Abstract
BACKGROUND AND PURPOSE: Early disturbances in systemic and cerebral hemodynamics are thought to mediate prematurity-related brain injury. However, the extent to which CBF is perturbed by preterm birth is unknown. Our aim was to compare global and regional CBF in preterm infants with and without brain injury on conventional MR imaging using arterial spin-labeling during the third trimester of ex utero life and to examine the relationship between clinical risk factors and CBF.
MATERIALS AND METHODS: We prospectively enrolled preterm infants younger than 32 weeks' gestational age and <1500 g and performed arterial spin-labeling MR imaging studies. Global and regional CBF in the cerebral cortex, thalami, pons, and cerebellum was quantified. Preterm infants were stratified into those with and without structural brain injury. We further categorized preterm infants by brain injury severity: moderate-severe and mild.
RESULTS: We studied 78 preterm infants: 31 without brain injury and 47 with brain injury (29 with mild and 18 with moderate-severe injury). Global CBF showed a borderline significant increase with increasing gestational age at birth (P = .05) and trended lower in preterm infants with brain injury (P = .07). Similarly, regional CBF was significantly lower in the right thalamus and midpons (P < .05) and trended lower in the midtemporal, left thalamus, and anterior vermis regions (P < .1) in preterm infants with brain injury. Regional CBF in preterm infants with moderate-severe brain injury trended lower in the midpons, right cerebellar hemisphere, and dentate nuclei compared with mild brain injury (P < .1). In addition, a significant, lower regional CBF was associated with ventilation, sepsis, and cesarean delivery (P < .05).
CONCLUSIONS: We report early disturbances in global and regional CBF in preterm infants following brain injury. Regional cerebral perfusion alterations were evident in the thalamus and pons, suggesting regional vulnerability of the developing cerebro-cerebellar circuitry.
ABBREVIATIONS:
- ASL
- arterial spin-labeling
- BI
- brain injury
- DLPF
- dorsolateral prefrontal
- GA
- gestational age
- IO
- inferior occipital
- MT
- midtemporal
- PM
- premotor
- PO
- parieto-occipital
- PT
- preterm
- T1b
- blood longitudinal relaxation time
Footnotes
Disclosures: Marni B. Jacobs—RELATED: Grant: National Institutes of Health, Comments: work supported by the Clinical and Translational Science Institute Center Grant awarded to Children's National as part of the Biostatistics, Epidemiology, and Research Design Core*; UNRELATED: Consultancy: PATH, Inova Children's Hospital, Comments: consulting fees paid for scientific merit review (PATH) and statistical analysis (Inova); Grants/Grants Pending: Jain Foundation, ATyr Pharma, Department of Defense, Comments: biostatistician on grants related to neuromuscular disorders*; Travel/Accommodations/Meeting Expenses Unrelated to Activities Listed: Treat-NMD, Comments: Travel paid for scientific review panel for neuromuscular grant submissions. Catherine Limperopoulos—RELATED: Grant: National Institutes of Health RO1HL116585–01, Canadian Institutes of Health Research MOP-81116.* *Money paid to the institution.
This work was supported by the Canadian Institutes of Health Research (MOP-81116) and the National Institutes of Health (R01 HL116585-01).
Paper previously presented, in part, orally at: Annual Meeting of the Radiological Society of North America, November 22–December 2, 2016; Chicago, Illinois. A fellow research award was granted.
- © 2018 by American Journal of Neuroradiology
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