Sequential Cranial Ultrasound and Cerebellar Diffusion Weighted Imaging Contribute to the Early Prognosis of Neurodevelopmental Outcome in Preterm Infants

Margaretha J Brouwer,Floris Groenendaal,Manon J N L Benders,Ingrid C Van Haastert,Britt J M Van Kooij,Corine Koopman-Esseboom,Linda S De Vries,Pierre Gressens

doi:10.1371/journal.pone.0109556

Margaretha J Brouwer, Floris Groenendaal + Show 6 more

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https://doi.org/10.1371/journal.pone.0109556

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Abstract

ObjectiveTo evaluate the contribution of sequential cranial ultrasound (cUS) and term-equivalent age magnetic resonance imaging (TEA-MRI) including diffusion weighted imaging (DWI) to the early prognosis of neurodevelopmental outcome in a cohort of very preterm infants (gestational age [GA] <31 weeks).Study designIn total, 93 preterm infants (median [range] GA in weeks: 28.3 [25.0–30.9]) were enrolled in this prospective cohort study and underwent early and term cUS as well as TEA-MRI including DWI. Early cUS abnormalities were classified as normal, mild, moderate or severe. Term cUS was evaluated for ex-vacuo ventriculomegaly (VM) and enlargement of the extracerebral cerebrospinal fluid (eCSF) space. Abnormalities on T1- and T2-weighted TEA-MRI were scored according to Kidokoro et al. Using DWI at TEA, apparent diffusion coefficients (ADCs) were measured in four white matter regions bilaterally and both cerebellar hemispheres. Neurodevelopmental outcome was assessed at two years’ corrected age (CA) using the Bayley Scales of Infant and Toddler Development, third edition. Linear regression analysis was conducted to explore the correlation between the different neuroimaging modalities and outcome.ResultsModerate/severe abnormalities on early cUS, ex-vacuo VM and enlargement of the eCSF space on term cUS and increased cerebellar ADC values on term DWI were independently associated with worse motor outcome (p<.05). Ex-vacuo VM on term cUS was also related to worse cognitive performance at two years’ CA (p<.01).ConclusionThese data support the clinical value of sequential cUS and recommend repeating cUS at TEA. In particular, assessment of moderate/severe early cUS abnormalities and ex-vacuo VM on term cUS provides important prognostic information. Cerebellar ADC values may further aid in the prognostication of gross motor function.

Highlights

During the last decades, several neuroimaging modalities have been introduced to evaluate the preterm brain during the neonatal period in order to improve prediction of developmental impairments.Cranial ultrasound has proven to be an accessible neuroimaging technique, which can be performed at the bedside to detect a variety of brain lesions in the preterm infant
Moderate/severe abnormalities on early cranial ultrasound (cUS), ex-vacuo VM and enlargement of the extracerebral cerebrospinal fluid (eCSF) space on term cUS and increased cerebellar apparent diffusion coefficients (ADCs) values on term diffusion weighted imaging (DWI) were independently associated with worse motor outcome (p,.05)
Cerebellar ADC values may further aid in the prognostication of gross motor function

Summary

Introduction

Several neuroimaging modalities have been introduced to evaluate the preterm brain during the neonatal period in order to improve prediction of developmental impairments.Cranial ultrasound (cUS) has proven to be an accessible neuroimaging technique, which can be performed at the bedside to detect a variety of brain lesions in the preterm infant. Conventional magnetic resonance imaging performed around term-equivalent age (TEA-MRI) or even soon after birth has been shown to be superior to cUS in detecting more subtle brain lesions. With the increasing availability of neuroimaging modalities, the question arises to which extent they are complementary, at which point in time they are most predictive and whether TEA-MRI should be performed in every extremely low birth weight infant. The aim of this cohort study among very preterm infants was to examine the contribution of sequential cUS and TEA-MRI including DWI to the early prognosis of neurodevelopmental outcome at two years’ corrected age (CA)

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