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Updated: May 11, 2026
Diffusion Tensor Magnetic Resonance Imaging in the Analysis of Neurodegenerative Diseases
Published on: July 28, 2013
Utility of Diffusion Tensor Imaging in Preterm Infants with Germinal Matrix Hemorrhage and Intraventricular
Katherine Riordan1, Brenden Barness1, Hasan Sumdani2
1College of Medicine, University of Arizona College of Medicine-Tucson, Tucson, Arizona, USA.
Insights
Diffusion tensor imaging (DTI) is more sensitive than cranial ultrasound (CUS) for detecting subtle brain injuries like germinal matrix hemorrhage (GMH) in preterm infants, correlating with neurodevelopmental outcomes.
Area of Science:
- Neonatal Neurology
- Neuroimaging
- Pediatric Radiology
Background:
- Intraventricular hemorrhage (IVH) and germinal matrix hemorrhage (GMH) are common in preterm infants, increasing risks for impaired neurodevelopment.
- Cranial ultrasound (CUS) is standard for screening but can miss subtle injuries, especially in the posterior fossa.
- Diffusion tensor imaging (DTI) offers a potential advancement in detecting these injuries.
Approach:
- A systematic review of PubMed, MEDLINE, and EMBASE was performed.
- Twenty studies involving 1574 infants, including 574 with GMH-IVH, were analyzed.
- Studies were assessed for quality, DTI application, and neurological outcomes.
Key Points:
- DTI detected GMH more accurately than CUS, particularly in the cerebellum.
- Decreased fractional anisotropy and asymmetrical myelination were observed in infants with GMH-IVH.
- Lower fractional anisotropy on DTI correlated with cognitive, language, and motor delays at follow-up.
Conclusions:
- DTI is more sensitive for subtle brain injury patterns than CUS.
- While CUS remains crucial for surgical indications, DTI provides deeper insights into microstructural changes and long-term outcomes.
- DTI-identified microstructural changes are linked to childhood motor and cognitive development in preterm infants with GMH-IVH.
Objective:
Intraventricular hemorrhage (IVH) and germinal matrix hemorrhage (GMH) are the most common brain injuries in preterm infants. Neonates with these injuries are at greater risk of impaired neurodevelopmental outcome. Current guidelines recommend screening infants with cranial ultrasound (CUS); however, this is prone to missing subtle injury patterns, particularly within the posterior fossa. The present report sought to discuss the utility of diffusion tensor imaging (DTI) in preterm infants.
Methods:
A systematic review of PubMed, Ovid MEDLINE, and Ovid EMBASE was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Included manuscripts were methodically scrutinized for quality, DTI use, and neurologic outcome.
Results:
Twenty studies with 1574 infants who underwent DTI were included. There were 574 preterm infants with GMH-IVH on DTI. Twelve studies documented decreased fractional anisotropy, whereas 6 demonstrated structural segregation and asymmetrical white matter myelination in these infants. Seven studies documented concurrent CUS use with 2 studies comparing DTI findings with CUS findings. In both studies, DTI more accurately detected presence of GMH, especially within the cerebellum. Among GMH-IVH preterm infants, 58.5% demonstrated cognitive, intellectual, and language delays at follow-up (mean, 32.4 months). Additionally, lower fractional anisotropy values on initial DTI were associated with cognitive, language, and motor delays.
Conclusions:
Although DTI is more sensitive for picking up subtle injury patterns, CUS remains the standard of care when screening for injuries that would necessitate surgical intervention. DTI offers a refined understanding of the sequelae of GMH-IVH with microstructural changes found on DTI being associated with childhood motor and cognitive outcomes.
