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Sequelae of Premature Birth in Young Adults : Incidental Findings on Routine Brain MRI
Dennis M Hedderich1,2, Tobias Boeckh-Behrens3,4, Josef G Bäuml3,4
1TUM-NIC Neuroimaging Center, Munich, Germany. dennis.hedderich@tum.de.
Insights
Routine brain MRI in adults born prematurely reveals enlarged lateral ventricles and white matter lesions. The frontal-occipital-horn ratio (FOHR) effectively detects these common sequelae of premature birth.
Area of Science:
- Neuroimaging
- Developmental Neuroscience
- Radiology
Background:
- Limited qualitative data exists on routine MRI findings in adults born prematurely.
- Premature birth (<32 weeks gestation or <1500g birth weight) can lead to long-term neurological abnormalities.
- Understanding these abnormalities is crucial for clinical management and future research.
Purpose of the Study:
- To qualitatively describe routine MRI findings in adults born very preterm (VP) or with very low birth weight (VLBW).
- To evaluate methods for routine interpretation of these imaging findings.
- To investigate the impact of perinatal variables on these abnormalities.
Main Methods:
- Two radiologists analyzed T1-weighted and FLAIR MRI scans of 100 VP/VLBW adults and 106 full-term (FT) controls.
- White matter lesions (WML) were counted by location; lateral ventricle volume (LVV) was assessed using subjective evaluation, Evans' index (EI), and frontal-occipital-horn ratio (FOHR).
- Freesurfer-based volumetry was used as a reference standard.
Main Results:
- Increased LVV was observed in 24.7% of VP/VLBW individuals and was significantly larger than in FT controls.
- The FOHR measurement demonstrated the highest accuracy (AUC=0.928) for detecting ventricular enlargement.
- Increased deep and periventricular WMLs were noted, while subcortical WMLs were not significantly different.
Conclusions:
- Enlarged LVV and deep/periventricular WMLs are characteristic findings on routine brain MRI in adults born prematurely.
- Measurement of FOHR is a practical and sensitive method for detecting abnormal LVV in clinical settings.
- Gestational age and neonatal intracranial hemorrhage are significant predictors of ventricular enlargement.
Background And Purpose:
Qualitative studies about the abnormalities appreciated on routine magnetic resonance imaging (MRI) sequences in prematurely born adults are lacking. This article aimed at filling this knowledge gap by (1) qualitatively describing routine imaging findings in prematurely born adults, (2) evaluating measures for routine image interpretation and (3) investigating the impact of perinatal variables related to premature birth.
Methods:
In this study two board-certified radiologists assessed T1-weighted and FLAIR-weighted images of 100 prematurely born adults born very preterm (VP <32 weeks) and/or at very low birth weight (VLBW <1500 g) and 106 controls born at full term (FT) (mean age 26.8 ± 0.7 years). The number of white matter lesions (WML) was counted according to localization. Lateral ventricle volume (LVV) was evaluated subjectively and by measurements of Evans' index (EI) and frontal-occipital-horn ratio (FOHR). Freesurfer-based volumetry served as reference standard. Miscellaneous incidental findings were noted as free text.
Results:
The LVV was increased in 24.7% of VP/VLBW individuals and significantly larger than in FT controls. This was best identified by measurement of FOHR (AUC = 0.928). Ventricular enlargement was predicted by low gestational age (odds ratio: 0.71, 95% CI 0.51-0.98) and presence of neonatal intracranial hemorrhage (odds ratio: 0.26, 95% CI 0.07-0.92). The numbers of deep and periventricular WML were increased while subcortical WMLs were not.
Conclusion:
Enlargement of the LVV and deep and periventricular WMLs are typical sequelae of premature birth that can be appreciated on routine brain MRI. To increase sensitivity of abnormal LVV detection, measurement of FOHR seems feasible in clinical practice.
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