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美国卫生研究院文献>NeuroImage : Clinical
>Neonatal physiological correlates of near-term brain development on MRI and DTI in very-low-birth-weight preterm infants
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Neonatal physiological correlates of near-term brain development on MRI and DTI in very-low-birth-weight preterm infants
Structural brain abnormalities identified at near-term age have been recognized as potential predictors of neurodevelopment in children born preterm. The aim of this study was to examine the relationship between neonatal physiological risk factors and early brain structure in very-low-birth-weight (VLBW) preterm infants using structural MRI and diffusion tensor imaging (DTI) at near-term age.Structural brain MRI, diffusion-weighted scans, and neonatal physiological risk factors were analyzed in a cross-sectional sample of 102 VLBW preterm infants (BW ≤ 1500 g, gestational age (GA) ≤ 32 weeks), who were admitted to the Lucile Packard Children's Hospital, Stanford NICU and recruited to participate prior to routine near-term brain MRI conducted at 36.6 ± 1.8 weeks postmenstrual age (PMA) from 2010 to 2011; 66/102 also underwent a diffusion-weighted scan. Brain abnormalities were assessed qualitatively on structural MRI, and white matter (WM) microstructure was analyzed quantitatively on DTI in six subcortical regions defined by DiffeoMap neonatal brain atlas. Specific regions of interest included the genu and splenium of the corpus callosum, anterior and posterior limbs of the internal capsule, the thalamus, and the globus pallidus. Regional fractional anisotropy (FA) and mean diffusivity (MD) were calculated using DTI data and examined in relation to neonatal physiological risk factors including gestational age (GA), bronchopulmonary dysplasia (BPD), necrotizing enterocolitis (NEC), retinopathy of prematurity (ROP), and sepsis, as well as serum levels of C-reactive protein (CRP), glucose, albumin, and total bilirubin.Brain abnormalities were observed on structural MRI in 38/102 infants including 35% of females and 40% of males. Infants with brain abnormalities observed on MRI had higher incidence of BPD (42% vs. 25%) and sepsis (21% vs. 6%) and higher mean and peak serum CRP levels, respectively, (0.64 vs. 0.34 mg/dL, p = .008; 1.57 vs. 0.67 mg/dL, p= .006) compared to those without. The number of signal abnormalities observed on structural MRI correlated to mean and peak CRP (rho = .316, p = .002; rho = .318, p= .002). The number of signal abnormalities observed on MRI correlated with thalamus MD (left: r= .382, p= .002; right: r= .400, p= .001), controlling for PMA-at-scan. Thalamus WM microstructure demonstrated the strongest associations with neonatal risk factors. Higher thalamus MD on the left and right, respectively, was associated with lower GA (r = −.322, p = .009; r= −.381, p= .002), lower mean albumin (r = −.276, p= .029; r= −.385, p= .002), and lower mean bilirubin (r = −.293, p= .020; r= −.337 p= .007).Results suggest that at near-term age, thalamus WM microstructure may be particularly vulnerable to certain neonatal risk factors. Interactions between albumin, bilirubin, phototherapy, and brain development warrant further investigation. Identification of physiological risk factors associated with selective vulnerability of certain brain regions at near-term age may clarify the etiology of neurodevelopmental impairment and inform neuroprotective treatment for VLBW preterm infants.
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机译：在早产儿发现的结构性脑异常已被认为是早产儿神经发育的潜在预测因子。这项研究的目的是通过结构性MRI和弥散张量成像（DTI）在近期年龄检查极低出生体重（VLBW）早产儿的新生儿生理危险因素与早期大脑结构之间的关系。在102位VLBW早产儿（BW≤1500 g，胎龄（GA）≤32周）的横断面样本中对MRI，扩散加权扫描和新生儿生理危险因素进行了分析，这些患者已入Lucile Packard儿童医院，斯坦福大学新生儿重症监护病房（UCU），并被招募参加从2010年至2011年经期后36.6±1.8周的常规近期脑部MRI检查； 66/102也进行了扩散加权扫描。在结构MRI上定性评估了脑部异常，并在DiffioMap新生儿脑图谱所定义的六个皮层下区域中的DTI上对白质（WM）显微结构进行了定量分析。感兴趣的特定区域包括call体的属和脾，内囊的前肢和后肢，丘脑和苍白球。使用DTI数据计算区域分数各向异性（FA）和平均扩散率（MD），并与包括胎龄（GA），支气管肺发育不良（BPD），坏死性小肠结肠炎（NEC），早产儿视网膜病变（ROP）在内的新生儿生理危险因素进行检查），败血症以及血清C反应蛋白（CRP），葡萄糖，白蛋白和总胆红素水平.38 / 102例婴儿的结构MRI出现脑异常，其中35％的女性和40％的男性。 MRI观察到的脑异常婴儿的BPD发生率较高（42％比25％）和败血症（21％比6％）且血清CRP水平分别为平均值和峰值（0.64 vs. 0.34 mg / dL， p = .008; 1.57 vs.0.67 mg / dL，p = .006）。在结构MRI上观察到的信号异常数量与平均CRP和峰值CRP相关（rho = .316，p = .002; rho = .318，p = .002）。在MRI上观察到的信号异常数量与丘脑MD相关（左：r = .382，p = .002;右：r = .400，p = .001），控制扫描时PMA。 Thalamus WM的微观结构显示出与新生儿危险因素之间最强的关联。左侧和右侧的丘脑MD较高分别与较低的GA（r = -.322，p = .009; r = -.381，p = .002），平均白蛋白较低（r = -.276， p = .029; r =-。385，p = .002），较低的平均胆红素（ r =-.. 293， p =。020; r = −。337 p =。007）。结果表明，在近期年龄，丘脑WM的微结构可能特别容易受到某些新生儿危险因素的影响。白蛋白，胆红素，光疗和大脑发育之间的相互作用值得进一步研究。识别与某些年龄段的某些大脑区域在近期年龄的选择性脆弱性相关的生理风险因素可能会澄清神经发育障碍的病因，并为VLBW早产儿提供神经保护性治疗。
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