differences.
Methods:
Structural images from 328 infants (91 VP, 63 MP, 104 LP and 70 FT) were segmented into white matter, cortical grey matter, cerebrospinal fluid (CSF), subcortical grey matter, brainstem and cerebellum. Global tissue volumes were analysed, and additionally, cortical grey matter and white matter volumes were analysed at the regional level using voxel-based morphometry. Fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD) and radial diffusivity (RD) images from 361 infants (92 VP, 69 MP, 120 LP and 80 FT) were analysed using Tract-Based Spatial Statistics. Statistical analyses involved examining the overall effect of GA group on global volumes (using linear regressions) and regional volumes and microstructure (using non-parametric permutation testing), as well performing post-hoc comparisons between the GA sub-groups.
Results:
On global analysis, cerebrospinal fluid (CSF) volume was larger in all preterm sub-groups compared with the FT group. On regional analysis, volume was smaller in parts of the temporal cortical grey matter, and parts of the temporal white matter and corpus callosum, in all preterm sub-groups compared with the FT group. FA was lower, and RD and MD were higher in voxels located in much of the white matter in all preterm sub-groups compared with the FT group. The anatomical locations of group differences were similar for each preterm vs. FT comparison, but the magnitude and spatial extent of group differences was largest for the VP, followed by the MP, and then the LP comparison. Comparing within the preterm groups, the VP sub-group had smaller frontal and temporal grey and white matter volume, and lower FA and higher MD and RD within voxels in the approximate location of the corpus callosum compared with the MP sub-group. There were few volume and microstructural differences between the MP and LP sub-groups.
Conclusion:
All preterm sub-groups had atypical brain volume and microstructure at TEA when compared with a FT group, particularly for the CSF, temporal grey and white matter, and corpus callosum. In general, the groups followed a gradient, where the differences were most pronounced for the VP group, less pronounced for the MP group, and least pronounced for the LP group. The VP sub-group was particularly vulnerable compared with the MP and LP sub-groups.
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