Pediatric Radiology

, Volume 42, Supplement 1, pp 33–61

Neuroimaging biomarkers of preterm brain injury: toward developing the preterm connectome

  • Ashok Panigrahy
  • Jessica L. Wisnowski
  • Andre Furtado
  • Natasha Lepore
  • Lisa Paquette
  • Stefan Bluml
Advances in Fetal and Neonatal Imaging

Abstract

For typically developing infants, the last trimester of fetal development extending into the first post-natal months is a period of rapid brain development. Infants who are born premature face significant risk of brain injury (e.g., intraventricular or germinal matrix hemorrhage and periventricular leukomalacia) from complications in the perinatal period and also potential long-term neurodevelopmental disabilities because these early injuries can interrupt normal brain maturation. Neuroimaging has played an important role in the diagnosis and management of the preterm infant. Both cranial US and conventional MRI techniques are useful in diagnostic and prognostic evaluation of preterm brain development and injury. Cranial US is highly sensitive for intraventricular hemorrhage (IVH) and provides prognostic information regarding cerebral palsy. Data are limited regarding the utility of MRI as a routine screening instrument for brain injury for all preterm infants. However, MRI might provide diagnostic or prognostic information regarding PVL and other types of preterm brain injury in the setting of specific clinical indications and risk factors. Further development of advanced MR techniques like volumetric MR imaging, diffusion tensor imaging, metabolic imaging (MR spectroscopy) and functional connectivity are necessary to provide additional insight into the molecular, cellular and systems processes that underlie brain development and outcome in the preterm infant. The adult concept of the “connectome” is also relevant in understanding brain networks that underlie the preterm brain. Knowledge of the preterm connectome will provide a framework for understanding preterm brain function and dysfunction, and potentially even a roadmap for brain plasticity. By combining conventional imaging techniques with more advanced techniques, neuroimaging findings will likely be used not only as diagnostic and prognostic tools, but also as biomarkers for long-term neurodevelopmental outcomes, instruments to assess the efficacy of neuroprotective agents and maneuvers in the NICU, and as screening instruments to appropriately select infants for longitudinal developmental interventions.

Keywords

White matter injury of prematurity Neuroimaging biomarkers Cranial US MRI 

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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Ashok Panigrahy
    • 1
    • 2
  • Jessica L. Wisnowski
    • 1
    • 4
  • Andre Furtado
    • 2
  • Natasha Lepore
    • 1
  • Lisa Paquette
    • 3
  • Stefan Bluml
    • 1
    • 5
  1. 1.Department of RadiologyChildren’s Hospital Los AngelesLos AngelesUSA
  2. 2.Department of Pediatric RadiologyChildren’s Hospital of Pittsburgh of UPMCPittsburghUSA
  3. 3.Center for Fetal and Neonatal MedicineChildren’s Hospital Los AngelesLos AngelesUSA
  4. 4.Brain and Creativity InstituteUniversity of Southern CaliforniaLos AngelesUSA
  5. 5.Department of Biomedical EngineeringUniversity of Southern CaliforniaLos AngelesUSA

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