Prediction of motor outcome in preterm infants with punctate white matter lesions using term equivalent age MRI

Introduction

This study assessed whether magnetic resonance imaging (MRI) at term equivalent age (TEA-MRI) is as predictive as preterm MRI, when using a white matter imaging rule which scores punctate white matter lesions (PWMLs) according to their location anterior or posterior to the midventricular line in a transverse plane. In addition, we assessed the number of PWMLs and their location in the coronal and sagittal planes.

Methods

Retrospective study, 41 preterm neonates <32 weeks' gestation with PWMLs on TEA-MRI and follow-up at two years corrected and/or 5–8 years of age. Scans were analysed in all planes, follow-up was assessed using standardized tests.

Results

18/41 infants (44 %) had adverse motor outcome, six had cerebral palsy (CP). In the transverse plane, 13/21 (62 %) infants with PWMLs anterior to the midventricular line, had adverse outcome and six (29 %) CP. In the coronal plane, 11/18 (61 %) with lesions crossing the posterior limb of internal capsule, had adverse motor outcome and five (28 %) CP. In the sagittal plane, 11/14 (79 %) infants with lesions crossing the central sulcus, had adverse motor outcome and six (43 %) CP. On the TEA-MRI, lesions anterior to the midventricular line in the transverse plane were predictive of adverse motor outcome. Involvement of the central sulcus in the sagittal plane had the highest predictive value.

Conclusion

The white matter imaging rule on preterm MRI is also of predictive value for motor outcome when used on the TEA-MRI. PWML location relative to the central sulcus in the sagittal plane was most predictive of adverse motor outcome.