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<meta name="DC.Title" content="Cerebral Perfusion Is Perturbed by Preterm Birth and Brain Injury" />
<meta name="DC.Identifier" content="10.3174/ajnr.A5669" />
<meta name="DC.Date" content="2018-07-01" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
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<meta name="DC.Description" content="BACKGROUND AND PURPOSE: Early disturbances in systemic and cerebral hemodynamics are thought to mediate prematurity-related brain injury. However, the extent to which CBF is perturbed by preterm birth is unknown. Our aim was to compare global and regional CBF in preterm infants with and without brain injury on conventional MR imaging using arterial spin-labeling during the third trimester of ex utero life and to examine the relationship between clinical risk factors and CBF.

MATERIALS AND METHODS: We prospectively enrolled preterm infants younger than 32 weeks' gestational age and &lt;1500 g and performed arterial spin-labeling MR imaging studies. Global and regional CBF in the cerebral cortex, thalami, pons, and cerebellum was quantified. Preterm infants were stratified into those with and without structural brain injury. We further categorized preterm infants by brain injury severity: moderate-severe and mild.

RESULTS: We studied 78 preterm infants: 31 without brain injury and 47 with brain injury (29 with mild and 18 with moderate-severe injury). Global CBF showed a borderline significant increase with increasing gestational age at birth ( P = .05) and trended lower in preterm infants with brain injury ( P = .07). Similarly, regional CBF was significantly lower in the right thalamus and midpons ( P &lt; .05) and trended lower in the midtemporal, left thalamus, and anterior vermis regions ( P &lt; .1) in preterm infants with brain injury. Regional CBF in preterm infants with moderate-severe brain injury trended lower in the midpons, right cerebellar hemisphere, and dentate nuclei compared with mild brain injury ( P &lt; .1). In addition, a significant, lower regional CBF was associated with ventilation, sepsis, and cesarean delivery ( P &lt; .05).

CONCLUSIONS: We report early disturbances in global and regional CBF in preterm infants following brain injury. Regional cerebral perfusion alterations were evident in the thalamus and pons, suggesting regional vulnerability of the developing cerebro-cerebellar circuitry.

ASL
:   arterial spin-labeling
BI
:   brain injury
DLPF
:   dorsolateral prefrontal
GA
:   gestational age
IO
:   inferior occipital
MT
:   midtemporal
PM
:   premotor
PO
:   parieto-occipital
PT
:   preterm
T1b
:   blood longitudinal relaxation time" />
<meta name="DC.Contributor" content="E.S. Mahdi" />
<meta name="DC.Contributor" content="M. Bouyssi-Kobar" />
<meta name="DC.Contributor" content="M.B. Jacobs" />
<meta name="DC.Contributor" content="J. Murnick" />
<meta name="DC.Contributor" content="T. Chang" />
<meta name="DC.Contributor" content="C. Limperopoulos" />
<meta name="article:published_time" content="2018-07-01" />
<meta name="article:section" content="Pediatrics" />
<meta name="citation_title" content="Cerebral Perfusion Is Perturbed by Preterm Birth and Brain Injury" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;Early disturbances in systemic and cerebral hemodynamics are thought to mediate prematurity-related brain injury. However, the extent to which CBF is perturbed by preterm birth is unknown. Our aim was to compare global and regional CBF in preterm infants with and without brain injury on conventional MR imaging using arterial spin-labeling during the third trimester of ex utero life and to examine the relationship between clinical risk factors and CBF.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;We prospectively enrolled preterm infants younger than 32 weeks9 gestational age and &amp;lt;1500 g and performed arterial spin-labeling MR imaging studies. Global and regional CBF in the cerebral cortex, thalami, pons, and cerebellum was quantified. Preterm infants were stratified into those with and without structural brain injury. We further categorized preterm infants by brain injury severity: moderate-severe and mild.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;We studied 78 preterm infants: 31 without brain injury and 47 with brain injury (29 with mild and 18 with moderate-severe injury). Global CBF showed a borderline significant increase with increasing gestational age at birth (&lt;i&gt;P&lt;/i&gt; = .05) and trended lower in preterm infants with brain injury (&lt;i&gt;P&lt;/i&gt; = .07). Similarly, regional CBF was significantly lower in the right thalamus and midpons (&lt;i&gt;P&lt;/i&gt; &amp;lt; .05) and trended lower in the midtemporal, left thalamus, and anterior vermis regions (&lt;i&gt;P&lt;/i&gt; &amp;lt; .1) in preterm infants with brain injury. Regional CBF in preterm infants with moderate-severe brain injury trended lower in the midpons, right cerebellar hemisphere, and dentate nuclei compared with mild brain injury (&lt;i&gt;P&lt;/i&gt; &amp;lt; .1). In addition, a significant, lower regional CBF was associated with ventilation, sepsis, and cesarean delivery (&lt;i&gt;P&lt;/i&gt; &amp;lt; .05).&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;We report early disturbances in global and regional CBF in preterm infants following brain injury. Regional cerebral perfusion alterations were evident in the thalamus and pons, suggesting regional vulnerability of the developing cerebro-cerebellar circuitry.&lt;/p&gt;" />
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<meta name="twitter:title" content="Cerebral Perfusion Is Perturbed by Preterm Birth and Brain Injury" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: Early disturbances in systemic and cerebral hemodynamics are thought to mediate prematurity-related brain injury. However, the extent to which CBF is perturbed by preterm birth is unknown. Our aim was to compare global and regional CBF in preterm infants with and without brain injury on conventional MR imaging using arterial spin-labeling during the third trimester of ex utero life and to examine the relationship between clinical risk factors and CBF.

