Radiology: High signal intensity may not = adverse outcomes in preterm infants
Diffuse excessive high signal intensity (DEHSI) is often detected on MRI of premature infants. Although there has been debate about whether it represents a true white matter abnormality, DEHSI is not associated with adverse neurodevelopmental outcomes, according to a study published online March 8 in Radiology.
The prevalence of neurodevelopmental disabilities is high among preterm infants, with 5 to 15 percent having cerebral palsy, severe neurosensory impairment or both. Study authors Tae Yeon Jeon, MD, and colleagues from the Sungkyunkwan University School of Medicine in Seoul, Korea, explained that DEHSI is defined as higher signal intensity in white matter than in normal unmyelinated white matter on T2-weighted images. What wasn’t known was whether DEHSI represents white matter injury or simply delayed maturation.
To compare outcomes between preterm infants with and without DEHSI, the authors conducted a retrospective study of 126 high-risk preterm infants who underwent a screening brain MRI at near-term equivalent age. After dividing the infants based on the presence of DEHSI, they analyzed the association of MR findings with the presence of cerebral palsy and neurosensory impairment.
Results showed that DEHSI was present in 75 percent of the infants, but subsequent neurodevelopmental outcomes did not differ significantly between the two groups.
“Our results suggest that DEHSI may not reflect a specific white matter injury, but rather developmental changes resulting from preterm delivery into the extrauterine environment of the neonatal intensive care unit or modifiable white matter change,” wrote the authors.
Severe motor delay and cerebral palsy were more common in infants with both DEHSI and other white matter lesions such as cystic encephalomalacia or punctate lesions.
The authors indicated their study is limited by the fact that there was only a two year follow-up, while developmental assessments are more predictive of ultimate developmental achievement when administered at five to eight years of age.
“Consequently, continued follow-up of this study will provide data regarding the robustness of the effect of DEHSI on MR images on neurodevelopment,” wrote the authors.
The prevalence of neurodevelopmental disabilities is high among preterm infants, with 5 to 15 percent having cerebral palsy, severe neurosensory impairment or both. Study authors Tae Yeon Jeon, MD, and colleagues from the Sungkyunkwan University School of Medicine in Seoul, Korea, explained that DEHSI is defined as higher signal intensity in white matter than in normal unmyelinated white matter on T2-weighted images. What wasn’t known was whether DEHSI represents white matter injury or simply delayed maturation.
To compare outcomes between preterm infants with and without DEHSI, the authors conducted a retrospective study of 126 high-risk preterm infants who underwent a screening brain MRI at near-term equivalent age. After dividing the infants based on the presence of DEHSI, they analyzed the association of MR findings with the presence of cerebral palsy and neurosensory impairment.
Results showed that DEHSI was present in 75 percent of the infants, but subsequent neurodevelopmental outcomes did not differ significantly between the two groups.
“Our results suggest that DEHSI may not reflect a specific white matter injury, but rather developmental changes resulting from preterm delivery into the extrauterine environment of the neonatal intensive care unit or modifiable white matter change,” wrote the authors.
Severe motor delay and cerebral palsy were more common in infants with both DEHSI and other white matter lesions such as cystic encephalomalacia or punctate lesions.
The authors indicated their study is limited by the fact that there was only a two year follow-up, while developmental assessments are more predictive of ultimate developmental achievement when administered at five to eight years of age.
“Consequently, continued follow-up of this study will provide data regarding the robustness of the effect of DEHSI on MR images on neurodevelopment,” wrote the authors.
Evan Godt, Writer
Evan joined TriMed in 2011, writing primarily for Health Imaging. Prior to diving into medical journalism, Evan worked for the Nine Network of Public Media in St. Louis. He also has worked in public relations and education. Evan studied journalism at the University of Missouri, with an emphasis on broadcast media.