Impact of Prematurity on the Tissue Properties of the Neonatal Brain Stem: A Quantitative MR Approach

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FIG 1.
ROI placement is shown on an SyMRI-generated T1-weighted MR image (TR/TE = 650/10 ms) of a term-born neonate (GA: 40 + 1 weeks). A, Midbrain. B.i, Pons (basis pontis and tegmentum pontis included). B.ii, Basis pontis (tegmentum pontis excluded). B.iii, Tegmentum pontis (basis pontis excluded). C, Medulla oblongata.
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FIG 2.
Pearson correlation between GA (weeks) at birth (x-axis) and physical MR parameters (y-axis) determined at term-equivalent age by rater 1. Left column: T1R (A–E). Middle column: T2R (F–J). Right column: PD (K–O).
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FIG 3.
The boxplots show descriptive data for quantitative MR parameters (y-axis) of (1) neonates born <28 + 0 weeks GA, (2) neonates born between 28 + 0–36 + 6 weeks GA, and (3) neonates born ≥37 + 0 weeks GA (x-axis) determined at term-equivalent age by rater 1. Left column: T1R (A–E). Middle column: T2R (F–J). Right column: PD (K–O).

Table 1:

Clinical characteristics and demographics

	Neonates: n = 55
	Extremely Preterm Birth (<28 + 0 weeks GA): n = 30	Preterm Birth (28 + 0–36 + 6 weeks GA): n = 10	Term Born (≥37 + 0 weeks GA): n = 15
Clinical characteristics
Male/female	10/20	5/5	6/9
GA at birth^{^a}	M = 25 + 5, SD = 1 + 4;R = 23 + 0–27 + 6	M = 32 + 4, SD = 3 + 1; R = 28 + 0–36 + 3	M = 39 + 5, SD = 0 + 6; R = 37 + 6–40 + 5
GA at MR imaging^{^a}	M = 38 + 2, SD = 2 + 0;R = 35 + 1–43 + 4	M = 39 + 0, SD = 6 + 1; R = 33 + 4–54 + 5	M = 41 + 5, SD = 2 + 1; R = 39 + 0–45 + 3
Clinical diagnosis
Without pathologic findings^{^b}	n = 15	n = 4	n = 5
Hemorrhage^{^b}^,^{^c}	n = 10^{^d}	n = 3^{^e}	n = 3^{^f}
Cystic PVL^{^b}	n = 2
Expired infarction^{^b}	n = 1	n = 1	n = 1
Blake pouch^{^b}	n = 1
Venous vessel malformation^{^b}	n = 1	n = 1
Intraventricular arachnoid cyst^{^b}		n = 1
HIE^{^b}			n = 4
Cephalohematoma^{^b}			n = 1
Hygroma^{^b}			n = 1

Note:—HIE indicates hypoxic-ischemic encephalopathy; PVL, periventricular leukomalacia.
↵a Data represented as mean (M), standard deviation (SD), and range (R).
↵b Data represented as total number.
↵c Including hyperacute, acute, subacute, and chronic intraventricular, cortical, subcortical, parenchymal, subarachnoid, and subdural hemorrhage.
↵d Grade III/IV intracranial hemorrhage (according to Deeg et al⁴³) in 1 of 10.
↵e Grade III/IV intracranial hemorrhage (according to Deeg et al⁴³) in 2 of 3.
↵f Grade III/IV intracranial hemorrhage (according to Deeg et al⁴³) in 1 of 3.

Table 2:

Bonferroni post hoc test results

ROI	Group vs Group		Significance	Differences: Mean vs Mean^{^a}
ROI	Group vs Group		Significance	Absolute^{^b}	Relative (%)^{^c}
Midbrain T1 relaxation time (ms)	Extremely preterm	Preterm	P < .001	84.4	6.3
	Extremely preterm	Term born	P < .001	182.1	13.7
	Preterm	Term born	P < .001	97.7	7.8
Pons T1 relaxation time (ms)	Extremely preterm	Preterm	P = .241	43.7	3
	Extremely preterm	Term born	P < .001	124.1	8.7
	Preterm	Term born	P = .02	80.4	5.8
Basis pontis T1 relaxation time (ms)	Extremely preterm	Preterm	P = 1	27.9	1.8
	Extremely preterm	Term born	P = .004	97.9	6.5
	Preterm	Term born	P = .147	70	4.7
Tegmentum pontis T1 relaxation time (ms)	Extremely preterm	Preterm	P = .051	54.7	4.2
	Extremely preterm	Term born	P < .001	181.4	13.8
	Preterm	Term born	P < .001	126.7	10.1
Medulla oblongata T1 relaxation time (ms)	Extremely preterm	Preterm	P = .334	24.5	2
	Extremely preterm	Term born	P < .001	130.9	10.6
	Preterm	Term born	P < .001	106.4	8.8
Midbrain T2 relaxation time (ms)	Extremely preterm	Preterm	P = .02	4.3	3.1
	Extremely preterm	Term born	P < .001	10.2	7.3
	Preterm	Term born	P = .006	5.9	4.4
Tegmentum pontis T2 relaxation time (ms)	Extremely preterm	Preterm	P = 1	1.1	0.8
	Extremely preterm	Term born	P < .001	8.4	6.3
	Preterm	Term born	P = .009	7.3	5.5
Tegmentum pontis PD (%)	Extremely preterm	Preterm	P = 1	0.1	0.1
	Extremely preterm	Term born	P = .004	1	1.2
	Preterm	Term born	P = .026	0.9	1