Pyramidal tract maturation after brain injury in newborns with heart disease.
OBJECTIVE
Our objective was to quantify white matter tract development in term newborns with congenital heart disease, a population at high risk for perioperative brain injury, using magnetic resonance imaging diffusion tensor tractography (DTT).


METHODS
Twenty-five newborns with congenital heart disease were imaged before and after surgery, with a median of 2 weeks between serial magnetic resonance imaging examinations. DTT was performed to segment bilateral pyramidal tracts using semiautomated fiber tracking software, and manual region of interest measurements were taken for comparison.


RESULTS
Significant maturational rates of increasing fractional anisotropy (median, 4.4% per week) and decreasing mean diffusivity (D(av)) (median, -2.0% per week) in the pyramidal tract were measured in infants without brain injury. Fractional anisotropy maturation rates were highest in newborns with normal scans, intermediate (median, 2.4% per week) in those with postoperative injury, and lowest (median, 0.9% per week) in those with preoperative injury, indicating a significant trend across brain injury groups (p = 0.015). D(av) maturation rates did not differ across injury groups (p = 0.15). Manual region of interest measures showed greater variability in serial measurements, and no significant differences were identified between injury groups, suggesting that DTT may provide more sensitive measures.


CONCLUSIONS
DTT is feasible in term newborns and may help to characterize abnormal white matter tract development following acquired brain injury.
Partridge
Savannah C
SC
Department of Radiology, University of California, San Francisco, San Francisco, CA, USA.
Vigneron
Daniel B
DB
Charlton
Natalie N
NN
Berman
Jeffrey I
JI
Henry
Roland G
RG
Mukherjee
Pratik
P
McQuillen
Patrick S
PS
Karl
Tom R
TR
Barkovich
A James
AJ
Miller
Steven P
SP
D001930:Brain Injuries / Q000150:complications / Q000473:pathology*; D001931:Brain Mapping; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006331:Heart Diseases / Q000150:complications / Q000473:pathology*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011446:Prospective Studies; D011712:Pyramidal Tracts / Q000254:growth & development* / Q000473:pathology*; D018709:Statistics, Nonparametric