Diffusion-tensor brain MRI of newborns helps predict neurological progression

Diffusion tensor MRI can identify white matter variation in newborns and ultimately help predict their neurological development, according to a June 4 study published in Radiology.

In fact, earlier white matter development positively correlated with higher neurodevelopmental test scores in areas such as language and motor function two years after birth, reported Kaiyang Feng, with the department of radiology and pediatrics at the University of Arkansas for Medical Sciences in Little Rock, and colleagues.

“With information obtained from this study, it is possible that neuroimaging in newborns may to some extent predict neurodevelopment even for healthy children, and prenatal intervention targeted at improving white matter integrity at birth will be important for further promoting neurodevelopment in children,” Feng and colleagues wrote.

It’s widely known, the researchers noted, that those born with white matter injuries such as premature newborns, those with congenital heart disease or with hypoxic-ischemic encephalopathy experience neurodevelopmental problems, but there isn’t as much research into white matter development in healthy babies and its impact on long-term neurodevelopmental outcomes.

To test this, the researchers prospectively enrolled 38 full term infants (20 boys, 18 girls) to undergo brain MRI, including diffusion tensor imaging, at 2 weeks. All infants later underwent testing at 2 years using the Bayley Scales of Infant Development (BSID).

The BSID includes five subscores: cognitive, language and motor scales based on observation of the child and socioemotional and adaptive behavior scales taken from parent responses to questionnaires. The scales evaluate everything from visual preference, memory and fine motor skills to adaptive behavior.

Overall, higher fractional anisotropy values—considered markers of white matter integrity—identified during imaging at 2 weeks correlated with improved neurodevelopment at 2 years.

After testing for several demographic and environmental factors, such as sex, family socioeconomic status and breastfeeding duration, for example, gestational age at birth was the only factor that did not correlate. This was not surprising, the authors noted, because gestational age impacts white matter development in healthy full-term newborns and their neurodevelopmental outcomes.

“Our findings not only reinforce the superior sensitivity of diffusion tensor MRI for detection of subtle changes in brain white matter but also highlight the significant correlations between early white matter development and later outcomes,” the researchers added.

These findings “open opportunities” for specialists to develop prenatal and postbirth interventions that may aid newborn development, wrote Houchun H. Hu, PhD, and Aaron S. McAllister, MD, both with Nationwide Children’s Hospital in Columbus, Ohio, in a related editorial.

“However, for such a pathway to be realized in a clinical setting, the prediction must be taken to the individual level. For the subsequent results to be efficacious and meaningful to the treating clinicians, normative standardized data, templates, and percentiles will be needed, much like the ubiquitous World Health Organization growth charts,” they wrote.