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Assessing Cortical Cerebral Microinfarcts on High Resolution MR Images
Published on: November 20, 2015
Diffuse excessive high signal intensity in the preterm brain on advanced MRI represents widespread neuropathology
Julia E Kline1, Jon Dudley2, Venkata Sita Priyanka Illapani1
1Neurodevelopmental Disorders Prevention Center, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.
Abstract:
Preterm brains commonly exhibit elevated signal intensity in the white matter on T2-weighted MRI at term-equivalent age. This signal, known as diffuse excessive high signal intensity (DEHSI) or diffuse white matter abnormality (DWMA) when quantitatively assessed, is associated with abnormal microstructure on diffusion tensor imaging. However, postmortem data are largely lacking and difficult to obtain, and the pathological significance of DEHSI remains in question. In a cohort of 202 infants born preterm at ≤32 weeks gestational age, we leveraged two newer diffusion MRI models - Constrained Spherical Deconvolution (CSD) and neurite orientation dispersion and density index (NODDI) - to better characterize the macro and microstructural properties of DWMA and inform the ongoing debate around the clinical significance of DWMA. With increasing DWMA volume, fiber density broadly decreased throughout the white matter and fiber cross-section decreased in the major sensorimotor tracts. Neurite orientation dispersion decreased in the centrum semiovale, corona radiata, and temporal lobe. These findings provide insight into DWMA's biological underpinnings and demonstrate that it is a serious pathology.
Insights
Preterm infants with diffuse white matter abnormality (DWMA) show reduced white matter microstructure. Advanced MRI models reveal decreased fiber density and neurite orientation, confirming DWMA as a significant pathology.
Area of Science:
- Neuroimaging
- Developmental Neuroscience
- Pediatric Radiology
Background:
- Preterm brains often show white matter T2 signal abnormalities (DEHSI/DWMA) at term-equivalent age.
- These abnormalities correlate with microstructural changes on diffusion tensor imaging.
- The pathological significance of DEHSI/DWMA requires further investigation due to limited postmortem data.
Purpose of the Study:
- To characterize the macro- and microstructural properties of diffuse white matter abnormality (DWMA) in preterm infants.
- To utilize advanced diffusion MRI models (CSD and NODDI) for detailed analysis.
- To contribute to the understanding of the clinical significance of DWMA.
Main Methods:
- Utilized Constrained Spherical Deconvolution (CSD) and neurite orientation dispersion and density index (NODDI) diffusion MRI models.
- Analyzed a cohort of 202 infants born preterm (≤32 weeks gestational age).
- Quantitatively assessed diffuse white matter abnormality (DWMA) volume and its relationship with microstructural metrics.
Main Results:
- Increasing DWMA volume correlated with decreased white matter fiber density.
- Major sensorimotor tracts showed reduced fiber cross-section with increasing DWMA.
- Decreased neurite orientation dispersion was observed in the centrum semiovale, corona radiata, and temporal lobe.
Conclusions:
- Findings provide insights into the biological underpinnings of DWMA.
- Demonstrates that DWMA represents a significant neuropathological condition in preterm infants.
- Highlights the utility of advanced diffusion MRI models in characterizing white matter abnormalities.
