Tract-Based Spatial Statistics in Preterm-Born Neonates Predicts Cognitive and Motor Outcomes at 18 Months.
OBJECTIVE
Adverse neurodevelopmental outcome is common in children born preterm. Early sensitive predictors of neurodevelopmental outcome such as MR imaging are needed. Tract-based spatial statistics, a diffusion MR imaging analysis method, performed at term-equivalent age (40 weeks) is a promising predictor of neurodevelopmental outcomes in children born very preterm. We sought to determine the association of tract-based spatial statistics findings before term-equivalent age with neurodevelopmental outcome at 18-months corrected age.


METHODS
Of 180 neonates (born at 24-32-weeks' gestation) enrolled, 153 had DTI acquired early at 32 weeks' postmenstrual age and 105 had DTI acquired later at 39.6 weeks' postmenstrual age. Voxelwise statistics were calculated by performing tract-based spatial statistics on DTI that was aligned to age-appropriate templates. At 18-month corrected age, 166 neonates underwent neurodevelopmental assessment by using the Bayley Scales of Infant Development, 3rd ed, and the Peabody Developmental Motor Scales, 2nd ed.


RESULTS
Tract-based spatial statistics analysis applied to early-acquired scans (postmenstrual age of 30-33 weeks) indicated a limited significant positive association between motor skills and axial diffusivity and radial diffusivity values in the corpus callosum, internal and external/extreme capsules, and midbrain (P < .05, corrected). In contrast, for term scans (postmenstrual age of 37-41 weeks), tract-based spatial statistics analysis showed a significant relationship between both motor and cognitive scores with fractional anisotropy in the corpus callosum and corticospinal tracts (P < .05, corrected). Tract-based spatial statistics in a limited subset of neonates (n = 22) scanned at <30 weeks did not significantly predict neurodevelopmental outcomes.


CONCLUSIONS
The strength of the association between fractional anisotropy values and neurodevelopmental outcome scores increased from early-to-late-acquired scans in preterm-born neonates, consistent with brain dysmaturation in this population.
From the Department of Paediatrics (E.G.D., J.F., V.C., H.B., S.P.M.), Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada.
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Duerden
From the Department of Paediatrics (E.G.D., J.F., V.C., H.B., S.P.M.), Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada.
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Foong
Department of Pediatrics (V.C., K.J.P., R.E.G., A.S., J.G.Z., S.P.M.), University of British Columbia, BC Children's and Women's Hospitals, Child and Family Research Institute, Vancouver, British Columbia, Canada.
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Chau
From the Department of Paediatrics (E.G.D., J.F., V.C., H.B., S.P.M.), Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada.
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Branson
Department of Pediatrics (V.C., K.J.P., R.E.G., A.S., J.G.Z., S.P.M.), University of British Columbia, BC Children's and Women's Hospitals, Child and Family Research Institute, Vancouver, British Columbia, Canada.
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Poskitt
Department of Pediatrics (V.C., K.J.P., R.E.G., A.S., J.G.Z., S.P.M.), University of British Columbia, BC Children's and Women's Hospitals, Child and Family Research Institute, Vancouver, British Columbia, Canada.
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Grunau
Department of Pediatrics (V.C., K.J.P., R.E.G., A.S., J.G.Z., S.P.M.), University of British Columbia, BC Children's and Women's Hospitals, Child and Family Research Institute, Vancouver, British Columbia, Canada.
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Synnes
Department of Pediatrics (V.C., K.J.P., R.E.G., A.S., J.G.Z., S.P.M.), University of British Columbia, BC Children's and Women's Hospitals, Child and Family Research Institute, Vancouver, British Columbia, Canada Department of Occupational Science and Occupational Therapy (J.G.Z.), University of British Columbia, Vancouver, British Columbia, Canada.
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Zwicker
From the Department of Paediatrics (E.G.D., J.F., V.C., H.B., S.P.M.), Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada Department of Pediatrics (V.C., K.J.P., R.E.G., A.S., J.G.Z., S.P.M.), University of British Columbia, BC Children's and Women's Hospitals, Child and Family Research Institute, Vancouver, British Columbia, Canada steven.miller@sickkids.ca.
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Miller
D016880:Anisotropy; D001921:Brain / Q000503:physiopathology*; D002648:Child; D002657:Child Development / Q000502:physiology*; D003071:Cognition / Q000502:physiology; D056324:Diffusion Tensor Imaging / Q000379:methods*; D005260:Female; D005865:Gestational Age; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D009048:Motor Skills / Q000502:physiology