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. 2019 Sep:98:53-60.
doi: 10.1016/j.pediatrneurol.2019.05.001. Epub 2019 May 9.

Early Detection of Cerebral Palsy Using Sensorimotor Tract Biomarkers in Very Preterm Infants

Nehal A Parikh  1 , Alexa Hershey  2 , Mekibib Altaye  3
Affiliations

Early Detection of Cerebral Palsy Using Sensorimotor Tract Biomarkers in Very Preterm Infants

Nehal A Parikh et al. Pediatr Neurol. 2019 Sep.

Abstract

Background: Our objectives were to evaluate the brain's sensorimotor network microstructure using diffusion magnetic resonance imaging (MRI) at term-corrected age and test the ability of sensorimotor microstructural parameters to accurately predict cerebral palsy in extremely-low-birth-weight infants.

Methods: We enrolled a prospective pilot cohort of extremely-low-birth-weight preterm infants (birth weight ≤ 1000 g) before neonatal intensive care unit discharge and studied them with structural and diffusion MRI at term-corrected age. Six sensorimotor tracts were segmented, and microstructural parameters from these tracts were evaluated for their ability to predict later development of cerebral palsy, diagnosed at 18 to 22 months corrected age.

Results: We found significant differences in multiple diffusion MRI parameters from five of the six sensorimotor tracts in infants who developed cerebral palsy (n = 5) versus those who did not (n = 36). When compared with structural MRI or individual diffusion MRI biomarkers, the combination of two individual biomarkers-fractional anisotropy of superior thalamic radiations (sensory component) and radial diffusivity of the corticospinal tract-exhibited the highest sensitivity (80%), specificity (97%), and positive likelihood ratio (28.0) for prediction of cerebral palsy. This combination of diffusion MRI biomarkers accurately classified 95% of the study infants.

Conclusions: Development of cerebral palsy in very preterm infants is preceded by early brain injury or immaturity to one or more sensorimotor tracts. A larger study is warranted to evaluate if a combination of sensorimotor microstructural biomarkers could accurately facilitate early diagnosis of cerebral palsy.

Keywords: Cerebral palsy; Cohort studies; Diffusion magnetic resonance imaging; Extremely low birth weight infant; Magnetic resonance imaging; Motor disorders; Premature; Prognosis.

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Conflict of interest statement

Competing interests. The authors declare no competing interests.

Figures

Figure 1.
Figure 1.. Sensorimotor network tractography superimposed on T2-weighted images in a very preterm infant.
Coronal (A), sagittal (B), and axial (C) views of the corticospinal tract (light blue), posterior thalamic radiations (orange), superior thalamic radiations – motor segment (dark blue), superior thalamic radiations – sensory segment (pink), posterior mid-body of the corpus callosum (CC; red), and isthmus of the CC (yellow).
Figure 2.
Figure 2.. Axial color maps and fractional anisotropy (FA) maps displaying location of seed masks (SM) and waypoint masks (WM).
(A) Waypoint mask for the posterior thalamic radiations (PTR; seed mask placed in thalamus using coronal view); (B) Common seed mask for superior thalamic radiations – motor (STRm) and sensory (STRs); (C) Waypoint mask for STRm; and (D) Waypoint mask for STRs.
See this image and copyright information in PMC

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