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      <h1 class="highwire-cite-title" id="page-title">On Behalf of Serial Imaging in Preterm Infants</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">J. Saraiva</span> and <span class="highwire-citation-author" data-delta="1">J.P. Soares-Fernandes</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">June 2024,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">45 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(6) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">E16; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A8223 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-108050--62007906457" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">J. Saraiva </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>Hospital de BragaBraga, Portugal</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.%2BSaraiva%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=Saraiva%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.%2BSaraiva%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/0000-0002-4219-7759" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for J. Saraiva</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">J.P. Soares-Fernandes </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>Hospital de BragaBraga, Portugal</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.P.%2BSoares-Fernandes%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=Soares-Fernandes%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 last"><a href="/search/author1%3AJ.P.%2BSoares-Fernandes%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div></div></div>  </div>

  
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    <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" data-highwire-cite-ref-tooltip-instance="highwire_reflinks_tooltip" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div class="article fulltext-view "><span class="highwire-journal-article-marker-start"></span><p id="p-1">We read with great interest the article by Roychaudhuri et al.<sup><a id="xref-ref-1-1" class="xref-bibr" href="#ref-1">1</a></sup> Having gathered a cohort of 30 preterm infants born at &lt;33 weeks’ gestational age, the authors found a strong correlation between the white matter injury (WMI) severity, as scored on brain MR imaging, at 2 time points: early (30–34 weeks’ postmenstrual age) and term-equivalent age (TEA). Specifically, approximately 80% of infants remained in the same WMI category from early to TEA assessments. Building on these results, the authors suggest performing early-brain MR imaging within 2 weeks after preterm birth. Despite acknowledging the potential prognostic value of an early-brain MR imaging, we are concerned about its applicability and propose a perhaps better-suited approach for less-resourced imaging centers.</p><p id="p-2">TEA-brain MR imaging is reliable at predicting motor outcome in infants with hypoxic-ischemic encephalopathy. The call for an early-brain MR imaging in premature infants is based on 2 premises: 1) We are not good at predicting nonmotor outcomes, and 2) MR imaging is superior to cranial ultrasound (CUS) at depicting noncystic WMI, notably diffuse periventricular leukomalacia (PVL) and punctate white matter lesions (PWMLs), which may be inconspicuous on TEA-brain MR imaging, yet still suspected to impair cognition.</p><p id="p-3">PWMLs have been reported to be the most frequent lesion type (41%) in premature infants, most of whom had other brain abnormalities.<sup><a id="xref-ref-2-1" class="xref-bibr" href="#ref-2">2</a></sup> We speculate that some of these additional lesions would be highly specific for abnormal cognitive outcomes (eg, hemorrhagic parenchymal infarction, cerebellar hemorrhage &gt;5 mm<sup>2</sup>) and are easily outlined on CUS.</p><p id="p-4">Given the presumable ischemic pathophysiology of diffuse PVL, we were intrigued by the low prevalence (&lt;7%) of diffusion-restricted lesions on the initial MR imaging, even though a sizable portion of infants (10 of 30) had a moderate/severe WMI on the later MR imaging; this issue seems to disclose the limited added value, grounded on a brief DWI abnormality and fast ADC pseudonormalization, of performing a complex grading system on a somewhat arbitrarily defined–and dependent on the preterm infant’s clinical stability–early-brain MR imaging compared with sequential CUSs.</p><p id="p-5">Most interesting, early confluent DWI hyperintensities–but not focal ones–have been shown to precede cystic degeneration.