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Background Cognitive and language impairments constitute the majority of disabilities observed in preterm infants. It remains unclear if diffuse excessive high signal intensity (DEHSI) on MRI at term represents delayed white matter maturation or pathology. Methods We hypothesized that diffusion tensor imaging-based objectively quantified DEHSI measures at term will be strong predictors of cognitive and language development at 2 years in a cohort of 41 extremely low birth weight (ELBW; ≤1000g) infants. Using an automated probabilistic atlas, mean diffusivity maps were used to objectively segment and quantify DEHSI volume and mean, axial, and radial diffusivity measures. Standardized neurodevelopment was assessed at 2 years of age using the Bayley Scales of Infant Development, third edition. Results Thirty-six of the 41 infants (88%) had complete developmental data at follow-up. Objectively quantified DEHSI volume correlated significantly with cognitive and language scores at 2 years (P<0.001 for both). The sum values of the three diffusivity measures in detected DEHSI regions also correlated significantly with the Bayley scores (R2 34.7%; P<0.001 for each). Infants in the highest quartile for DEHSI volumes had scores between 19–24 points lower than infants in the lowest quartile (P<0.01). When diagnosed subjectively by neuroradiologists however, Bayley scores were not significantly lower in infants with extensive DEHSI. Conclusions These findings lend further evidence that DEHSI is pathologic and that objectively quantified diffusion-based DEHSI volume at term is associated with cognitive and language impairments. Our approach could be utilized for risk stratification and early intervention for such high-risk extremely preterm infants.

Background: Extremely-low-birth-weight (ELBW; ≤1,000 g) infants are at high risk for neurodevelopmental impairments. Conventional brain MRI at term-equivalent age is increasingly used for prediction of outcomes. However, optimal prediction models remain to be determined, especially for cognitive outcomes. Objective: The aim was to evaluate the accuracy of a data-driven MRI scoring system to predict neurodevelopmental impairments. Methods: 122 ELBW infants had a brain MRI performed at term-equivalent age. Conventional MRI findings were scored with a standardized algorithm and tested using a multivariable regression model to predict neurodevelopmental impairment, defined as one or more of the following at 18-24 months' corrected age: cerebral palsy, bilateral blindness, bilateral deafness requiring amplification, and/or cognitive/language delay. Results were compared with a commonly cited scoring system. Results: In multivariable analyses, only moderate-to-severe gyral maturational delay was a significant predictor of overall neurodevelopmental impairment (OR: 12.6, 95% CI: 2.6, 62.0; p < 0.001). Moderate-to-severe gyral maturational delay also predicted cognitive delay, cognitive delay/death, and neurodevelopmental impairment/death. Diffuse cystic abnormality was a significant predictor of cerebral palsy (OR: 33.6, 95% CI: 4.9, 229.7; p < 0.001). These predictors exhibited high specificity (range: 94-99%) but low sensitivity (30-67%) for the above outcomes. White or gray matter scores, determined using a commonly cited scoring system, did not show significant association with neurodevelopmental impairment. Conclusions: In our cohort, conventional MRI at term-equivalent age exhibited high specificity in predicting neurodevelopmental outcomes. However, sensitivity was suboptimal, suggesting additional clinical factors and biomarkers are needed to enable accurate prognostication.

ObjectiveTo relate volumetric MRI findings to hypothermia therapy and neurosensory impairments.Study DesignNewborns ≥ 36 weeks’ gestation with hypoxic-ischemic encephalopathy who participated in the NICHD hypothermia randomized trial at our center were eligible. We determined the relationship between hypothermia treatment and usual care (control) to absolute and relative cerebral tissue volumes. Further, we correlated brain volumes with death or neurosensory impairments at 18 to 22 months.ResultsBoth treatment groups were comparable before randomization. Total brain tissue volumes did not differ in relation to treatment assignment. However, relative volumes of subcortical white matter were significantly larger in hypothermia-treated than control infants. Furthermore, relative total brain volumes correlated significantly with death or neurosensory impairments. Relative volumes of the cortical gray and subcortical white matter also correlated significantly with Bayley Scales psychomotor development index.ConclusionSelected volumetric MRI findings correlated with hypothermia therapy and neurosensory impairments. Larger studies utilizing MRI brain volumes as a secondary outcome measure are needed.

We report a rare case of bilateral absence of the CCAs with separate origins of the ICAs and ECAs, detected by CTA.