title: [Exploring the clinical significance of continuously measuring apparent diffusion coefficient values in the preterm infants with punctate white matter damage by applying diffusion weighted imaging].
abstract: OBJECTIVE
  To observe the dynamic changes of MRI in the preterm infants with punctate white matter damage (PWMD), and to explore the clinical significance of apparent diffusion coefficient (ADC) values by continuously measuring the lesions and surrounding region by applying diffusion weighted imaging (DWI).
  
  
  METHODS
  MRI, using conventional and diffusion weighted imaging, was performed in 151 preterm infants within 7 days after birth between October 2010 to June 2011 in NICU. Twenty-four preterm infants with PWMD and 24 controls were obtained according to their MRI results. The control group infants were those with normal MRI results and at the same gestational age as those with PWMDs. The ADC value was measured for the lesions and their surrounding regions, and for the same sites of the controls. All the PWMD were followed up for 2-5 weeks, and apparent diffusion coefficients were measured at the same regions. The variation of magnetic resonance imaging was observed and the apparent diffusion coefficients were compared.
  
  
  RESULTS
  The first MRI scanning: in the 24 cases with PWMD, high signals on DWI were seen in all patients (100%), increased signal intensity on T1-weighted images were seen in 19 (79.2%) patients, increased signal intensity on T1-weighted images and decreased signal intensity on T2-weighted images were seen in 4 (16.6%) patients. The second MRI scanning: in the 24 cases with PWMD, The high signal on DWI vanished in all patients (100%), the increased signal intensity on T1-weighted images vanished in 9 (39.1%) patients, the increased signal intensity on T1-weighted images did not vanish but was smaller than before in 14 (60.9%) patients. The measurement of ADC values: the mean ADC value of the lesions in the group of PWMD was (942 ± 170)×10(-3)mm(2)/s, significantly lower than the area surrounding (1 554 ± 116)×10(-3)mm(2)/s and the same area of the control group (1 524 ± 116)×10(-3)mm(2)/s ( P < 0.05). The second MRI scanning: the mean ADC of the lesions in the PWMD group was up to (1 468 ± 195)×10(-3)mm(2)/s, which is significantly higher than before, but still lower than the areas surrounding the lesion (1 586 ± 97)×10(-3)mm(2)/s (P < 0.05).
  
  
  CONCLUSIONS
  Continuous measurement of ADC values in the lesions and surrounding areas is important to describe the micro-change of PWMD.
authors.affiliation: Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang 110004, China.
authors.forename: Xin
authors.initials: X
authors.lastname: Tong
authors.affiliation: Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang 110004, China. Email:xdxue@163.com.
authors.forename: Xindong
authors.initials: X
authors.lastname: Xue
authors.affiliation: Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang 110004, China.
authors.forename: Jianhua
authors.initials: J
authors.lastname: Fu
mesh_terms: D001049:Apnea / Q000175:diagnosis / Q000473:pathology; D001724:Birth Weight; D001921:Brain / Q000473:pathology; D001927:Brain Diseases / Q000175:diagnosis* / Q000473:pathology; D016022:Case-Control Studies; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000175:diagnosis* / Q000473:pathology; D008297:Male