Proper timing for the evaluation of neonatal brain white matter development: a diffusion tensor imaging study
Proper timing for the evaluation of neonatal brain white matter development: a diffusion tensor imaging study
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评估新生儿脑白质的适当时机：弥散张量成像研究
DOI：
10.1007/s00330-018-5665-y
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发表时间：
2019-03-01
影响因子：
5.9
通讯作者：
Yang, Jian
中科院分区：
文献类型：
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作者：
Jin, Chao;Li, Yanyan;Yang, Jian
我们的目的是确定评估出生状态的发育中的大脑（即出生时的大脑成熟度）的时机，通过探索出生后的年龄相关的变化，新生儿脑白色物质（WM）。133例新生儿（胎龄，30-42周）没有异常的MRI进行了研究，关于WM的发展扩散张量成像衍生的分数各向异性（FA）。采用基于道的空间统计（TBSS）、局部加权散点图平滑（LOESS）和分段线性拟合等方法研究FA与出生后年龄的关系。皮质脊髓束（CST）、视辐射（OR）、听辐射（AR）和丘脑-初级躯体感觉皮层的FA沿着（thal-PSC）通过自动纤维束定量提取;通过Wilcoxon秩和检验和Pearson相关性分析了它们的差异以及与不同出生后年龄段新生儿神经行为评分的相关性。出生后1-28天的胎龄与CST、OR、AR和thal-PSC等多种WM的FA呈正相关（p<0.05）。另一方面，当将出生后年龄窗口缩小到1-14天时，未发现显著相关性，表明WM发展为双相。LOESS和分段线性拟合表明，FA在第14天之前略有增加，此后加速增长。FA和与出生后年龄范围2的神经行为评分的相关性（第15-28天）显着高于范围1（第1-14天）（FA比较：p<0.05;最大相关系数：结论新生儿期脑WM的发育包括两个阶段，即前14天内的接近出生期和随后的加速成熟期。因此，最好在第一个时期进行出生状态的评估。关键点·出生后前两周内的脑白色物质发育类似于接近出生的成熟。·出生后两周后，视听和感觉运动区域的大脑白色物质发育加速。·在比较早产儿和足月新生儿时，应考虑出生后年龄相关的影响。
ObjectiveWe aimed to determine the timing for assessing birth status of the developing brain (i.e. brain maturity at birth) by exploring the postnatal age-related changes in neonatal brain white matter (WM).MethodsThe institutional review board approved this study and all informed parental consents were obtained. 133 neonates (gestational age, 30–42 weeks) without abnormalities on MRI were studied with regard to WM development by diffusion tensor imaging-derived fractional anisotropy (FA). Tract-based spatial statistics (TBSS), locally-weighted scatterplot smoothing (LOESS) and piecewise linear-fitting were used to investigate the relationship between FA and postnatal age. FA along corticospinal tract (CST), optic radiation (OR), auditory radiation (AR) and thalamus-primary somatosensory cortex (thal-PSC) were extracted by automated fibre-tract quantification; their differences and associations with neonatal neurobehavioural scores at various postnatal age ranges were analysed by Wilcoxon’s rank-sum test and Pearson’s correlation.ResultsUsing TBSS, postnatal age (days 1–28) positively correlated with FA in multiple WMs, including CST, OR, AR and thal-PSC (p<0.05). On the other hand, when narrowing the postnatal age window to days 1–14, no significant correlation was found, suggesting a biphasic WM development. LOESS and piecewise linear-fitting indicated that FA increased mildly before day 14 and its growth accelerated thereafter. Both FA and correlations with neurobehavioural scores in postnatal age range 2 (days 15–28) were significantly higher than in range 1 (days 1–14) (FA comparison:p<0.05; maximal correlation-coefficient: 0.693 vs. 0.169).ConclusionBrain WM development during the neonatal stage includes two phases, i.e. a close-to-birth period within the first 14 days and a following accelerated maturation period. Therefore, evaluations of birth status should preferably be performed during the first period.Key Points• Brain white matter development within the first two postnatal weeks resembles a close-to-birth maturation.• Brain white matter development in the audio-visual, sensorimotor regions accelerates after two postnatal weeks.• Postnatal age-related effects should be considered in comparing preterm and term neonates.