Sagittal strata and periventricular crossroads as additional neuroimaging criteria in prediction of neurodevelopmental risk in prematurely born infants

INTRODUCTION: One of the most challenging pursuits in translational and clinical neuroscience is to find reliable criteria for prediction of neurological and cognitive outcome in prematurely born infants using available neuroimaging METHODS, such as magnetic resonance imaging (MRI). Previous studies showed that vulnerability of axonal pathways to hypoxic-ischemic events observed in spatiotemporal context of white matter segments described by Von Monakow could provide us more precise information about nature of perinatal lesions. Finding certain neuroimaging “biomarkers”, especially considering subtle lesions, would help us to design timely appropriate and targeted early intervention during period of optimal neuroplasticity. Patients/METHODS: In order to examine the associations between qualitatively defined visibility (not visible/poor visibility/good visibility) of 2nd white matter segment (sagittal strata and periventricular crossroads C1-C6) on MRI and neurodevelopmental outcome, we performed a prospective longitudinal pilot study in the group of 31 prematurely born infants (median age=28+5 gestational weeks). The infants were MRI scanned shortly after birth and at term-equivalent age, and brain injuries were classified as normal or mild according to standardized MRI scoring system. 48 % infants from our cohort had no evident brain injury, while 52% had mild brain injury at term- equivalent age, according to the scoring mentioned above. The Bayley Scales of Infant and Toddler Development-III (Bayley-III) and Hempel Neurological Assessment were performed at 2nd year of corrected age as a part of clinical follow-up. RESULTS: At 2 years of age, 30% of infants had minor neurological dysfunctions and 16% severe motor impairment according to Hempel assessment. On Bayley-III, 30% of infants had cognitive delay, 31% had language delay and 35% showed deficits in motor skills. As expected, increased severity of brain injury was associated with adverse outcomes on both assessments. In addition, the visibility of frontal and occipital sagittal strata at preterm MRI was positively correlated with better outcome on Bayley-III motor scale. This association was mediated by severity of brain injury. Furthermore, better visibility of periventricular crossroads C2 and C6 and frontal sagittal strata on MRI performed at term- equivalent age correlated with higher scoring points on Bayley-III language scale. CONCLUSIONS: Our findings suggest a role for sagittal strata and periventricular crossroads visibility in perinatal neuroimaging at preterm and term- equivalent age in risk stratification of language and motor skills for extremely premature and very premature infants. White matter segments and their developmental dynamics give us more precise insight in topography of developmental lesions and should definitely be considered as an additional tool in perinatal neuroimaging in prediction of neurodevelopmental risk.