Impact of Prematurity on the Tissue Properties of the Neonatal Brain Stem: A Quantitative MR Approach

Schmidbauer, Victor; Dovjak, Gregor; Geisl, Gudrun; Weber, Michael; Diogo, Mariana Cardoso; Yildirim, M.S.; Goeral, Katharina; Klebermass-Schrehof, Katrin; Berger, Angelika; Prayer, Daniela; Kasprian, Gregor

doi:10.3174/ajnr.a6945

Cited by 8 publications

(14 citation statements)

References 41 publications

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“…However, even though T1 MR imaging metrics proved sufficient to quantify brain myelination in neonates, T1R/R1 did not reveal significant changes prenatally. 11 Generally, similar to T1R/T2R, the PD decreases as myelin development proceeds. 30 In this study, there were no significant correlations between GA and spin density, confirming that PD does not allow a reliable quantitative characterization of brain myelination at early developmental stages.…”

Section: Discussionmentioning

confidence: 90%

“…Moreover, this technique provides information about tissue-specific properties, which enables the characterization of brain myelination by a quantitative approach. 11,17 In fetuses, the maximum quantities of myelin deposition are detectable in the brain stem. 26,32 Thus, this region best reflects myelin-induced changes in tissue-specific properties.…”

Section: Discussionmentioning

confidence: 99%

“…30 In this study, there were no significant correlations between GA and spin density, confirming that PD does not allow a reliable quantitative characterization of brain myelination at early developmental stages. 11,30 Delayed brain maturation is associated with neuropsychiatric disorders. 39,40 Quantitative MR imaging techniques generate valuable image data for the qualitative assessment of fetal brain maturity.…”

Section: Discussionmentioning

confidence: 99%

“…[6][7][8][9] Foremost among these is that current sonography imaging systems do not allow a tissue-specific quantitative characterization of fetal brain maturity. 10 Physical MR imaging properties have been proved to provide noninvasive biomarkers for the assessment of brain maturation 11 and may offer new possibilities in the prenatal detection of neurodevelopmental anomalies. Until now, the acquisition of quantitative parameters, underlying visually perceptible MR imaging signal intensity (SI) values, was considered a highly time-consuming process, which limited its applicability in a clinical setting.…”

mentioning

confidence: 99%

“…19 MDME-based imaging proved beneficial in a neonatal neuroimaging setting because this technique allows a reduction in examination time, while providing a variety of imaging data beyond the standard neonatal MR imaging protocol. 11,15,16 However, currently, the full potential of this technology for the investigation of brain maturation at early developmental stages is widely unexplored.…”

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confidence: 99%

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Mapping Human Fetal Brain Maturation In Vivo Using Quantitative MRI

Schmidbauer

Dovjak

Yildirim

et al. 2021

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: On the basis of a single multidynamic multiecho sequence acquisition, SyMRI generates a variety of quantitative image data that can characterize tissue-specific properties. The aim of this retrospective study was to evaluate the feasibility of SyMRI for the qualitative and quantitative assessment of fetal brain maturation. MATERIALS AND METHODS:In 52 fetuses, multidynamic multiecho sequence acquisitions were available. SyMRI was used to perform multidynamic multiecho-based postprocessing. Fetal brain maturity was scored qualitatively on the basis of SyMRI-generated MR imaging data. The results were compared with conventionally acquired T1-weighted/T2-weighted contrasts as a standard of reference. Myelinrelated changes in T1-/T2-relaxation time/relaxation rate, proton density, and MR imaging signal intensity of the developing fetal brain stem were measured. A Pearson correlation analysis was used to detect correlations between the following: 1) the gestational age at MR imaging and the fetal brain maturity score, and 2) the gestational age at MR imaging and the quantitative measurements.RESULTS: SyMRI provided images of sufficient quality in 12/52 (23.08%) (range, 23 1 6-34 1 0) fetal multidynamic multiecho sequence acquisitions. The fetal brain maturity score positively correlated with gestational age at MR imaging (SyMRI: r ¼ 0.915, P , .001/standard of reference: r ¼ 0.966, P , .001). Myelination-related changes in the T2 relaxation time/T2 relaxation rate of the medulla oblongata significantly correlated with gestational age at MR imaging (T2-relaxation time: r ¼ -0.739, P ¼ .006/T2-relaxation rate: r ¼ 0.790, P ¼ .002).CONCLUSIONS: Fetal motion limits the applicability of multidynamic multiecho-based postprocessing. However, SyMRI-generated image data of sufficient quality enable the qualitative assessment of maturity-related changes of the fetal brain. In addition, quantitative T2 relaxation time/T2 relaxation rate mapping characterizes myelin-related changes of the brain stem prenatally. This approach, if successful, opens novel possibilities for the evaluation of structural and biochemical aspects of fetal brain maturation.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Mapping Human Fetal Brain Maturation In Vivo Using Quantitative MRI

Schmidbauer

Dovjak

Yildirim

et al. 2021

AJNR Am J Neuroradiol

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Quantitative Magnetic Resonance Imaging for Neurodevelopmental Outcome Prediction in Neonates Born Extremely Premature—An Exploratory Study

