Corticospinal Tract Injury Precedes Thalamic Volume Reduction in Preterm Infants with Cystic Periventricular Leukomalacia

• Published in: The Journal of pediatrics Vol. 167; no. 2; pp. 260 - 268.e3
• Main Authors: Kersbergen, Karina J., MD, de Vries, Linda S., MD, PhD, Groenendaal, Floris, MD, PhD, van Haastert, Ingrid C., MA, PhD, Chew, Andrew T.M., MD, Makropoulos, Antonios, PhD, Dawson, Sarah L., BA, MBBS, Cowan, Frances M., PhD, MRCPCH, Benders, Manon J.N.L., MD, PhD, Counsell, Serena J., PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-08-2015; Mosby
• Subjects: Anisotropy; Diffusion Tensor Imaging - methods; Female; Gestational Age; Humans; Infant, Newborn; Infant, Premature; Leukomalacia, Periventricular - pathology; Magnetic Resonance Imaging - methods; Male; Original; Pediatrics; Pyramidal Tracts - pathology; Retrospective Studies; Thalamus - pathology; Cerebral palsy; Mean diffusivity; Radial diffusivity; MRI; PVL; Gross motor function classification system; Gestational age; AUC; c-PVL; Postmenstrual age; NPV; Area under the curve; MD; PPV; Corticospinal tract; GA; GMFCS; Cystic periventricular leukomalacia; Term equivalent age; AD; CST; PMA; Total brain volume; Negative predictive value; TBV; CP; Repetition time; Diffusion tensor imaging; Axial diffusivity; TE; TEA; RD; PLIC; Magnetic resonance imaging; Posterior limb of the internal capsule; Periventricular leukomalacia; DTI; Fractional anisotropy; Echo time; Positive predictive value; FA; TR
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/j.jpeds.2015.05.013

Objectives To measure both fractional anisotropy (FA) values in the corticospinal tracts (CSTs) and volume of the thalami in preterm infants with cystic periventricular leukomalacia (c-PVL) and to compare these measurements with control infants. Study design Preterm infants with c-PVL and controls with magnetic resonance imaging data acquired between birth and term equivalent age (TEA) were retrospectively identified in 2 centers. Tractography of the CST and segmentation of the thalamus were performed, and values from infants with c-PVL and controls were compared. Results Thirty-three subjects with c-PVL and 31 preterm controls were identified. All had at least 1 scan up to TEA, and multiple scans were performed in 31 infants. A significant difference in FA values of the CST was found between cases and controls on the scans both before and at TEA. Absolute thalamic volumes were significantly reduced at TEA but not on the earlier scans. Data acquired in infancy showed lower FA values in infants with c-PVL. Conclusions Damage to the CST can be identified on the early scan and persists, whereas the changes in thalamic volume develop in the weeks between the early and term equivalent magnetic resonance imaging. This may reflect the difference between acute and remote effects of the extensive injury to the white matter caused by c-PVL.