Malova Mariya, Morelli Elena, Cardiello Valentina, Tortora Domenico, Severino Mariasavina, Calevo Maria Grazia, Parodi Alessandro, De Angelis Laura Costanza, Minghetti Diego, Rossi Andrea, Ramenghi Luca Antonio
Neonatal Intensive Care Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy.
Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy.
Front Neurol. 2021 Apr 29;12:657461. doi: 10.3389/fneur.2021.657461. eCollection 2021.
The pathogenesis of punctuate white matter lesions (PWMLs), a mild form of white matter damage observed in preterm infants, is still a matter of debate. Susceptibility-weighted imaging (SWI) allows to differentiate PWMLs based on the presence (SWI+) or absence (SWI-) of hemosiderin, but little is known about the significance of this distinction. This retrospective study aimed to compare neuroradiological and clinical characteristics of SWI+ and SWI- PWMLs. MR images of all VLBW infants scanned consecutively at term-equivalent age between April 2012 and May 2018 were retrospectively reviewed, and infants with PWMLs defined as small areas of high T1 and/or low T2 signal in the periventricular white matter were selected and included in the study. Each lesion was analyzed separately and characterized by localization, organization pattern, and distance from the lateral ventricle. Clinical data were retrieved from the department database. A total of 517 PWMLs were registered in 81 patients, with 93 lesions (18%) visible on SWI (SWI+), revealing the presence of hemosiderin deposits. On univariate analysis, compared to SWI- PWML, SWI+ lesions were closer to the ventricle wall, more frequently organized in linear pattern and associated with lower birth weight, lower gestational age, lower admission temperature, need for intubation, bronchopulmonary dysplasia, retinopathy of prematurity, and presence of GMH-IVH. On multivariate analysis, closer distance to the ventricle wall on axial scan and lower birth weight were associated with visibility of PMWLs on SWI ( = 0.003 and = 0.0001, respectively). Our results suggest a nosological difference between SWI+ and SWI- PWMLs. Other prospective studies are warranted to corroborate these observations.
点状白质病变（PWMLs）是早产儿中观察到的一种轻度白质损伤形式，其发病机制仍存在争议。磁敏感加权成像（SWI）可根据含铁血黄素的存在（SWI+）或不存在（SWI-）来区分PWMLs，但关于这种区分的意义知之甚少。这项回顾性研究旨在比较SWI+和SWI- PWMLs的神经放射学和临床特征。对2012年4月至2018年5月间在足月等效年龄连续扫描的所有极低出生体重儿的磁共振图像进行回顾性分析，选择脑室周围白质中存在小面积高T1和/或低T2信号的PWMLs患儿纳入研究。对每个病变进行单独分析，并根据其定位、组织模式和距侧脑室的距离进行特征描述。临床数据从科室数据库中检索。81例患者共记录了517个PWMLs，其中93个病变（18%）在SWI上可见（SWI+），显示存在含铁血黄素沉积。单因素分析显示，与SWI- PWML相比，SWI+病变更靠近脑室壁，更常呈线性排列，且与较低的出生体重、较低的胎龄、较低的入院体温、插管需求、支气管肺发育不良、早产儿视网膜病变和脑室内出血-IV级有关。多因素分析显示，轴位扫描时距脑室壁更近和出生体重较低与SWI上PWMLs的可见性相关（分别为 = 0.003和 = 0.0001）。我们的结果表明SWI+和SWI- PWMLs之间存在病种学差异。需要其他前瞻性研究来证实这些观察结果。
