title: White matter injury in newborns with congenital heart disease: a diffusion tensor imaging study.
abstract: BACKGROUND
  Brain injury is observed on cranial magnetic resonance imaging preoperatively in up to 50% of newborns with congenital heart disease. Newer imaging techniques such as diffusion tensor imaging provide sensitive measures of the white matter integrity. The objective of this study was to evaluate the diffusion tensor imaging analysis technique of tract-based spatial statistics in newborns with congenital heart disease.
  
  
  METHODS
  Term newborns with congenital heart disease who would require surgery at less than 1 month of age were prospectively enrolled (n = 19). Infants underwent preoperative and postoperative brain magnetic resonance imaging with diffusion tensor imaging. Tract-based spatial statistics, an objective whole-brain diffusion tensor imaging analysis technique, was used to determine differences in white matter fractional anisotropy between infant groups. Term control infants were also compared with congenital heart disease infants. Postmenstrual age was equivalent between congenital heart disease infant groups and between congenital heart disease and control infants.
  
  
  RESULTS
  Ten infants had preoperative brain injury, either infarct or white matter injury, by conventional brain magnetic resonance imaging. The technique of tract-based spatial statistics showed significantly lower fractional anisotropy (P < 0.05, corrected) in multiple major white matter tracts in the infants with preoperative brain injury compared with infants without preoperative brain injury. Fractional anisotropy values increased in the white matter tracts from the preoperative to the postoperative brain magnetic resonance imaging correlating with brain maturation. Control infants had higher fractional anisotropy in multiple white matter tracts compared with infants with congenital heart disease.
  
  
  CONCLUSIONS
  Tract-based spatial statistics is a valuable diffusion tensor imaging analysis technique that may have better sensitivity in detecting white matter injury compared with conventional brain magnetic resonance imaging in term newborns with congenital heart disease.
authors.affiliation: Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas. Electronic address: mulkeysarah@uams.edu.
authors.forename: Sarah B
authors.initials: SB
authors.lastname: Mulkey
authors.affiliation: Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
authors.forename: Xiawei
authors.initials: X
authors.lastname: Ou
authors.affiliation: Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
authors.forename: Raghu H
authors.initials: RH
authors.lastname: Ramakrishnaiah
authors.affiliation: Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
authors.forename: Charles M
authors.initials: CM
authors.lastname: Glasier
authors.affiliation: Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Swearingen
authors.affiliation: Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
authors.forename: Maria S
authors.initials: MS
authors.lastname: Melguizo
authors.affiliation: Department of Pediatrics, NewYork-Presbyterian-Weill Cornell Medical College, New York, New York.
authors.forename: Vivien L
authors.initials: VL
authors.lastname: Yap
authors.affiliation: Department of Anesthesiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Schmitz
authors.affiliation: Department of Pediatrics, University of Maryland, Baltimore, Maryland.
authors.forename: Adnan T
authors.initials: AT
authors.lastname: Bhutta
mesh_terms: D016880:Anisotropy; D001921:Brain / Q000473:pathology*; D001930:Brain Injuries / Q000150:complications* / Q000473:pathology*; D038524:Diffusion Magnetic Resonance Imaging; D056324:Diffusion Tensor Imaging; D006331:Heart Diseases / Q000150:complications* / Q000601:surgery; D006801:Humans; D007231:Infant, Newborn; D010865:Pilot Projects; D011446:Prospective Studies; D066127:White Matter / Q000473:pathology*
keywords: brain magnetic resonance imaging; congenital heart disease; diffusion tensor imaging; fractional anisotropy; newborn brain injury; tract-based spatial statistics; white matter injury