MATERIALS AND METHODS: We prospectively enrolled preterm infants younger than 32 weeks' gestational age and &lt;1500 g and performed arterial spin-labeling MR imaging studies. Global and regional CBF in the cerebral cortex, thalami, pons, and cerebellum was quantified. Preterm infants were stratified into those with and without structural brain injury. We further categorized preterm infants by brain injury severity: moderate-severe and mild.

RESULTS: We studied 78 preterm infants: 31 without brain injury and 47 with brain injury (29 with mild and 18 with moderate-severe injury). Global CBF showed a borderline significant increase with increasing gestational age at birth ( P = .05) and trended lower in preterm infants with brain injury ( P = .07). Similarly, regional CBF was significantly lower in the right thalamus and midpons ( P &lt; .05) and trended lower in the midtemporal, left thalamus, and anterior vermis regions ( P &lt; .1) in preterm infants with brain injury. Regional CBF in preterm infants with moderate-severe brain injury trended lower in the midpons, right cerebellar hemisphere, and dentate nuclei compared with mild brain injury ( P &lt; .1). In addition, a significant, lower regional CBF was associated with ventilation, sepsis, and cesarean delivery ( P &lt; .05).

CONCLUSIONS: We report early disturbances in global and regional CBF in preterm infants following brain injury. Regional cerebral perfusion alterations were evident in the thalamus and pons, suggesting regional vulnerability of the developing cerebro-cerebellar circuitry.

ASL
:   arterial spin-labeling
BI
:   brain injury
DLPF
:   dorsolateral prefrontal
GA
:   gestational age
IO
:   inferior occipital
MT
:   midtemporal
PM
:   premotor
PO
:   parieto-occipital
PT
:   preterm
T1b
:   blood longitudinal relaxation time" />
<meta name="og-title" property="og:title" content="Cerebral Perfusion Is Perturbed by Preterm Birth and Brain Injury" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/39/7/1330" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: Early disturbances in systemic and cerebral hemodynamics are thought to mediate prematurity-related brain injury. However, the extent to which CBF is perturbed by preterm birth is unknown. Our aim was to compare global and regional CBF in preterm infants with and without brain injury on conventional MR imaging using arterial spin-labeling during the third trimester of ex utero life and to examine the relationship between clinical risk factors and CBF.

MATERIALS AND METHODS: We prospectively enrolled preterm infants younger than 32 weeks' gestational age and &lt;1500 g and performed arterial spin-labeling MR imaging studies. Global and regional CBF in the cerebral cortex, thalami, pons, and cerebellum was quantified. Preterm infants were stratified into those with and without structural brain injury. We further categorized preterm infants by brain injury severity: moderate-severe and mild.

RESULTS: We studied 78 preterm infants: 31 without brain injury and 47 with brain injury (29 with mild and 18 with moderate-severe injury). Global CBF showed a borderline significant increase with increasing gestational age at birth ( P = .05) and trended lower in preterm infants with brain injury ( P = .07). Similarly, regional CBF was significantly lower in the right thalamus and midpons ( P &lt; .05) and trended lower in the midtemporal, left thalamus, and anterior vermis regions ( P &lt; .1) in preterm infants with brain injury. Regional CBF in preterm infants with moderate-severe brain injury trended lower in the midpons, right cerebellar hemisphere, and dentate nuclei compared with mild brain injury ( P &lt; .1). In addition, a significant, lower regional CBF was associated with ventilation, sepsis, and cesarean delivery ( P &lt; .05).

CONCLUSIONS: We report early disturbances in global and regional CBF in preterm infants following brain injury. Regional cerebral perfusion alterations were evident in the thalamus and pons, suggesting regional vulnerability of the developing cerebro-cerebellar circuitry.

