Microstructural changes of white matter assessed with diffusional kurtosis imaging in extremely preterm infants with severe intraventricular hemorrhage

Li-Min Guo; Meng Zhao; Yue Cai; Na Li; Xiao-Quan Xu; Xuan Zhang; Jiu-Lou Zhang; Qi-Lian Xie; Si-Si Li; Xiao-Qing Chen; Shu-Dong Cui; Chao Lu

doi:10.3389/fped.2022.1054443

Microstructural changes of white matter assessed with diffusional kurtosis imaging in extremely preterm infants with severe intraventricular hemorrhage

Front Pediatr. 2022 Dec 20:10:1054443. doi: 10.3389/fped.2022.1054443. eCollection 2022.

Authors

Li-Min Guo¹, Meng Zhao², Yue Cai¹, Na Li¹, Xiao-Quan Xu², Xuan Zhang², Jiu-Lou Zhang², Qi-Lian Xie³, Si-Si Li⁴, Xiao-Qing Chen¹, Shu-Dong Cui¹, Chao Lu¹

Affiliations

¹ Department of Pediatrics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
² Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
³ Department of Critical Care Medicine, Anhui Children's Hospital, Hefei, China.
⁴ Clinical Laboratory, Children's Hospital of Zhejiang University School of Medicine, Hangzhou, China.

Abstract

Objective: Intraventricular hemorrhage (IVH) is a serious neurological complication in premature infants. This study aimed to investigate the white matter impairments and neurodevelopmental outcomes of severe IVH in extremely preterm infants with gestation age less than 28 weeks.

Methods: We retrospectively evaluated the extremely preterm infants between 2017 and 2020. Neurodevelopmental outcomes were evaluated with the Bayley Scales of Infant and Toddler Development-III at 2 years of corrected age. Diffusional kurtosis imaging (DKI) was employed to evaluate the microstructural changes in white matter tracts. Mean kurtosis (MK) and fractional anisotropy (FA) values of DKI were measured in the brain regions including posterior limbs of the internal capsule (PLIC) and the corpus callosum at term equivalent age.

Results: Of 32 extremely preterm infants with severe IVH during the follow-up period, 18 cases were identified as neurodevelopmental impairments. The delay rates of motor and language were 58.4% and 52.7%. The cases with neurodevelopmental impairments had lower MK and FA values in both bilateral PLIC and the corpus callosum. The analysis of multivariable regression models predicting motor and language outcomes at 2 years of corrected age, showed that the decreases of MK values in both PLIC and the corpus callosum at the term equivalent age contributed to a significantly increased risk of neurodevelopmental impairments (all p < 0.05). During follow-up period, obvious loss of nerve fiber bundles was observed with DKI tractography.

Conclusion: Motor and language abilities at age 2 years were associated with MK values of DKI at the term equivalent age in both PLIC and the corpus callosum of extremely preterm infants with severe IVH. The evaluation of white matter microstructural changes with MK values might provide feasible indicators of neurodevelopmental outcomes of extremely preterm infants with severe intraventricular hemorrhage.

Keywords: diffusional kurtosis imaging; extremely preterm infants; intraventricular hemorrhage; mean kurtosis; microstructural changes; white matter.