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Regional impairment of cortical and deep gray matter perfusion in preterm neonates with low-grade germinal matrix-intraventricular hemorrhage: an ASL study

  • Paediatric Neuroradiology
  • Published:
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Abstract

Purpose

The long-term impact of low-grade germinal matrix-intraventricular hemorrhage (GMH-IVH) on brain perfusion has not been fully investigated. We aimed to compare cortical and deep gray matter (GM) cerebral blood flow (CBF) obtained with pseudo-continuous arterial spin labeling (pCASL), among preterm neonates with and without low-grade GMH-IVH and full-term controls.

Methods

3T-pCASL examinations of 9 healthy full-term neonates (mean gestational age 38.5 weeks, range 38–39) and 28 preterm neonates studied at term-equivalent age were analyzed. Eighteen preterm neonates presented normal brain MRI (mean gestational age 30.50 weeks, range 29–31) and 10 low-grade GMH-IVH according to Volpe’s grading system (mean gestational age 32 weeks, range 28–34). A ROI-based mean CBF quantification was performed in 5 cortical (frontal, parietal, temporal, insula, occipital), and 4 subcortical GM regions (caudate, putamen, pallidum, thalamus) for each cerebral hemisphere. CBF differences were explored using a nonparametric analysis of covariance.

Results

Low-grade GMH-IVH hemispheres showed consistently lower CBF in all GM regions when compared with healthy preterm neonates, after controlling the confounding effect of gestational age, postmenstrual age, and birth weight P < .001, η2 = .394. No significant differences were observed between neonates with low-grade GMH and full-term controls. Healthy preterm neonates showed significantly higher CBF than full-term controls in parietal (P = .032), temporal (P = .016), and occipital cortex (P = .024), and at level of thalamus (P = .023) and caudate nucleus (P = .014).

Conclusion

Low-grade GMH-IVH is associated with lower CBF in posterior cortical and subcortical gray matter regions in preterm neonates, suggesting regional vulnerability of these developing brain structures.

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Data Availability

Data used for the present analysis are available. For further information, please write to domenicotortora@gaslini.org.

Abbreviations

ASL:

Arterial spin labeling

CBF:

Cerebral blood flow

GMH-IVH:

Germinal matrix and intraventricular hemorrhage

HP:

Healthy preterm

HT:

Healthy term

pCASL:

Pseudo-continuous arterial spin labeling

TEA:

Term-equivalent age

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Acknowledgments

This work was supported by Eu-Brain Non-profit Association, Genoa, Italy.

Funding

This work was supported by funds from “Ricerca Corrente Disordini Neurologici e Muscolari (Linea 5)” of the Italian Ministry of Health.

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Author notes

  1. DT and FMLR contributed equally to this work.

Authors and Affiliations

  1. Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy

    Domenico Tortora, Mariasavina Severino & Andrea Rossi

  2. Department of Neuroradiology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy

    Francesco Maria Lo Russo

  3. Neonatal Intensive Care Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy

    Alessandro Parodi, Paolo Massirio & Luca Antonio Ramenghi

  4. Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy

    Luca Antonio Ramenghi

  5. Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy

    Andrea Rossi

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  1. Domenico Tortora
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Contributions

- Domenico Tortora: design of the study, data collection, data analysis, manuscript draft, revision of the manuscript

- Francesco Maria Lo Russo: data analysis, images preparation, revision of the manuscript

- Mariasavina Severino: manuscript draft, data collection, revision of the manuscript

- Alessandro Parodi: data collection, revision of the manuscript

- Paolo Massirio: data collection, revision of the manuscript

- Luca Antonio Ramenghi: data collection, revision of the manuscript

- Andrea Rossi: manuscript draft, revision of the manuscript, design of the study

Corresponding author

Correspondence to Mariasavina Severino.

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All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Our institutional review (Comitato Etico Regione Liguria) board approved this retrospective study.

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Tortora, D., Lo Russo, F.M., Severino, M. et al. Regional impairment of cortical and deep gray matter perfusion in preterm neonates with low-grade germinal matrix-intraventricular hemorrhage: an ASL study. Neuroradiology 62, 1689–1699 (2020). https://doi.org/10.1007/s00234-020-02514-9

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