Lin Shiwei, Lin Xiaoshan, Liang Qunjun, Chen Shengli, Zhang Yanyu, Li Ying, Dong Tianfa, Qiu Yingwei
Department of Radiology, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, China.
Department of Radiology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China.
J Magn Reson Imaging. 2025 Apr;61(4):1761-1769. doi: 10.1002/jmri.29615. Epub 2024 Sep 20.
Birth asphyxia (BA) and germinal matrix hemorrhage-intraventricular hemorrhage (GMH-IVH) are common clinical events in preterm neonates. However, their effects on the glymphatic system (GS) development in preterm neonates remain arcane.
To evaluate the developmental trajectory of the GS, and to investigate the effects of BA and GMH-IVH on GS function in preterm neonates.
Prospective.
Two independent datasets, prospectively acquired internal dataset (including 99 preterm neonates, 40 female, mean [standard deviation] gestational age (GA) at birth, 29.95 [2.63] weeks) and the developing Human Connectome Project (dHCP) dataset (including 81 preterm neonates, 29 female, median [interquartile range] GA at birth, 32.71 [4.28] weeks).
FIELD STRENGTH/SEQUENCE: 3.0 T MRI and diffusion-weighted spin-echo planar imaging sequence.
The diffusion-weighted images were preprocessed in volumetric space using the FMRIB Software Library and diffusion along the perivascular space (DTI-ALPS) index was accessed to evaluate GS function.
Two sample t tests, one-way analysis of variance followed by least-significant difference (LSD) post hoc analysis, chi-squared tests, and Pearson's correlation analysis. Significance level: P < 0.05.
In prospectively acquired internal dataset, preterm neonates with BA exhibited a significant lower DTI-ALPS index than those without BA (0.98 ± 0.08 vs. 1.08 ± 0.07, T = -5.89); however, GMH-IVH did not exert significant influences on the DTI-ALPS index (P = 0.83 and 0.27). The DTI-ALPS index increased significantly at postmenstrual age ranging from 25 to 34 weeks (r = 0.38) and then plateaued after 34 weeks (P = 0.35), which we also observed in the dHCP dataset.
BA rather than GMH-IVH serves as the major influencing factor in the development of GS in preterm neonates. Moreover, as GS development follows a nonlinear trajectory, we recommend close monitoring of GS development in preterm neonates with a GA less than 34 weeks.
2 TECHNICAL EFFICACY: Stage 2.
出生窒息（BA）和生发基质出血-脑室内出血（GMH-IVH）是早产儿常见的临床事件。然而，它们对早产儿淋巴系统（GS）发育的影响仍不清楚。
评估GS的发育轨迹，并研究BA和GMH-IVH对早产儿GS功能的影响。
前瞻性研究。
两个独立数据集，前瞻性获取的内部数据集（包括99例早产儿，40例女性，出生时平均[标准差]胎龄（GA）为29.95[2.63]周）和人类连接组计划发育中数据集（dHCP，包括81例早产儿，29例女性，出生时中位数[四分位间距]GA为32.71[4.28]周）。
场强/序列：3.0 T MRI和扩散加权自旋回波平面成像序列。
使用FMRIB软件库在容积空间中对扩散加权图像进行预处理，并获取沿血管周围间隙扩散（DTI-ALPS）指数以评估GS功能。
两样本t检验、单因素方差分析及最小显著差异（LSD）事后分析、卡方检验和Pearson相关分析。显著性水平：P < 0.05。
在前瞻性获取的内部数据集中，患有BA的早产儿的DTI-ALPS指数显著低于未患BA的早产儿（0.98±0.08 vs. 1.08±0.07，T = -5.89）；然而，GMH-IVH对DTI-ALPS指数没有显著影响（P = 0.83和0.27）。在月经后年龄25至34周时，DTI-ALPS指数显著增加（r = 0.38），34周后趋于平稳（P = 0.35），这在dHCP数据集中也有观察到。
BA而非GMH-IVH是早产儿GS发育的主要影响因素。此外，由于GS发育遵循非线性轨迹，我们建议密切监测胎龄小于34周的早产儿的GS发育情况。
2 技术效能：2级
