Relationship between Proton Magnetic Resonance Spectroscopy of Frontoinsular Gray Matter and Neurodevelopmental Outcomes in Very Low Birth Weight Children at the Age of 4

Abstract

Very low birth weight is associated with long term neurodevelopmental complications. Macroscopic brain abnormalities in prematurity survivors have been investigated in several studies. However, there is limited data regarding local cerebral metabolic status and neurodevelopmental outcomes. The purpose of this study was to characterize the relationship between proton magnetic resonance spectra in basal ganglia, frontal white matter and frontoinsular gray matter, neurodevelopmental outcomes assessed with the Leiter scale and the Developmental Test of Visual Perception and selected socioeconomic variables in a cohort of very low birth weight children at the age of four. Children were divided in three groups based on the severity of neurodevelopmental impairment. There were no differences in spectroscopy in basal ganglia and frontal white matter between the groups. Lower concentrations of N-acetylaspartate (NAA), choline (Cho) and myoinositol (mI) were observed in the frontoinsular cortex of the left hemisphere in children with neurodevelopmental impairment compared to children with normal neurodevelopmental outcomes. Higher parental education, daycare attendance and breastfeeding after birth were associated with more favorable neurodevelopmental prognosis, whereas rural residence was more prevalent in children with moderate and severe impairment. Our study demonstrates the role of long term neurometabolic disruption in the left frontoinsular cortex and selected socioeconomic variables in determination of neurodevelopmental prognosis in prematurity survivors.

Proton MR Spectroscopy in Patients with Nonlesional Insular Cortex Epilepsy Confirmed by Invasive EEG Recordings

“…More recently, Durlak et al investigated 1 H-MRS spectra in fronto-insular gray matter, basal nuclei, and the white matter of frontal lobes using 6 cm 3 volumes of interest in very low birth weight children at the age of 4 with neurodevelopmental impairments. 26 None of these studies directly tested for within-group differences in [NAA] or NAA/Cr ratios between the left and right insulae, but the data provided in Durlak et al's study do not suggest any interhemispheric difference in fronto-insular NAA/Cr ratios either in the healthy control or the patient groups. It is also possible that the observed asymmetry could result from a chemical shift displacement effect, resulting in a different level of partial volume effects with cerebrospinal fluid (CSF) and white matter between the hemispheres.…”

“…Section thickness was set to 15 mm and the width of the volume of interest was adjusted for each individual case, depending on head size. More recently, Durlak et al investigated 1 H‐MRS spectra in fronto‐insular gray matter, basal nuclei, and the white matter of frontal lobes using 6 cm 3 volumes of interest in very low birth weight children at the age of 4 with neurodevelopmental impairments . None of these studies directly tested for within‐group differences in [NAA] or NAA/Cr ratios between the left and right insulae, but the data provided in Durlak et al's study do not suggest any interhemispheric difference in fronto‐insular NAA/Cr ratios either in the healthy control or the patient groups.…”