弥散张量成像作为极低出生体重儿认知和语言发育的独立预测因子的作用。
Role of diffusion tensor imaging as an independent predictor of cognitive and language development in extremely low-birth-weight infants.
机构信息
From the Division of Neonatology (U.P., K.B., R.E.L., P.W.E., N.A.P.).
出版信息
AJNR Am J Neuroradiol. 2014 Apr;35(4):790-6. doi: 10.3174/ajnr.A3725. Epub 2013 Sep 19.
BACKGROUND AND PURPOSE
Diffusion tensor imaging at term can predict later development of cerebral palsy. Less is known about its ability to independently predict cognitive and language development in extremely preterm infants. The goals of the study were to investigate the following: 1) whether regional DTI measures at term-equivalent age in extremely low-birth-weight infants (birth weight, ≤1000 g) are predictive of Bayley III developmental scores at 18- to 22-months' corrected age, and 2) to compare white matter microstructural development at term and neurodevelopmental outcomes of extremely low-birth-weight infants with healthy term controls.
MATERIALS AND METHODS
Fractional anisotropy and mean diffusivity in 7 vulnerable cerebral regions were measured in 42 extremely low-birth-weight and 16 term infants with high-quality DTI scans. The Bayley mental scale score (average of cognitive and language scale scores) was the primary outcome of interest with individual scores serving as secondary outcomes. Multiple linear regression modeling was used to identify the incremental ability of DTI measures to predict Bayley scores over known predictors.
RESULTS
Compared with healthy term infants, extremely low-birth-weight infants exhibited significantly higher mean diffusivity and lower fractional anisotropy in 6 of 7 regions. At 18- to 22-months' corrected age, 39 extremely low-birth-weight infants (93%) and 14 term infants (88%) had undergone neurodevelopmental assessments. Although not statistically significant, extremely low-birth-weight infants averaged 7-9 points lower on Bayley subtests than term controls. In multivariable analyses, centrum semiovale mean diffusivity was a significant predictor of mental and language scale scores, and subventricular zone fractional anisotropy was a significant predictor of cognitive scale scores. A 10% increase in centrum semiovale mean diffusivity was associated with a 4.6 (95% CI, 1.6-7.6) point lower mental scale score (adjusted R(2) = 0.341, P = .001).
CONCLUSIONS
In our extremely low-birth-weight cohort, DTI was an independent predictor of later cognitive and language development.
背景与目的
足月时的弥散张量成像（DTI）可以预测脑瘫的后期发展。然而，关于其独立预测极早产儿认知和语言发育的能力，我们知之甚少。本研究的目的是探讨以下两个问题：1）极低出生体重儿（出生体重≤1000g）在接近足月时的各脑区 DTI 测量值是否可以预测 18-22 月龄校正年龄时的贝利 III 发育评分；2）比较极早产儿和健康足月对照组的脑白质微观结构发育与神经发育结局。
材料与方法
对 42 例极低出生体重儿和 16 例健康足月儿进行了高质量的 DTI 扫描，测量了 7 个易损脑区的各向异性分数（fractional anisotropy，FA）和平均弥散系数（mean diffusivity，MD）。贝利精神量表评分（认知和语言量表评分的平均值）是主要的观察指标，各单项评分作为次要观察指标。采用多元线性回归模型，以确定 DTI 测量值对贝利评分的预测能力是否超过已知的预测因素。
结果
与健康足月儿相比，极早产儿在 7 个脑区中的 6 个脑区的 MD 值较高，FA 值较低。在 18-22 月龄校正年龄时，39 例极低出生体重儿（93%）和 14 例足月儿（88%）接受了神经发育评估。尽管没有统计学意义，但极低出生体重儿在贝利各分项测试中的得分平均比足月对照组低 7-9 分。在多变量分析中，半卵圆中心 MD 值是精神和语言量表评分的显著预测因素，侧脑室下区 FA 值是认知量表评分的显著预测因素。半卵圆中心 MD 值增加 10%，精神量表评分降低 4.6（95%CI：1.6-7.6）分（调整 R（2）=0.341，P=0.001）。
结论
在本极低出生体重儿队列中，DTI 是后期认知和语言发育的独立预测因素。
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