Periventricular Leukomalacia: Comparison of Parenchymal Signal and Volume Changes on Brain MRI in Paediatric Cases with Healthy Peers
Öz
Background/aims: Previous MRI studies have shown white matter (WM) and gray matter (GM) of cerebrum and cerebellum, corpus callosum (CC) abnormalities in periventricular leukomalacia (PVL). But, the WM FLAIR signal ratio in MRI may provide quantitative data in the diagnosis and follow-up, as a new radiologic method. Thalamic involvement may be a biomarker for neuronal damage and disease severity. We aimed to re-investigate both WM and GM volume changes of cerebrum and cerebellum, CC surface area in PVL, and to evaluate the diagnostic accuracy of the thalamus L sign and FLAIR signal ratio.
Methods: MRI scans of 30 pediatric patients with PVL and 42 healthy controls were analyzed to examine WM and GM volume changes, FLAIR signal ratio, CC surface area, and thalamus L sign. Volumetric analyses were done with the Volbrain program.
Results: Decreased subcortical GM volumes were found in PVL (p<0.001). There was a significant positive correlation between FLAIR signal ratio, various GM and cerebellum volumes. In patients with thalamus L sign, decreased GM volume and increased abnormal signaled WM volume were observed. The most important variable in the diagnosis of PVL was abnormally signaled WM volume (p>0.001).
Conclusions: Our results emphasise the role of MRI in the detection of PVL, the evaluation of GM changes and brain damage, and the importance of thalamus L sign and FLAIR signal ratio in the evaluation of the severity of the disease. Comprehensive studies in this direction may contribute to the development of targeted treatment strategies aimed at reducing cognitive and motor impairments in PVL.
Anahtar Kelimeler
periventricular leukomalacia, brain volume, FLAIR signal ratio, thalamus L sign, gray matter, corpus callosum
Etik Beyan
Ethical approval: This article does not contain any studies with human participants or animals performed by any of the authors. This study was approved by the local medical ethical committee (2023/514/258/25), and all data was processed anonymously, according to the privacy legislation.
Kaynakça
- Zubiaurre-Elorza L, Soria-Pastor S, Junque C, Segarra D, Bargalló N, Mayolas N, et al. Gray matter volume decrements in preterm children with periventricular leukomalacia. Pediatr Res. 2011 Jun;69(6):554-60
- Inder TE, Huppi PS, Warfield S, Kikinis R, Zientara GP, Barnes PD, et al. Periventricular white matter injury in the premature infant is followed by reduced cerebral cortical gray matter volume at term. Ann Neurol. 1999 Nov;46(5):755-60
- Chao CP, Zaleski CG, Patton AC. Neonatal hypoxic-ischemic encephalopathy: multimodality imaging findings. Radiographics. 2006 Oct;26 Suppl 1:S159-72
- Epelman M, Daneman A, Blaser SI, Ortiz-Neira C, Konen O, Jarrín J, et al. Differential diagnosis of intracranial cystic lesions at head US: correlation with CT and MR imaging. Radiographics. 2006 Jan-Feb;26(1):173-96
- Cheong JL, Thompson DK, Wang HX, Hunt RW, Anderson PJ, Inder TE, et al. Abnormal white matter signal on MR imaging is related to abnormal tissue microstructure. AJNR Am J Neuroradiol. 2009 Mar;30(3):623-8
- Davatzikos C, Barzi A, Lawrie T, Hoon AH Jr, Melhem ER. Correlation of corpus callosal morphometry with cognitive and motor function in periventricular leukomalacia. Neuropediatrics. 2003 Jun;34(5):247-52
- Misser SK, Lotz JW, van Toorn R, Mchunu N, Archary M, Barkovich AJ. Thalamus L-Sign: A Potential Biomarker of Neonatal Partial, Prolonged Hypoxic-Ischemic Brain Injury or Hypoglycemic Encephalopathy? AJNR Am J Neuroradiol. 2022 Jun;43(6):919-925
- Manjón JV, Coupé P. volBrain: An Online MRI Brain Volumetry System. Front Neuroinform. 2016 Jul 27;10:30
- Coupé P, Mansencal B, Clément M, Giraud R, Denis de Senneville B, Ta VT, et al. AssemblyNet: A large ensemble of CNNs for 3D whole brain MRI segmentation. Neuroimage. 2020 Oct 1;219:117026
- Pierson CR, Folkerth RD, Billiards SS, Trachtenberg FL, Drinkwater ME, Volpe JJ, et al. Gray matter injury associated with periventricular leukomalacia in the premature infant. Acta Neuropathol. 2007 Dec;114(6):619-31