Neonatal DTI early after birth predicts motor outcome in preterm infants with periventricular hemorrhagic infarction

Pediatr Res. 2015 Sep;78(3):298-303. doi: 10.1038/pr.2015.94. Epub 2015 May 15.

Abstract

Background: To determine the association between early neonatal diffusion tensor imaging (DTI) and the development of unilateral spastic cerebral palsy (USCP) in preterm infants with periventricular hemorrhagic infarction (PVHI).

Methods: Preterm infants with PVHI were assessed with early (≤4 wk after birth) and term-equivalent age MRI-DTI. Involvement of corticospinal tracts was assessed by visual assessment of the posterior limb of the internal capsule (PLIC) on DTI (classified asymmetrical, equivocal, or symmetrical) and by an atlas-based approach calculating fractional anisotropy asymmetry index in the PLIC. Motor outcome was assessed at ≥15 mo corrected age.

Results: Seven out of 23 infants with PVHI developed USCP. Their PLIC was visually scored as asymmetrical in 6 and equivocal in 1 on the early DTI. Thirteen out of 16 infants with a symmetrical motor development had a symmetrical PLIC on early DTI, the remaining 3 were equivocal. All infants with USCP had a fractional anisotropy asymmetry index of >0.05 (optimal cut-off value) on early DTI. In infants with a symmetrical motor development (n = 16), 14 had an asymmetry index ≤0.05 while 2 had an index >0.05.

Conclusion: DTI in preterm infants with PVHI within a few weeks after birth is associated with later motor development.

MeSH terms

  • Anisotropy
  • Brain Infarction / pathology*
  • Cerebral Palsy / diagnosis
  • Cerebral Palsy / pathology*
  • Child
  • Child, Preschool
  • Cognition
  • Diffusion Tensor Imaging*
  • Female
  • Follow-Up Studies
  • Hemorrhage / pathology*
  • Humans
  • Infant, Newborn
  • Infant, Premature
  • Intensive Care, Neonatal
  • Magnetic Resonance Imaging
  • Male
  • Motor Skills*
  • Neuropsychological Tests
  • ROC Curve
  • Treatment Outcome