Characterization of Extensive Microstructural Variations Associated with Punctate White Matter Lesions in Preterm Neonates

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Fig 1.
The appearances of 3 PWML grades (A, grade I; B, grade II; C, grade III) on T1WI and T2WI.
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Fig 2.
Changes in DTI metrics (FA, AD, and RD) in preterm neonates with severe PWMLs compared with controls revealed by TBSS (there were no significant changes in neonates with PWML grades I and II). Green regions represent the mean FA skeleton without any significant differences. Significant decreases in neonates with PWMLs compared with controls are shown in cool colors (blue and light blue). Significant increases in neonates with PWMLs compared with controls are shown in warm colors (red and yellow).
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Fig 3.
Changes in DTI metrics (FA, AD, and RD) along white matter tracts in preterm neonates with PWML grades I, II, and III compared with controls.

Table 1:

Demographics of preterm neonates with PWMLs and controls^{^a}

	PWML Grade I (n = 15)	Controls (n = 15)	P Value	PWML Grade II (n = 9)	Controls (n = 9)	P Value	PWML Grade III (n = 9)	Controls (n = 9)	P Value
GA (wk)	34 + 2	34 + 1	.21	33 + 6	33 + 6	.76	33 + 0	33 + 2	.37
GA (wk)	(32 + 0∼35 + 6)	(32 + 6∼36 + 2)	.21	(30 + 5∼34 + 5)	(30 + 1∼35 + 0)	.76	(32 + 3∼35 + 4)	(32 + 1∼35 + 6)	.37
Postnatal age at scan (days)	8	8	.53	10	10	.67	10	9	.80
Postnatal age at scan (days)	(1∼13)	(1∼13)	.53	(6∼14)	(8∼14)	.67	(4∼13)	(1∼14)	.80
PMA (wk)	35 + 5	36 + 0	.32	35 + 3	35 + 1	.23	34 + 5	35 + 2	.40
PMA (wk)	(33 + 1∼37 + 2)	(33 + 3∼37 + 1)	.32	(32 + 1∼36 + 0)	(32 + 1∼36 + 4)	.23	(33 + 1∼36 + 3)	(32 + 5∼36 + 5)	.40
Birth weight (g)	1780	1760	.22	1950	1750	.26	1920	1700	.51
Birth weight (g)	(1470∼2360)	(1410∼2400)	.22	(1480∼2700)	(1460∼2360)	.26	(1650∼2760)	(1460∼2570)	.51
Sex (male/female)	10:5	10:5	–	4:5	4:5	–	3:6	3:6	–

Note:—GA indicates gestational age; PMA, postmenstrual age.
↵a GA, PMA, and birth weight values are medians (ranges). Values in the row of sex are subject numbers. Wilcoxon signed rank tests were used to test the group difference between each grade of PWML and its matched control group due to non-normal distributions of variables. The sex ratios were not tested because they were the same in PWML and the corresponding control groups.

Table 2:

Clinical history of subjects

	No. of Subjects (Column-Based Percentage)				Controls (n = 33)
	All Grades (n = 33)	Grade I (n = 15)	Grade II (n = 9)	Grade III (n = 9)	Controls (n = 33)
Hypoxic-ischemic encephalopathy	20 (61%)	7 (47%)	5 (56%)	8 (89%)	0 (0%)
Neonatal asphyxia	17 (52%)	7 (47%)	3 (33%)	7 (78%)	7 (21%)
Neonatal respiratory distress syndrome	13 (40%)	4 (27%)	3 (33%)	6 (67%)	6 (18%)
Neonatal pneumonia	11 (33%)	6 (40%)	2 (22%)	3 (33%)	2 (6%)
Electrolyte disturbances	10 (30%)	4 (27%)	4 (44%)	2 (22%)	0 (0%)
Neonatal anemia	9 (27%)	4 (27%)	3 (33%)	2 (22%)	4 (12%)
Metabolic acidosis	8 (24%)	3 (20%)	2 (22%)	3 (33%)	7 (21%)
Congenital heart disease	6 (18%)	3 (20%)	0 (0%)	3 (33%)	3 (9%)
Neonatal hypoglycemia	4 (12%)	0 (0%)	2 (22%)	2 (22%)	1 (3%)
Neonatal intracranial hemorrhage	4 (12%)	0 (0%)	2 (22%)	2 (22%)	0 (0%)
Neonatal polycythemia	2 (6%)	0 (0%)	1 (11%)	1 (11%)	0 (0%)
Hyperbilirubinemia	2 (6%)	1 (7%)	1 (11%)	0 (0%)	6 (18%)
Agenesis of bronchus	1 (3%)	0 (0%)	1 (11%)	0 (0%)	0 (0%)
Neonatal hypocalcemia	0 (0%)	0 (0%)	0 (0%)	0 (0%)	9 (27%)
Aspiration pneumonia	0 (0%)	0 (0%)	0 (0%)	0 (0%)	7 (21%)

Table 3:

Lesion load of PWMLs in the anterior, central, and posterior regions^{^a}

↵a The inter-region comparisons were performed with the Wilcoxon signed rank test after the Friedman test. The anterior region is anterior to the frontal horn of the lateral ventricles. The central region is between the frontal horn and the trigon of the lateral ventricles. The posterior region is posterior to the lateral ventricles.
↵b P <.05.
↵c P < .017 (.05/3), significant after the Bonferroni correction.