Department of Neurosurgery, University Hospital Dubrava, University of Zagreb, School of Medicine, Avenija Gojka Suska 6, HR-10000, Zagreb, Croatia.
Croatian Institute for Brain Research, Centre of Excellence for Basic, Clinical and Translational Neuroscience, University of Zagreb, School of Medicine, Zagreb, Croatia.
Clin Neuroradiol. 2021 Dec;31(4):1005-1020. doi: 10.1007/s00062-021-01017-1. Epub 2021 May 4.
White matter lesions in hypoxic-ischemic encephalopathy (HIE) are considered to be the important substrate of frequent neurological consequences in preterm infants. The aim of the study was to analyze volumes and tractographic parameters of the cortico-ponto-cerebellar axis to assess alterations in the periventricular fiber system and crossroads, corticopontine and corticospinal pathways and prospective transsynaptic changes of the cerebellum.Term infants (control), premature infants without (normotypic) and with perinatal HIE (HIE) underwent brain magnetic resonance imaging at term-equivalent age (TEA) and at 2 years. Cerebrum, cerebellum, brainstem divisions and ventrodorsal compartments volumetric analysis were performed, as well as fractional anisotropy (FA) and apparent diffusion coefficient (ADC) of corticopontine, corticospinal pathways and middle cerebellar peduncles. Amiel-Tison scale at TEA and the Hempel test at 2 years were assessed.Cerebellum, brainstem and its compartments volumes were decreased in normotypic and HIE groups at TEA, while at 2 years volumes were significantly reduced in the HIE group, accompanied by decreased volume and FA and increased ADC of corticopontine and corticospinal pathways. Negative association of the brainstem, cerebellum, mesencephalon, pons, corticopontine volumes and corticospinal pathway FA at TEA with the neurological score at 2 years. Cerebellum and pons volumes presented as potential prognostic indicators of neurological outcomes.Our findings agree that these pathways, as a part of the periventricular fiber system and crossroads, exhibit lesion-induced reaction and vulnerability in HIE. Structural differences between normotypic and HIE group at the 2 years suggest a different developmental structural plasticity.
缺氧缺血性脑病（HIE）中的白质病变被认为是早产儿频繁发生神经后果的重要基础。本研究旨在分析皮质-桥脑-小脑轴的体积和轨迹参数，以评估脑室周围纤维系统和交叉处、皮质桥脑和皮质脊髓通路的改变，以及小脑的前瞻性突触变化。足月婴儿（对照组）、无（正常型）和有围产期 HIE（HIE）的早产儿在足月龄（TEA）和 2 岁时进行脑磁共振成像。进行大脑、小脑、脑干分区和背腹室容积分析，以及皮质桥脑、皮质脊髓通路和小脑中间脑桥束的各向异性分数（FA）和表观扩散系数（ADC）。TEA 时进行 Amiel-Tison 量表评估，2 岁时进行 Hempel 测试。TEA 时，正常型和 HIE 组的小脑、脑干及其分区体积减小，而 2 岁时 HIE 组的体积明显减小，同时皮质桥脑和皮质脊髓通路的体积和 FA 降低，ADC 增加。TEA 时脑干、小脑、中脑、脑桥、皮质桥脑体积和皮质脊髓通路 FA 与 2 岁时神经评分呈负相关。TEA 时小脑和脑桥体积与 2 岁时的神经评分呈负相关，表明其为神经预后的潜在预测指标。我们的研究结果表明，这些通路作为脑室周围纤维系统和交叉处的一部分，在 HIE 中表现出损伤诱导的反应和易损性。正常型和 HIE 组在 2 岁时的结构差异表明了不同的发育结构可塑性。
