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PEDIATRICS Vol. 112 No. 1 July 2003, pp. 1-7

Diffusion-Weighted Imaging of the Brain in Preterm Infants With Focal and Diffuse White Matter Abnormality

Serena J. Counsell, MSc*, Joanna M. Allsop, DCR*, Michael C. Harrison, MRCP{ddagger}, David J. Larkman, PhD*, Nigel L. Kennea, MRCP{ddagger}, Olga Kapellou, MRCPCH{ddagger}, Frances M. Cowan, PhD{ddagger}, Joseph V. Hajnal, PhD*, A. David Edwards, F Med Sci, FRCP*,{ddagger} and Mary A. Rutherford, FRCPCH, FRCR*,{ddagger}

* Robert Steiner Magnetic Resonance Unit, Imaging Sciences Department, MRC Clinical Sciences Centre
{ddagger} Department of Paediatrics, Faculty of Medicine, Imperial College, Hammersmith Campus, London, United Kingdom

Objective. The most common finding on magnetic resonance imaging (MRI) of the brain in preterm infants at term-equivalent age is diffuse excessive high signal intensity (DEHSI) in the white matter. It is unclear whether DEHSI represents a biological abnormality. This study used diffusion-weighted imaging (DWI) to compare apparent diffusion coefficient (ADC) values in DEHSI with infants with normal imaging and those with overt brain damage to determine whether DEHSI shows the diffusion characteristics of normal or abnormal tissue.

Methods. MRI, using conventional and diffusion-weighted imaging (DWI), was performed in 50 preterm infants at term-equivalent age using a 1.5 Tesla MR scanner. The infants were divided into 3 groups on the basis of their MRI results: 1) normal white matter, 2) DEHSI, or 3) overt white matter pathology. ADC values were measured in the frontal, central, and posterior white matter at the level of the centrum semiovale. ADC values in the 3 groups of preterm infants were compared using a 1-way analysis of variance with a Bonferroni test for multiple comparisons.

Results. ADC values were significantly higher in infants with DEHSI and infants with overt white matter pathology than in infants with normal white matter. There was no significant difference between ADC values in infants with DEHSI and those with overt white matter pathology.

Conclusions. This study provides objective evidence that DEHSI represents diffuse white matter abnormality.

Key Words: magnetic resonance imaging • diffusion weighted imaging • DEHSI • preterm • brain

Abbreviations: PVL, periventricular leukomalacia • PHI, periventricular hemorrhagic infarction • IVH, intraventricular hemorrhage • MRI, magnetic resonance imaging • DEHSI, diffuse excessive high signal intensity • DWI, diffusion-weighted imaging • ADC, apparent diffusion coefficient • GA, gestational age • PMA, postmenstrual age • CSE, conventional spin echo • FSE, fast spin echo • ROI, region of interest • DTI, diffusion tensor imaging

Received for publication Sep 11, 2002; Accepted Dec 20, 2002.




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