ASL
:   arterial spin-labeling
BI
:   brain injury
DLPF
:   dorsolateral prefrontal
GA
:   gestational age
IO
:   inferior occipital
MT
:   midtemporal
PM
:   premotor
PO
:   parieto-occipital
PT
:   preterm
T1b
:   blood longitudinal relaxation time" />
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    <div class="highwire-article-citation highwire-citation-type-highwire-article node61856--7" data-node-nid="61856" id="top-node-61856--8588562795" data-pisa="ajnr;39/7/1330" data-pisa-master="ajnr;ajnr.A5669" data-apath="/ajnr/39/7/1330.atom" data-hw-author-tooltip-instance="highwire_author_tooltip"><div class="highwire-cite highwire-cite-highwire-article highwire-citation-jcore-article-title-complete clearfix has-author-tooltip highwire-citation-highwire-article-top-a">
  
  
      <div class="highwire-cite-overline"><span  class="highwire-cite-metadata-article-type highwire-cite-metadata">Research Article</span><span class="separator-pipe"></span><span  class="highwire-cite-metadata-art-cat highwire-cite-metadata"><span class="wrapper">Pediatrics</span></span></div>
  
      <div class="highwire-cite-access"><span class="highwire-citation-access"><i class="highwire-access-icon highwire-access-icon-open-access open-access hw-icon-open-access" title="Open Access" aria-hidden="true"></i><span  class="element-invisible highwire-access-icon highwire-access-icon-open-access" style="">Open Access</span></span></div>
  
      <h1 class="highwire-cite-title" id="page-title">Cerebral Perfusion Is Perturbed by Preterm Birth and Brain Injury</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">E.S. Mahdi</span>, <span class="highwire-citation-author" data-delta="1">M. Bouyssi-Kobar</span>, <span class="highwire-citation-author" data-delta="2">M.B. Jacobs</span>, <span class="highwire-citation-author" data-delta="3">J. Murnick</span>, <span class="highwire-citation-author" data-delta="4">T. Chang</span> and <span class="highwire-citation-author" data-delta="5">C. Limperopoulos</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">July 2018,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">39 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(7) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1330-1335; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A5669 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-61856--8588562795" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">E.S. Mahdi </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Developing Brain Research Program (E.S.M., M.B.-K., J.M., C.L.), Department of Diagnostic Imaging and Radiology</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=E.S.%2BMahdi%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Mahdi%20E&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AE.S.%2BMahdi%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-5727-4681" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for E.S. Mahdi</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">M. Bouyssi-Kobar </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Developing Brain Research Program (E.S.M., M.B.-K., J.M., C.L.), Department of Diagnostic Imaging and Radiology</div><div class='author-affiliation'><span class='nlm-sup'>b</span>Department of Neurology (T.C.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=M.%2BBouyssi-Kobar%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Bouyssi-Kobar%20M&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AM.%2BBouyssi-Kobar%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0001-9526-2182" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for M. Bouyssi-Kobar</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">M.B. Jacobs </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>c</span>Department of Epidemiology and Biostatistics (M.B.J.), Children's Research Institute, Children's National Health System, Washington, DC</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=M.B.%2BJacobs%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Jacobs%20M&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AM.B.%2BJacobs%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0001-6649-6692" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for M.B. Jacobs</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">J. Murnick </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Developing Brain Research Program (E.S.M., M.B.-K., J.M., C.L.), Department of Diagnostic Imaging and Radiology</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=J.%2BMurnick%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Murnick%20J&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AJ.%2BMurnick%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0003-0582-428X" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for J. Murnick</a></li></ul></div><div class="author-tooltip-4"><div class="author-tooltip-name">T. Chang </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Department of Neurology (T.C.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=T.%2BChang%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Chang%20T&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AT.%2BChang%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-1797-8449" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for T. Chang</a></li></ul></div><div class="author-tooltip-5"><div class="author-tooltip-name">C. Limperopoulos </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Developing Brain Research Program (E.S.M., M.B.-K., J.M., C.L.), Department of Diagnostic Imaging and Radiology</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=C.%2BLimperopoulos%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Limperopoulos%20C&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AC.%2BLimperopoulos%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0003-1735-0069" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for C. Limperopoulos</a></li></ul></div></div></div>  </div>

  
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    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">E.S.</span> <span class="nlm-surname">Mahdi</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">M.</span> <span class="nlm-surname">Bouyssi-Kobar</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">M.B.</span> <span class="nlm-surname">Jacobs</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">J.</span> <span class="nlm-surname">Murnick</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">T.</span> <span class="nlm-surname">Chang</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">C.</span> <span class="nlm-surname">Limperopoulos</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-oa-ind highwire-cite-metadata"><i class="highwire-oa-indicator"></i> </span><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Jul 2018, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">39 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(7) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1330-1335; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A5669 </span></div>
  
  
  
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