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White Matter Integrity Differences in 2-Year-Old Children Treated With ECMO: A Diffusion-Weighted Imaging Study
Michaela Ruttorf1,2, Julia Filip1,2, Thomas Schaible3
1Computer Assisted Clinical Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
Insights
Diffusion-weighted imaging (DWI) detects white matter alterations in 2-year-old survivors of neonatal extracorporeal membrane oxygenation (ECMO) treatment. These early brain changes correlate with later neurodevelopmental delays, offering a non-invasive assessment tool.
Area of Science:
- Neuroimaging
- Developmental Neuroscience
- Neonatal Medicine
Background:
- Neonatal extracorporeal membrane oxygenation (ECMO) survivors often experience long-term neurodevelopmental deficits.
- Neuropsychological testing in follow-up programs documents these delays, including memory, spatial, and motor issues.
- Early detection of brain alterations could improve long-term outcomes for these children.
Purpose of the Study:
- To investigate if diffusion-weighted imaging (DWI) can identify white matter (WM) changes in infants treated with neonatal ECMO.
- To correlate early DWI findings with known neurodevelopmental outcomes observed later in life.
- To establish DWI as an objective tool for assessing structural brain changes in ECMO survivors.
Main Methods:
- Utilized diffusion-weighted imaging (DWI) on 56 children, comparing ECMO survivors with a control group.
- Calculated diffusion metrics: fractional anisotropy (FA), first fibre partial volume fraction (F1), radial diffusivity (RD), and mean diffusivity (MD).
- Employed tract-based spatial statistics with a pediatric brain atlas to analyze WM tracts and specific brain regions.
Main Results:
- Significant differences in FA, F1, RD, and MD were observed in major WM tracts between ECMO and no-ECMO groups.
- Specific regions, including the corpus callosum, internal capsule, and fornix, showed significant diffusion measure variations.
- These identified WM alterations in ECMO survivors align with reported neurodevelopmental delays.
Conclusions:
- DWI at two years of age effectively detects structural white matter changes in neonatal ECMO survivors.
- Early DWI analysis serves as a valuable, non-participatory tool for identifying potential neurodevelopmental risks.
- Findings suggest DWI can complement or precede traditional neuropsychological assessments in ECMO follow-up programs.
Abstract:
School-aged and adolescent survivors of neonatal extracorporeal membrane oxygenation (ECMO) treatment still suffer from neurodevelopmental delays such as verbal, visuo-spatial and working memory problems, motor dysfunction and sensorineural hearing loss, respectively, later in life, which is well-documented by neuropsychological testing within follow-up programs. In this study, we demonstrate that diffusion-weighted imaging (DWI) in 2-year-old survivors of neonatal ECMO treatment reveals white matter (WM) alterations in brain regions related to neurodevelopmental outcome seen later in life. From the DWI data of 56 children, fractional anisotropy (FA), first fibre partial volume fraction estimate (F1), radial diffusivity (RD) and mean diffusivity (MD) are calculated and compared using tract-based spatial statistics adapted to a paediatric brain atlas. Significant differences in FA, F1, RD and MD between the no-ECMO and ECMO groups are seen in major WM tracts. Additionally, we examine individual diffusion measures by looking at 50 regions supplied with the paediatric brain atlas. We find the following regions to have significantly different means in the no-ECMO compared with the ECMO group matching reports of neuropsychological delays found in behavioural tests: left anterior corona radiata, left anterior limb of internal capsule, left anterior commissure, left and right corpus callosum (genu, body and splenium), left and right crus of fornix and left tapetum. Analysing diffusion measures at an early stage of life serves as a good tool to detect structural WM changes in survivors of neonatal ECMO treatment. Compared with neuropsychological testing, DWI does not depend on the child's active participation.
