Quantitative assessment of white matter injury in preterm neonates
Quantitative assessment of white matter injury in preterm neonates
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DOI：
10.1212/wnl.0000000000003606
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发表时间：
2017-02-14
期刊：
影响因子：
9.9
通讯作者：
Miller, Steven P.
中科院分区：
文献类型：
--
作者：
Guo, Ting;Duerden, Emma G.;Miller, Steven P.
目的：为了定量评估白色损伤（白质损伤）的体积和位置在非常早产儿，并检查病变体积和位置与18个月的neurodevelopmental outcomes.Methods的关联：体积和位置的白质损伤进行了量化的MRI在216名新生儿（中位胎龄27.9周）谁在18个月的校正年龄（CA）的运动，认知和语言评估。新生儿在月经后32.1周（中位数）进行扫描，68例（31.5%）有MRI; 66例存活者中，58例（87.9%）有MRI和18个月的结局。人工分割血管并将其转换为常见的图像空间，考虑受试者间的解剖变异性。概率图描述的病变预测不良18个月outcomes developed.Results的可能性发生在一个特征的拓扑结构，大多数病变发生在脑室周围的中心区域，其次是后部和额叶区域。无论病变位置如何，更大的脊髓体积预测运动结果较差（p = 0.001）。脑叶区域分析显示，额叶、顶叶和颞叶的额叶体积越大，运动结果越差（所有，p < 0.05），但只有额叶体积越大，认知结果越差（p = 0.002）。考虑到病变的位置和体积，体素优势比（OR）图显示额叶病变预测不良认知和语言发育，最大优势比（OR）分别为78.9和17.5，而广泛损伤预测不良运动结果，最大OR为63.8。结论：当考虑到额叶白质体积的神经发育意义时，额叶白质体积的预测价值突出了病变位置的重要性。额叶病变尤其值得关注。
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 (p = 0.001). Lobar regional analysis revealed that greater WMI volumes in frontal, parietal, and temporal lobes have adverse motor outcomes (all, p < 0.05), but only frontal WMI volumes predicted adverse cognitive outcomes (p = 0.002). To account for lesion location and volume, voxel-wise odds ratio (OR) maps demonstrate that frontal lobe lesions predict adverse cognitive and language development, with maximum odds ratios (ORs) of 78.9 and 17.5, respectively, while adverse motor outcomes are predicted by widespread injury, with maximum OR of 63.8.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.