Guo Ting, Duerden Emma G, Adams Elysia, Chau Vann, Branson Helen M, Chakravarty M Mallar, Poskitt Kenneth J, Synnes Anne, Grunau Ruth E, Miller Steven P
From Neurosciences and Mental Health (T.G., E.G.D., V.C., S.P.M.), The Hospital for Sick Children Research Institute; Departments of Paediatrics (T.G., E.G.D., E.A., V.C., S.P.M.) and Diagnostic Imaging (H.M.B.), The Hospital for Sick Children and the University of Toronto; Cerebral Imaging Centre (M.M.C.), Douglas Mental Health Research Institute, Verdun; Department of Psychiatry (M.M.C.) and Biological and Biomedical Engineering (M.M.C.), McGill University, Montreal; and Department of Pediatrics (K.J.P., A.S., R.E.G.), University of British Columbia, and BC Children's Hospital Research Institute, Vancouver, Canada.
Neurology. 2017 Feb 14;88(7):614-622. doi: 10.1212/WNL.0000000000003606. Epub 2017 Jan 18.
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.
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.
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 ( = 0.001). Lobar regional analysis revealed that greater WMI volumes in frontal, parietal, and temporal lobes have adverse motor outcomes (all, < 0.05), but only frontal WMI volumes predicted adverse cognitive outcomes ( = 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.
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.
定量评估极早产儿的白质损伤（WMI）体积和位置，并研究损伤体积和位置与18个月神经发育结局的关联。
对216例新生儿（中位胎龄27.9周）进行MRI检查，以量化WMI的体积和位置，这些新生儿在18个月矫正年龄（CA）时进行了运动、认知和语言评估。新生儿在月经龄32.1周（中位）时进行扫描，68例（31.5%）有WMI；66例幸存者中，58例（87.9%）有MRI和18个月结局。WMI通过手动分割并转换到一个通用图像空间，以考虑个体间的解剖变异。绘制了描述病变预测18个月不良结局可能性的概率图。
WMI以特征性拓扑结构出现，大多数病变发生在脑室周围中央区域，其次是后部和额叶区域。无论病变位置如何，更大的WMI体积预示着运动结局较差（P = 0.001）。脑叶区域分析显示，额叶、顶叶和颞叶中更大的WMI体积有不良运动结局（均P < 0.05），但只有额叶WMI体积预示着不良认知结局（P = 0.002）。为了考虑病变位置和体积，逐体素比值比（OR）图显示，额叶病变预示着不良认知和语言发育，最大比值比分别为78.9和17.5，而广泛损伤预示着不良运动结局，最大OR为63.8。
额叶WMI体积的预测价值突出了在考虑WMI的神经发育意义时病变位置的重要性。额叶病变尤其值得关注。
