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Microstructural changes of white matter assessed with diffusional kurtosis imaging in extremely preterm infants with
Li-Min Guo1, Meng Zhao2, Yue Cai1
1Department of Pediatrics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Insights
Severe intraventricular hemorrhage (IVH) in premature infants is linked to white matter damage. Diffusional kurtosis imaging (DKI) can predict neurodevelopmental outcomes in these infants.
Area of Science:
- Neuroscience
- Neonatology
- Radiology
Background:
- Intraventricular hemorrhage (IVH) is a significant neurological complication in premature infants.
- Extremely preterm infants (gestation < 28 weeks) with severe IVH face high risks of neurodevelopmental impairments.
Purpose of the Study:
- To investigate white matter impairments using Diffusional Kurtosis Imaging (DKI).
- To determine the association between white matter microstructural changes and neurodevelopmental outcomes in extremely preterm infants with severe IVH.
Main Methods:
- Retrospective evaluation of extremely preterm infants (gestation < 28 weeks) between 2017-2020.
- Neurodevelopmental outcomes assessed using Bayley Scales of Infant and Toddler Development-III at 2 years corrected age.
- DKI measured Mean Kurtosis (MK) and Fractional Anisotropy (FA) in the posterior limbs of the internal capsule (PLIC) and corpus callosum at term equivalent age.
Main Results:
- 18 out of 32 infants with severe IVH showed neurodevelopmental impairments, with motor and language delays in 58.4% and 52.7% respectively.
- Infants with impairments had lower MK and FA values in the PLIC and corpus callosum.
- Decreased MK values in the PLIC and corpus callosum predicted increased risk of neurodevelopmental impairments (p < 0.05).
- DKI tractography revealed nerve fiber bundle loss during follow-up.
Conclusions:
- Motor and language abilities at 2 years are associated with DKI MK values in the PLIC and corpus callosum.
- DKI's MK values offer potential indicators for predicting neurodevelopmental outcomes in extremely preterm infants with severe IVH.
Objective:
Intraventricular hemorrhage (IVH) is a serious neurological complication in premature infants. This study aimed to investigate the white matter impairments and neurodevelopmental outcomes of severe IVH in extremely preterm infants with gestation age less than 28 weeks.
Methods:
We retrospectively evaluated the extremely preterm infants between 2017 and 2020. Neurodevelopmental outcomes were evaluated with the Bayley Scales of Infant and Toddler Development-III at 2 years of corrected age. Diffusional kurtosis imaging (DKI) was employed to evaluate the microstructural changes in white matter tracts. Mean kurtosis (MK) and fractional anisotropy (FA) values of DKI were measured in the brain regions including posterior limbs of the internal capsule (PLIC) and the corpus callosum at term equivalent age.
Results:
Of 32 extremely preterm infants with severe IVH during the follow-up period, 18 cases were identified as neurodevelopmental impairments. The delay rates of motor and language were 58.4% and 52.7%. The cases with neurodevelopmental impairments had lower MK and FA values in both bilateral PLIC and the corpus callosum. The analysis of multivariable regression models predicting motor and language outcomes at 2 years of corrected age, showed that the decreases of MK values in both PLIC and the corpus callosum at the term equivalent age contributed to a significantly increased risk of neurodevelopmental impairments (all p < 0.05). During follow-up period, obvious loss of nerve fiber bundles was observed with DKI tractography.
Conclusion:
Motor and language abilities at age 2 years were associated with MK values of DKI at the term equivalent age in both PLIC and the corpus callosum of extremely preterm infants with severe IVH. The evaluation of white matter microstructural changes with MK values might provide feasible indicators of neurodevelopmental outcomes of extremely preterm infants with severe intraventricular hemorrhage.
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