Quantitative assessment of white matter injury in preterm neonates: Association with outcomes.

Authors

Ting Guo, Neurosciences and Mental Health, The Hospital for Sick Children Research Institute & Departments of Paediatrics, The Hospital for Sick Children and the University of Toronto
Emma G Duerden, Neurosciences and Mental Health, The Hospital for Sick Children Research Institute & Departments of Paediatrics, The Hospital for Sick Children and the University of Toronto
Elysia Adams, Departments of Paediatrics, The Hospital for Sick Children and the University of Toronto
Vann Chau, Neurosciences and Mental Health, The Hospital for Sick Children Research Institute & Departments of Paediatrics, The Hospital for Sick Children and the University of Toronto
Helen M Branson, Diagnostic Imaging, The Hospital for Sick Children and the University of Toronto
M Mallar Chakravarty, Cerebral Imaging Centre Douglas Mental Health Research Institute, Verdun & Department of Psychiatry and Biological and Biomedical Engineering McGill University, Montreal
Kenneth J Poskitt, Department of Pediatrics University of British Columbia, and BC Children's Hospital Research Institute, Vancouver, Canada
Anne Synnes, Department of Pediatrics University of British Columbia, and BC Children's Hospital Research Institute, Vancouver, Canada
Ruth E Grunau, Department of Pediatrics University of British Columbia, and BC Children's Hospital Research Institute, Vancouver, Canada
Steven P Miller, Neurosciences and Mental Health, The Hospital for Sick Children Research Institute & Departments of Paediatrics, The Hospital for Sick Children and the University of Toronto

Document Type

Article

Publication Date

2-14-2017

Journal

Neurology

Volume

88

Issue

7

First Page

614

Last Page

622

URL with Digital Object Identifier

10.1212/WNL.0000000000003606

Abstract

OBJECTIVE: To quantitatively assess white matter injury (WMI) volume and location in very preterm neonates, and to examine the association of lesion volume and location with 18-month neurodevelopmental outcomes.

METHODS: Volume and location of WMI was quantified on MRI in 216 neonates (median gestational age 27.9 weeks) who had motor, cognitive, and language assessments at 18 months corrected age (CA). Neonates were scanned at 32.1 postmenstrual weeks (median) and 68 (31.5%) had WMI; of 66 survivors, 58 (87.9%) had MRI and 18-month outcomes. WMI was manually segmented and transformed into a common image space, accounting for intersubject anatomical variability. Probability maps describing the likelihood of a lesion predicting adverse 18-month outcomes were developed.

RESULTS: WMI occurs in a characteristic topology, with most lesions occurring in the periventricular central region, followed by posterior and frontal regions. Irrespective of lesion location, greater WMI volumes predicted poor motor outcomes (

CONCLUSIONS: The predictive value of frontal lobe WMI volume highlights the importance of lesion location when considering the neurodevelopmental significance of WMI. Frontal lobe lesions are of particular concern.