Published online July 3, 2006
PEDIATRICS Vol. 118 No. 1 July 2006, pp. 23-33 (doi:10.1542/peds.2005-2675)

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Regional Brain Development in Serial Magnetic Resonance Imaging of Low-Risk Preterm Infants

Andrea U.J. Mewes, MD^a, Petra S. Hüppi, MD^b, Heidelise Als, PhD^c, Frank J. Rybicki, MD, PhD^a, Terrie E. Inder, MD^d, Gloria B. McAnulty, PhD^c, Robert V. Mulkern, PhD^e, Richard L. Robertson, MD^e, Michael J. Rivkin, MD^f, Simon K. Warfield, PhD^a,e

^a Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
^b Child Development Unit, Department of Pediatrics, University Children's Hospital, Geneva, Switzerland
^c Psychiatry
^e Radiology
^f Neurology, Children's Hospital, Harvard Medical School, Boston, Massachusetts
^d Department of Pediatrics, Washington University, St Louis, Missouri

OBJECTIVE. MRI studies have shown that preterm infants with brain injury have altered brain tissue volumes. Investigation of preterm infants without brain injury offers the opportunity to define the influence of early birth on brain development and provide normative data to assess effects of adverse conditions on the preterm brain. In this study, we investigated serial MRI of low-risk preterm infants with the aim to identify regions of altered brain development.

METHODS. Twenty-three preterm infants appropriate for gestational age without magnetic resonance–visible brain injury underwent MRI twice at 32 and at 42 weeks’ postmenstrual age. Fifteen term infants were scanned 2 weeks after birth. Brain tissue classification and parcellation were conducted to allow comparison of regional brain tissue volumes. Longitudinal brain growth was assessed from preterm infants’ serial scans.

RESULTS. At 42 weeks’ postmenstrual age, gray matter volumes were not different between preterm and term infants. Myelinated white matter was decreased, as were unmyelinated white matter volumes in the region including the central gyri. The gray matter proportion of the brain parenchyma constituted 30% and 37% at 32 and 42 weeks’ postmenstrual age, respectively.

CONCLUSIONS. This MRI study of preterm infants appropriate for gestational age and without brain injury establishes the influence of early birth on brain development. No decreased cortical gray matter volumes were found, which is in contrast to findings in preterm infants with brain injury. Moderately decreased white matter volumes suggest an adverse influence of early birth on white matter development. We identified a sharp increase in cortical gray matter volume in preterm infants’ serial data, which may correspond to a critical period for cortical development.

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Key Words: magnetic resonance imaging • preterm infants • regional brain development • parcellation • segmentation

Abbreviations: UMWM—unmyelinated white matter • MWM—myelinated white matter • PMA—postmenstrual age • AGA—appropriate for gestational age • ICV—intracranial volume • MR—magnetic resonance • SPGR—spoiled gradient recalled • CSF—cerebrospinal fluid • CGM—cortical gray matter • SGM—subcortical gray matter • CPAR—cerebral parenchyma • STAPLE—Simultaneous Truth and Performance Level Estimation • ANCOVA—analysis of covariance

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Accepted Feb 13, 2006.

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