Skranes J, Vangberg T R, Kulseng S, Indredavik M S, Evensen K A I, Martinussen M, Dale A M, Haraldseth O, Brubakk A-M
Department of Laboratory Medicine, Children's and Women's Health, Medical Faculty, Norwegian University of Science and Technology, Trondheim, Norway.
Brain. 2007 Mar;130(Pt 3):654-66. doi: 10.1093/brain/awm001.
Very low birth weight (VLBW) children are at high risk of perinatal white matter injury, which, when subtle, may not be seen using conventional magnetic resonance imaging. The relationship between clinical findings and fractional anisotropy (FA) measurements in white matter of adolescents born prematurely with VLBW was studied in 34 subjects (age = 15 years, birth weight </=1500 g) and 47 age-matched controls born at term, who were examined both clinically and with diffusion tensor imaging (DTI). Perceptual and cognitive functions were evaluated by visual motor integration (VMI) with supplementary tests and sub-tests from WISC-III, motor function by movement ABC and Grooved Pegboard test and psychiatric symptoms by the schedule for affective disorders and schizophrenia for school-age children semistructured interview, the Autism Spectrum Screening Questionnaire and attention deficit hyperactivity disorder (ADHD) rating scale IV. Overall functioning was scored on the children's global assessment scale. DTI scans were performed for calculation of FA maps and areas of significant differences in mean FA values between subjects and controls were compared with their clinical data. The VLBW children had reduced FA values in the internal and external capsule, corpus callosum and superior, middle superior and inferior fasciculus. Within this group of children, visual motor and visual perceptual deficits were associated with low FA values in the external capsule, posterior part of the internal capsule and in the inferior fasciculus. Children with low IQ had low FA values in the external capsule and inferior and middle superior fasciculus. Fine motor impairment was related to low FA values in the internal and external capsule and superior fasciculus. Eight VLBW children with inattention symptoms or a diagnosis of ADHD had significantly lower FA values in several areas. Mild social deficits correlated with reduced FA values in the external capsule and superior fasciculus. We conclude that DTI was able to detect differences in FA between VLBW adolescents and controls in several white matter areas at risk of periventricular leucomalacia in VLBW newborns. Our results show that low FA values in these areas were associated with perceptual, cognitive, motor and mental health impairments. These conclusions indicate that perinatal injury of white matter tracts persist with clinical significance in adolescence.
极低出生体重（VLBW）儿童围产期白质损伤风险很高，当损伤很轻微时，使用传统磁共振成像可能无法发现。对34名极低出生体重的早产青少年（年龄 = 15岁，出生体重≤1500克）和47名足月出生的年龄匹配对照组进行了研究，对他们进行了临床检查和扩散张量成像（DTI），以研究临床发现与白质分数各向异性（FA）测量值之间的关系。通过视觉运动整合（VMI）以及韦氏儿童智力量表第三版（WISC - III）的补充测试和子测试来评估感知和认知功能，通过动作ABC和槽式钉板测试评估运动功能，通过学龄儿童情感障碍和精神分裂症半结构化访谈时间表、自闭症谱系筛查问卷和注意力缺陷多动障碍（ADHD）评定量表IV评估精神症状。根据儿童整体评估量表对整体功能进行评分。进行DTI扫描以计算FA图，并将受试者与对照组之间平均FA值的显著差异区域与其临床数据进行比较。极低出生体重儿童在内囊、外囊、胼胝体以及上纵束、中上纵束和下纵束中的FA值降低。在这组儿童中，视觉运动和视觉感知缺陷与外囊、内囊后部及下纵束中的低FA值相关。智商低的儿童在外囊、下纵束和中上纵束中的FA值较低。精细运动障碍与内囊、外囊及上纵束中的低FA值有关。八名有注意力不集中症状或被诊断为ADHD的极低出生体重儿童在几个区域的FA值明显较低。轻度社交缺陷与外囊和上纵束中FA值降低相关。我们得出结论，DTI能够检测出极低出生体重青少年与对照组在几个白质区域的FA差异，这些区域在极低出生体重新生儿中存在脑室周围白质软化风险。我们的结果表明，这些区域的低FA值与感知、认知、运动和心理健康损害有关。这些结论表明，白质束的围产期损伤在青春期持续存在且具有临床意义。
