Brain positron emission tomography in preterm and term newborn infants

https://doi.org/10.1016/j.earlhumdev.2009.02.002Get rights and content

Abstract

Objective

To study the clinical values of positron emission tomography (PET) in preterm and term newborn infants through observing brain glucose metabolism by 18F-fluorodeoxyglucose (18F-FDG) PET.

Method

To observe the brain 18F-FDG PET imaging in 9 term and 7 preterm newborn infants in the same condition after administration of 0.1 mCi/kg 18F-FDG.

Result

The brain 18F-FDG PET imaging showed that the uptake of 18F-FDG was relatively more in the thalamus, and less in the cerebral cortex in preterm and term newborn infants. The uptake of 18F-FDG of cerebral cortex in preterm infants was less than that in term infants, so the structure of brain 18F-FDG PET imaging was a little fainter in preterm neonates as compared with that in term newborns.

Conclusion

18F-FDG PET imaging could show different glucose metabolisms of brain in preterm and term infants. Brain 18F-FDG PET imaging might be a useful tool for estimating the brain function in newborn infants, and its clinical values need further investigation.

Introduction

Positron emission tomography PET is a noninvasive measurement of the levels of radiopharmaceuticals labeled with positron emitters. The most frequently used tracer for the assessment of tissue glucose metabolism is 18F-fluorodeoxyglucose (18F-FDG) [1]. PET has been widely used in a lot of cerebral diseases in adults. Only a few pediatric and even fewer neonatal PET studies have been presented so far. Preliminary research has suggested that PET scan might have some changes in term newborn infants with hypoxic ischemic encephalopathy [2], [3], [4]. There have been few data on PET scan in preterm infants except one research report, which studied the cerebral glucose transport and metabolism in 6 preterm infants. In addition, all the previous studies were performed in ill neonates [5]. Up to now, no report on PET scan in clinically normal newborn infants has been present, but some newborn infants, especially those preterm, suffered from some cerebral dysfunctions without any early clinical and experimental evidence [6]. Hence, it's reasonable that measurement of the cerebral metabolism by PET should be important to understand the physiology and pathophysiology of the developing brain in preterm and term infants.

Section snippets

Subjects

Sixteen neonates born on January 2004–December 2006 (male 9, female 7) were studied. According to their gestational age, there were 9 term and 7 preterm infants. The gestational age and the birth-weight were 33.5 ± 3.1 wk and 1650 ± 720 g in the preterm infants respectively, whereas 38.7 ± 1.6 wk and 2960 ± 1040 g in the term infants respectively. PET scan was applied at an average time of 8.4 ± 4.9 d after birth (from 3 to 21 d). All the neonates had no perinatal asphyxia with an Apgar score of 8–10.

Results

Table 1 showed the SUV values of the preterm and term newborn infants.

18F-FDG PET images were relatively high in thalamus, cerebellum, sensorimotor cortex and basal ganglia, whereas relatively low in cerebral cortex (frontal, parietal, and occipital regions). There were significant differences in SUV values in thalamus, cerebellum, basal ganglia, and parietal region of the cortical areas between preterm and term neonates. The brain 18F-FDG PET image of neonates was not clearly demarcated in

Discussion

PET offers a unique possibility and further insight into the various processes in the developing brain [10]. SUV provides a semiquantitative method to analyze PET data. A good relationship between the cerebral SUV and local cerebral metabolic rate of glucose in infants has been established [2], [11]. The SUV method has been shown to be affected by the blood glucose level in the analysis of 18F-FDG PET images. Nevertheless, if no blood samples are available in preterm and term infants, the

Acknowledgement

This study was supported by grants from the Natural Research Foundation of Chongqing, China (2004BB5249).

References (23)

  • W.J. Powers et al.

    Cerebral glucose transport and metabolism in preterm human infants

    J Cereb Blood Flow Metab

    (1998)
  • Cited by (22)

    • Arterial spin labeling perfusion in neonates

      2020, Seminars in Fetal and Neonatal Medicine
      Citation Excerpt :

      Positron emission tomography and xenon-enhanced computed tomography allow more accurate whole-brain perfusion evaluation. However, they require injection of contrast material and exposure to high doses of ionizing radiation, and are therefore considered unsafe for neonates [11,12]. Dynamic susceptibility-weighted perfusion MRI is a less invasive technique providing relative measurements of brain perfusion.

    • Injury and repair in perinatal brain injury: Insights from non-invasive MR perfusion imaging

      2015, Seminars in Perinatology
      Citation Excerpt :

      Thus, ASL-MRI appears to be useful for identifying a developing brain injury.19,20 Hyperperfusion has been related to “luxury perfusion,” which is thought to represent the physiologic transient reperfusion (flow restoration),25–27 most often described as exceeding the metabolic demands of the injured brain areas.10–18,21 This “neurovascular uncoupling” triggers a complex cascade of interconnected perfusion, metabolic, and molecular disturbances—such as excitotoxicity, proinflammatory cascades, and oxidative injury—which lead to secondary injury.1,28,29

    • Measurement of brain perfusion in newborns: Pulsed arterial spin labeling (PASL) versus pseudo-continuous arterial spin labeling (pCASL)

      2014, NeuroImage: Clinical
      Citation Excerpt :

      A main limitation of this study is the lack of gold standard of perfusion measurements in newborns compared to adults, making it difficult to assess accuracy. However, our measurements were in accordance with brain perfusion measurements obtained in newborns by other methods, i.e., positron emission tomography (Altman et al., 1988; Shi et al., 2009) and xenon 133 clearance (Pryds et al., 1990). Another limitation of the study is that the commercially available PASL sequence that was used in this study did not employ QUIPSS2/Q2TIPS type saturation to spoil residual label in the tagging slab.

    • Changes of positron emission tomography in newborn infants at different gestational ages, and neonatal hypoxic-ischemic encephalopathy

      2012, Pediatric Neurology
      Citation Excerpt :

      In infants manifesting severe periventricular leukomalacia and hypsarrhythmia, 18F-fluorodeoxyglucose positron emission tomography could identify dysfunctions of the sensorimotor cortex, whereas magnetic resonance imaging reveals periventricular injury [22]. Our preliminary study reported the characteristics of preterm and term infants [23]. An abnormal change in cerebral glucose metabolism and local blood supply was evident in two newborn infants with a cerebral infarction [24].

    View all citing articles on Scopus

    The corresponding authors have the right to grant, on behalf of all authors, an exclusive licence on a worldwide basis to permit this article (if accepted) to be published in Early Human Development. There is no competing interests.

    View full text