Abstract
ObjectivesThe software “SyMRI” generates different MR contrasts and characterizes tissue properties based on a single acquisition of a multi-dynamic multi-echo (MDME)-FLAIR sequence. The aim of this study was to assess the applicability of “SyMRI” in the assessment of myelination in preterm and term-born neonates. Furthermore, “SyMRI” was compared with conventional MRI.MethodsA total of 30 preterm and term-born neonates were examined at term-equivalent age using a standardized MRI protocol. MDME sequence (acquisition time, 5 min, 24 s)–based post-processing was performed using “SyMRI”. Myelination was assessed by scoring seven brain regions on quantitative T1-/T2-maps, generated by “SyMRI” and on standard T1-/T2-weighted images, acquired separately. Analysis of covariance (ANCOVA) (covariate, gestational age (GA) at MRI (GAMRI)) was used for group comparison.ResultsIn 25/30 patients (83.3%) (18 preterm and seven term-born neonates), “SyMRI” acquisitions were successfully performed. “SyMRI”-based myelination scores were significantly lower in preterm compared with term-born neonates (ANCOVA: T1: F(1, 22) = 7.420, p = 0.012; T2: F(1, 22) = 5.658, p = 0.026). “SyMRI”-based myelination scores positively correlated with GAMRI (T1: r = 0.662, n = 25, p ≤ 0.001; T2: r = 0.676, n = 25, p ≤ 0.001). The myelination scores based on standard MRI did not correlate with the GAMRI. No significant differences between preterm and term-born neonates were detectable.Conclusions“SyMRI” is a highly promising MR technique for neonatal brain imaging. “SyMRI” is superior to conventional MR sequences in the visual detection of delayed myelination in preterm neonates.Key Points• By providing multiple MR contrasts, “SyMRI” is a time-saving method in neonatal brain imaging.• Differences concerning the myelination in term-born and preterm infants are visually detectable on T1-/T2-weighted maps generated by “SyMRI”.• “SyMRI” allows a faster and more sensitive assessment of myelination compared with standard MR sequences.
Highlights
Myelin forms a spiral layer around the nerve fibers in the central nervous system [1]
There was a high degree of concordance between the T1 and the T2 myelin total score (MTS) values assessed by both raters on quantitative MR maps, generated by the MR data postprocessing software “SyMRI”: the average measured intra-class correlation (ICC) for the T1 MTS was 0.866 with a 95% confidence interval from 0.696 to 0.941 (F(24, 24) = 7.463, p ≤ 0.001); the average measured ICC for the T2 MTS was 0.810 with a 95% confidence interval from 0.568 to 0.916 (F(24, 24) = 5.251, p ≤ 0.001)
Myelination positively correlates with higher neurocognitive functions, whereas reduced myelination has been associated with cognitive deficits during later life [44]
Summary
Myelin forms a spiral layer around the nerve fibers in the central nervous system [1]. Myelination is the structural basis for fast transmission of information, and is integral in developmental and neurobiological processes [1, 2]. Brain myelination proceeds step-by-step and essential developmental stages can be recorded by MRI [6,7,8]. Myelin can be visualized on conventional T1- and T2-contrasts and serves as a non-invasive imaging biomarker for brain maturation. Preterm birth interferes with the process of white matter maturation [9, 10], resulting in a delay of myelination [11]. Neonatal brain MRI is sensitive for the prognostic assessment of subtle cerebral pathologies of preterm neonates [12,13,14]. Conventional MRI is a highly time-consuming procedure and currently lacks diagnostic sensitivity for the assessment of myelination
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