Neuroimaging biomarkers of preterm brain injury: toward developing the preterm connectome

Abstract

For typically developing infants, the last trimester of fetal development extending into the first post-natal months is a period of rapid brain development. Infants who are born premature face significant risk of brain injury (e.g., intraventricular or germinal matrix hemorrhage and periventricular leukomalacia) from complications in the perinatal period and also potential long-term neurodevelopmental disabilities because these early injuries can interrupt normal brain maturation. Neuroimaging has played an important role in the diagnosis and management of the preterm infant. Both cranial US and conventional MRI techniques are useful in diagnostic and prognostic evaluation of preterm brain development and injury. Cranial US is highly sensitive for intraventricular hemorrhage IVH and provides prognostic information regarding cerebral palsy. Data are limited regarding the utility of MRI as a routine screening instrument for brain injury for all preterm infants. However, MRI might provide diagnostic or prognostic information regarding PVL and other types of preterm brain injury in the setting of specific clinical indications and risk factors. Further development of advanced MR techniques like volumetric MR imaging, diffusion tensor imaging, metabolic imaging (MR spectroscopy) and functional connectivity are necessary to provide additional insight into the molecular, cellular and systems processes that underlie brain development and outcome in the preterm infant. The adult concept of the “connectome” is also relevant in understanding brain networks that underlie the preterm brain. Knowledge of the preterm connectome will provide a framework for understanding preterm brain function and dysfunction, and potentially even a roadmap for brain plasticity. By combining conventional imaging techniques with more advanced techniques, neuroimaging findings will likely be used not only as diagnostic and prognostic tools, but also as biomarkers for long-term neurodevelopmental outcomes, instruments to assess the efficacy of neuroprotective agents and maneuvers in the NICU, and as screening instruments to appropriately select infants for longitudinal developmental interventions.

Gut microbiota, the immune system, and diet influence the neonatal gut–brain axis

“…Hence, imaging techniques that define injury to the connectome is receiving high interest (106,107). Injurious agents or neurotransmissions from the gut that reach the brain of preterm infants via the GBA are probably causes of brain injury (45,55).…”

Chronic morbidities of premature newborns

“…Az IVH mellett a PVL cisztás formája nagy rizikót jelent a koraszülöttek agyi bénulására [58,59]. A neonatológia fejlődése az utóbbi években csökkentette a PVL incidenciáját [60].…”

“…Marad a rizikófaktorok prevenciója, korai felismerésük esetében eliminálása. A PVL azonban képalkotó módszerekkel jól követhető [58,59,63].…”

“…A szürke-állomány, a basalis nucleusok, a cerebellum, az agyi metabolizmus, a perfúziós elemzés, a funkcionális MRI pontosabban kategorizálhatja majdan a koraszülöttek agyi laesióit, specifi kus kezelést indikálhatnak, életminő-séget prognosztizálhatnak. A koraszülött-agykutatásban is új tudomány születhet, az idegsejtek közötti kapcsolat tudománya, amelynek modellje a koraszülöttek connectomja [59]. A koraszülött-connectom térképet ad majd számunkra az egészséges és beteg agy szerveződésére, a minőségi túlélés esélyéhez segíti majd a jövő koraszü-löttjeit.…”

The Role of Diffusion-Tensor Magnetic Resonance Imaging and Tractography in the Diagnosis of Structural Brain Disorders in Children with Cerebral Palsy

“…Diffuse Excessive High Signal Intensity, DEHSI) [38]. По данным ряда исследователей, перивентрикуляная лейкомаляция и PWML могут рассматриваться в каче-стве предикторов двигательного и умственного разви-тия ребенка, в то время как нейровизуализационный феномен DEHSI в настоящее время не имеет само-стоятельного прогностического значения и, по данным патоморфологических исследований, может рассматри-ваться как этап нормального развития мозга [39][40][41]. Нейровизуализационный феномен PWML в остром пери-оде представлен очагами повышенной интенсивности МР-сигнала в режиме Т 1 и сниженной -в режиме Т 2 -ВИ и патоморфологически может иметь различный суб-страт -очаги микрокровоизлияний, глиоза, активации микроглии [42].…”