Diffuse excessive high signal intensity in low-risk preterm infants at term-equivalent age does not predict outcome at 1 year: a prospective study

Abstract

DEHSI in premature infants is neither a predictive measure for short-term adverse neurobehavioral outcome nor related to perinatal risk characteristics. Extrauterine exposure time had a differential effect on WM maturational trajectories in infants with DEHSI compared to those without. We suggest DEHSI may represent an alteration in WM maturational characteristics. Further follow-up studies may verify later consequences of DEHSI in premature infants.

Neonatal brain MRI: how reliable is the radiologist’s eye?

“…While it has been shown that the detectability of low-contrast lesions can be affected by retinal photoreceptor light adaptation [15], to our knowledge there is no published work evaluating observer variability in interpreting newborn brain MRI. The scale chosen for the comparison is similar to that used in previously published studies [11,16].Our results show fair to substantial intra-and inter-observer agreement in the analysis of white matter signal intensity. If we simplify our scale by combining grades 1 and 2 to reduce subjectivity, we see a slight improvement in the inter-and intraobserver Fleiss' kappa agreement, as might be expected.…”

“…Each radiologist has his or her own way of looking at this exam, as illustrated by the numerous scoring systems for determining the nature and extent of MR imaging abnormalities [3]. The premature newborn brain is a peculiar entityno longer fetal, but not yet adult.Subjective analysis can be an issue, as demonstrated recently by the debate overdiffuse excessive high signal intensity (DEHSI).DEHSI was initially described as regions of "high signal intensity in the periventricular frontal and parieto-occipital area on T2-weighted images, [4,5] and has been reported in up to 80% of very premature infants at term-equivalent age [6].Though its prognostic value is under debate [7][8][9][10][11][12], DEHSI are now considered a development-related imaging pattern [8]. This finding can influence medical decisions when associated with other abnormalities such as white matter punctate lesions, in which case it may then have significant ethical implications.…”

Cranial ultrasound findings in late preterm infants and correlation with perinatal risk factors

“…Moreover, in previous studies, unlike the present one, diffuse excessive high-signal intensity on T2-weighted MR images (the so called DEHSI) has been considered part of the spectrum of white matter injury. However, according to recent evidence DEHSI should be considered a developmental phenomenon related to prematurity rather than a pathological finding itself and this theory is well supported by the lack of correlation of this common MR finding in preterm infants at term with adverse long-term neurobehavioral outcome [ 25 , 26 ].…”

Clinical Implications of Diffuse Excessive High Signal Intensity (DEHSI) on Neonatal MRI in School Age Children Born Extremely Preterm

“…It can either be seen in isolation or together with other white matter changes, such as reduced volume, cystic lesions, and delayed myelination, and it has been suggested that DEHSI reflects diffuse white matter injury [ 3 , 5 , 6 ]. Although visual inspection of DEHSI is a subjective measure, diffusion MRI studies have shown that preterm infants with DEHSI display changes in diffusion measures, indicating altered white matter microstructure, when compared to infants without DEHSI [ 4 , 7 , 8 ].…”

“…Several studies have evaluated the influence of DEHSI on development in preterm infants at toddler age and contradictory results have been reported. While some studies showed an association between DEHSI and developmental outcomes [ 5 , 12 – 14 ], others did not find any relationship to outcome [ 8 , 15 – 18 ]. To our knowledge, there are no previous studies that have explored the relationship between the occurrence of DEHSI in the absence of other white matter abnormalities, and long-term outcomes in extremely preterm born children.…”