Schmidbauer,

Yildirim,

Dovjak

et al. 2024

Clin Neuroradiol

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Purpose Neonates born at < 28 weeks of gestation are at risk for neurodevelopmental delay. The aim of this study was to identify quantitative MR-based metrics for the prediction of neurodevelopmental outcomes in extremely preterm neonates. Methods T1-/T2-relaxation times (T1R/T2R), ADC, and fractional anisotropy (FA) of the left/right posterior limb of the internal capsule (PLIC) and the brainstem were determined at term-equivalent ages in a sample of extremely preterm infants (n = 33). Scores for cognitive, language, and motor outcomes were collected at one year corrected-age. Pearson’s correlation analyses detected relationships between quantitative measures and outcome data. Stepwise regression procedures identified imaging metrics to estimate neurodevelopmental outcomes. Results Cognitive outcomes correlated significantly with T2R (r = 0.412; p = 0.017) and ADC (r = −0.401; p = 0.021) (medulla oblongata). Furthermore, there were significant correlations between motor outcomes and T1R (pontine tegmentum (r = 0.346; p = 0.049), midbrain (r = 0.415; p = 0.016), right PLIC (r = 0.513; p = 0.002), and left PLIC (r = 0.504; p = 0.003)); T2R (right PLIC (r = 0.405; p = 0.019)); ADC (medulla oblongata (r = −0.408; p = 0.018) and pontine tegmentum (r = −0.414; p = 0.017)); and FA (pontine tegmentum (r = −0.352; p = 0.045)). T2R/ADC (medulla oblongata) (cognitive outcomes (R2 = 0.296; p = 0.037)) and T1R (right PLIC)/ADC (medulla oblongata) (motor outcomes (R2 = 0.405; p = 0.009)) revealed predictive potential for neurodevelopmental outcomes. Conclusion There are relationships between relaxometry‑/DTI-based metrics determined by neuroimaging near term and neurodevelopmental outcomes collected at one year of age. Both modalities bear prognostic potential for the prediction of cognitive and motor outcomes. Thus, quantitative MRI at term-equivalent ages represents a promising approach with which to estimate neurologic development in extremely preterm infants.

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T1-weighted fast fluid-attenuated inversion-recovery sequence (T1-FFLAIR) enables the visualization and quantification of fetal brain myelination in utero

Milos,

Schmidbauer,

Watzenboeck

et al. 2023

Eur Radiol

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Objectives To investigate the advantage of T1-weighted fast fluid-attenuated inversion-recovery MRI sequence without (T1-FFLAIR) and with compressed sensing technology (T1-FFLAIR-CS), which shows improved T1-weighted contrast, over standard used T1-weighted fast field echo (T1-FFE) sequence for the assessment of fetal myelination. Materials and methods This retrospective single-center study included 115 consecutive fetal brain MRI examinations (63 axial and 76 coronal, mean gestational age (GA) 28.56 ± 5.23 weeks, range 19–39 weeks). Two raters, blinded to GA, qualitatively assessed a fetal myelin total score (MTS) on each T1-weighted sequence at five brain regions (medulla oblongata, pons, mesencephalon, thalamus, central region). One rater performed region-of-interest quantitative analysis (n = 61) at the same five brain regions. Pearson correlation analysis was applied for correlation of MTS and of the signal intensity ratios (relative to muscle) with GA on each T1-weighted sequence. Fetal MRI–based results were compared with myelination patterns of postmortem fetal human brains (n = 46; GA 18 to 42), processed by histological and immunohistochemical analysis. Results MTS positively correlated with GA on all three sequences (all r between 0.802 and 0.908). The signal intensity ratios measured at the five brain regions correlated best with GA on T1-FFLAIR (r between 0.583 and 0.785). T1-FFLAIR demonstrated significantly better correlations with GA than T1-FFE for both qualitative and quantitative analysis (all p < 0.05). Furthermore, T1-FFLAIR enabled the best visualization of myelinated brain structures when compared to histology. Conclusion T1-FFLAIR outperforms the standard T1-FFE sequence in the visualization of fetal brain myelination, as demonstrated by qualitative and quantitative methods. Clinical relevance statement T1-weighted fast fluid-attenuated inversion-recovery sequence (T1-FFLAIR) provided best visualization and quantification of myelination in utero that, in addition to the relatively short acquisition time, makes feasible its routine application in fetal MRI for the assessment of brain myelination. Key Points • So far, the assessment of fetal myelination in utero was limited due to the insufficient contrast. • T1-weighted fast fluid-attenuated inversion-recovery sequence allows a qualitative and quantitative assessment of fetal brain myelination. • T1-weighted fast fluid-attenuated inversion-recovery sequence outperforms the standard used T1-weighted sequence for visualization and quantification of myelination in utero. Graphical abstract

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Impact of Prematurity on the Tissue Properties of the Neonatal Brain Stem: A Quantitative MR Approach

Cited by 8 publications

References 41 publications

Mapping Human Fetal Brain Maturation In Vivo Using Quantitative MRI

Mapping Human Fetal Brain Maturation In Vivo Using Quantitative MRI

Quantitative Magnetic Resonance Imaging for Neurodevelopmental Outcome Prediction in Neonates Born Extremely Premature—An Exploratory Study

T1-weighted fast fluid-attenuated inversion-recovery sequence (T1-FFLAIR) enables the visualization and quantification of fetal brain myelination in utero

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