基于体素的空间统计学方法在早产儿中可预测18个月时的认知和运动结局。
Tract-Based Spatial Statistics in Preterm-Born Neonates Predicts Cognitive and Motor Outcomes at 18 Months.
作者信息
Duerden E G, Foong J, Chau V, Branson H, Poskitt K J, Grunau R E, Synnes A, Zwicker J G, Miller S P
机构信息
From the Department of Paediatrics (E.G.D., J.F., V.C., H.B., S.P.M.), Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada.
Department of Pediatrics (V.C., K.J.P., R.E.G., A.S., J.G.Z., S.P.M.), University of British Columbia, BC Children's and Women's Hospitals, Child and Family Research Institute, Vancouver, British Columbia, Canada.
出版信息
AJNR Am J Neuroradiol. 2015 Aug;36(8):1565-71. doi: 10.3174/ajnr.A4312. Epub 2015 Apr 30.
BACKGROUND AND PURPOSE
Adverse neurodevelopmental outcome is common in children born preterm. Early sensitive predictors of neurodevelopmental outcome such as MR imaging are needed. Tract-based spatial statistics, a diffusion MR imaging analysis method, performed at term-equivalent age (40 weeks) is a promising predictor of neurodevelopmental outcomes in children born very preterm. We sought to determine the association of tract-based spatial statistics findings before term-equivalent age with neurodevelopmental outcome at 18-months corrected age.
MATERIALS AND METHODS
Of 180 neonates (born at 24-32-weeks' gestation) enrolled, 153 had DTI acquired early at 32 weeks' postmenstrual age and 105 had DTI acquired later at 39.6 weeks' postmenstrual age. Voxelwise statistics were calculated by performing tract-based spatial statistics on DTI that was aligned to age-appropriate templates. At 18-month corrected age, 166 neonates underwent neurodevelopmental assessment by using the Bayley Scales of Infant Development, 3rd ed, and the Peabody Developmental Motor Scales, 2nd ed.
RESULTS
Tract-based spatial statistics analysis applied to early-acquired scans (postmenstrual age of 30-33 weeks) indicated a limited significant positive association between motor skills and axial diffusivity and radial diffusivity values in the corpus callosum, internal and external/extreme capsules, and midbrain (P < .05, corrected). In contrast, for term scans (postmenstrual age of 37-41 weeks), tract-based spatial statistics analysis showed a significant relationship between both motor and cognitive scores with fractional anisotropy in the corpus callosum and corticospinal tracts (P < .05, corrected). Tract-based spatial statistics in a limited subset of neonates (n = 22) scanned at <30 weeks did not significantly predict neurodevelopmental outcomes.
CONCLUSIONS
The strength of the association between fractional anisotropy values and neurodevelopmental outcome scores increased from early-to-late-acquired scans in preterm-born neonates, consistent with brain dysmaturation in this population.
背景与目的
早产出生的儿童中不良神经发育结局很常见。需要诸如磁共振成像（MR成像）等神经发育结局的早期敏感预测指标。基于纤维束的空间统计学是一种扩散MR成像分析方法，在足月等效年龄（40周）进行时，是极早产出生儿童神经发育结局的一种有前景的预测指标。我们试图确定在足月等效年龄之前基于纤维束的空间统计学结果与矫正年龄18个月时的神经发育结局之间的关联。
材料与方法
在纳入的180例新生儿（妊娠24 - 32周出生）中，153例在月经龄32周时早期进行了扩散张量成像（DTI）检查，105例在月经龄39.6周时较晚进行了DTI检查。通过对与年龄相适应模板配准的DTI进行基于纤维束的空间统计学计算体素统计量。在矫正年龄18个月时，166例新生儿使用贝利婴幼儿发育量表第3版和皮博迪发育运动量表第2版进行了神经发育评估。
结果
应用于早期获取扫描（月经龄30 - 33周）的基于纤维束的空间统计学分析表明，运动技能与胼胝体、内囊和外囊/极端囊以及中脑的轴向扩散率和径向扩散率值之间存在有限的显著正相关（P < 0.05，校正）。相比之下，对于足月扫描（月经龄37 - 41周），基于纤维束的空间统计学分析显示运动和认知评分与胼胝体和皮质脊髓束中的各向异性分数均存在显著关系（P < 0.05，校正）。在小于30周时扫描的有限新生儿亚组（n = 22）中，基于纤维束的空间统计学不能显著预测神经发育结局。
结论
极早产出生新生儿中，从早期获取扫描到晚期获取扫描，各向异性分数值与神经发育结局评分之间的关联强度增加，这与该人群脑发育不成熟一致。
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