Correlative value of magnetic resonance imaging for neurodevelopmental outcome in periventricular leukomalacia

Abstract

The aim of this study was to evaluate the correlative value of magnetic resonance imaging (MRI) in children with periventricular leukomalacia (PVL) for neurodevelopmental outcome. MRI examinations of 89 children (46 males, 43 females) with PVL (median age 4y, range 1 to 14y) were reevaluated. PVL was graded as follows: grade I, unilateral or bilateral areas of periventricular hyperintensity (1-3); grade II, hyperintensity more than 3; grade III, hyperintense lesions more than 3 and ventricular wall irregularity; grade IV, diffuse PVL and ventricular dilatation. Localizations of PVL and brain abnormalities associated with PVL were also noted. Assignment to PVL grades on MRI was as follows: PVL I (n=22), PVL II (n=18), PVL III (n=30), and PVL IV (n=19). Cerebral palsy was slightly less common in children with PVL I and II compared with PVL III to IV. Motor function was normal in 50% of children with PVL grade I, but severely impaired in 73.7% of children with PVL grade IV. Results of visual function were normal in all with PVL I, but pathological in 42.1% of patients with PVL IV. Developmental tests were appropriate for age in 75% of patients with PVL I, but significantly delayed in all patients with PVL IV. Thinning of the corpus callosum and presence of cortical atrophy were also correlated with neurological outcome. Significant risk factors associated with developmental delay were asphyxia at birth (odds ratio [OR] 4.3), PVL localization numbers over 3 (OR 4.4), PVL III to IV (OR 15), thinning of corpus callosum, and cortical atrophy.

MRI Brain in Perinatal Hypoxia – A Case Series.

“…Approximately 28 % patients had diplegia. [11] Thus, our findings are in concordance with this study.…”

“…MRI was normal in 18 % of the infants. [11] In a similar study done by PavithraLogitharajah, the major sites of injury were basal ganglia (BG, 75%), white matter (89%), Cortex was involved (58%) followed by brain stem in 44% cases No abnormality was found in 32%. Significant central gray matter and brainstem injury was found in many preterm infants with HIE.…”

Motor development and sleep, play, and feeding positions in very‐low‐birthweight infants with and without white matter disease

“…The literature suggests that approximately 20 to 80% of infants with WMD are later given a diagnosis of cerebral palsy (CP) in varying grades of severity. [17][18][19][20] The etiology is thought to be neonatal injury to the periventricular white matter (e.g. necrosis of axons, impairment of myelination) in areas containing the cortico-spinal tracts, which pass near the lateral ventricles and involve motor pathways.…”

MRI Findings in Patients with Hemiparetic Cerebral Palsy

“…Selective vulnerability of the immature cerebral blood vessels and oligodendroglia in the periventricular white matter to fluctuations in cerebral perfusion and to oxygen free radicals is thought to be responsible for this specific pattern of brain injury in the preterm neonate 2,11-13 . Findings of PVL are related to injury to developing periventricular white matter during the late second and early third trimesters of pregnancy 11,[14][15][16][17] . After about 34 weeks of gestation, subcortical and cortical areas are the most vulnerable regions of the brain for hypoxic-ischemic insult and the resulting lesions include subcortical leukomalacia, multicystic encephalamalacia and gliosis [5][6][7]18 .…”