<sup><a id="xref-ref-3-1" class="xref-bibr" href="#ref-3">3</a></sup> We believe that optimizing diffusion sequences for portable MR imaging systems<sup><a id="xref-ref-4-1" class="xref-bibr" href="#ref-4">4</a></sup> may be a “game changer” by enabling serial monitoring for confluent diffusion-restricted lesions, efficiently forecasting cystic WMI in at-risk premature infants.</p><div class="section fn-group" id="fn-group-1"><h2>Footnotes</h2><ul><li class="fn-financial-disclosure" id="fn-1"><p id="p-6"><a href="https://www.ajnr.org/sites/default/files/additional-assets/Disclosures/June%202024/0082.pdf">Disclosure forms</a> provided by the authors are available with the full text and PDF of this article at <a href="http://www.ajnr.org">www.ajnr.org</a>.</p></li></ul></div><div class="section ref-list" id="ref-list-1"><h2 class="">References</h2><ol class="cit-list ref-use-labels"><li><span class="ref-label">1.</span><a class="rev-xref-ref" href="#xref-ref-1-1" title="View reference 1. in text" id="ref-1">↵</a><div class="cit ref-cit ref-journal" id="cit-45.6.E16.1" data-doi="10.3174/ajnr.A8105"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Roychaudhuri</span>  <span class="cit-name-given-names">S</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Côté-Corriveau</span>  <span class="cit-name-given-names">G</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Erdei</span>  <span class="cit-name-given-names">C</span></span>, <span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">White matter injury on early versus-term-equivalent age brain MRI in infants born preterm</span>. <abbr class="cit-jnl-abbrev">AJNR Am J Neuroradiol</abbr> <span class="cit-pub-date">2024</span>;<span class="cit-vol">45</span>:<span class="cit-fpage">224</span>–<span class="cit-lpage">28</span><span class="cit-pub-id-sep cit-pub-id-doi-sep"> </span><span class="cit-pub-id cit-pub-id-doi"><span class="cit-pub-id-scheme-doi">doi:</span>10.3174/ajnr.A8105</span><span class="cit-pub-id-sep cit-pub-id-pmid-sep"> </span><span class="cit-pub-id cit-pub-id-pmid"><span class="cit-pub-id-scheme-pmid">pmid:</span>38216303</span></cite></div><div class="cit-extra"><a href="/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiYWpuciI7czo1OiJyZXNpZCI7czo4OiI0NS8yLzIyNCI7czo0OiJhdG9tIjtzOjE5OiIvYWpuci80NS82L0UxNi5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=" class="cit-ref-sprinkles cit-ref-sprinkles-ijlink"><span><span class="cit-reflinks-abstract">Abstract</span><span class="cit-sep cit-reflinks-variant-name-sep">/</span><span class="cit-reflinks-full-text"><span class="free-full-text">FREE </span>Full Text</span></span></a></div></div></li><li><span class="ref-label">2.</span><a class="rev-xref-ref" href="#xref-ref-2-1" title="View reference 2. in text" id="ref-2">↵</a><div class="cit ref-cit ref-journal" id="cit-45.6.E16.2" data-doi="10.3174/ajnr.A6666"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Arulkumaran</span>  <span class="cit-name-given-names">S</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Tusor</span>  <span class="cit-name-given-names">N</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Chew</span>  <span class="cit-name-given-names">A</span></span>, <span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">MRI findings at term-corrected age and neurodevelopmental outcomes in a large cohort of very preterm infants</span>. <abbr class="cit-jnl-abbrev">AJNR Am J Neuroradiol</abbr> <span class="cit-pub-date">2020</span>;<span class="cit-vol">41</span>:<span class="cit-fpage">1509</span>–<span class="cit-lpage">16</span><span class="cit-pub-id-sep cit-pub-id-doi-sep"> </span><span class="cit-pub-id cit-pub-id-doi"><span class="cit-pub-id-scheme-doi">doi:</span>10.3174/ajnr.A6666</span><span class="cit-pub-id-sep cit-pub-id-pmid-sep"> </span><span class="cit-pub-id cit-pub-id-pmid"><span class="cit-pub-id-scheme-pmid">pmid:</span>32796100</span></cite></div><div class="cit-extra"><a href="/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiYWpuciI7czo1OiJyZXNpZCI7czo5OiI0MS84LzE1MDkiO3M6NDoiYXRvbSI7czoxOToiL2FqbnIvNDUvNi9FMTYuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9" class="cit-ref-sprinkles cit-ref-sprinkles-ijlink"><span><span class="cit-reflinks-abstract">Abstract</span><span class="cit-sep cit-reflinks-variant-name-sep">/</span><span class="cit-reflinks-full-text"><span class="free-full-text">FREE </span>Full Text</span></span></a></div></div></li><li><span class="ref-label">3.</span><a class="rev-xref-ref" href="#xref-ref-3-1" title="View reference 3. in text" id="ref-3">↵</a><div class="cit ref-cit ref-journal" id="cit-45.6.E16.3" data-doi="10.1371/journal.pone.0156245"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Martinez-Biarge</span>  <span class="cit-name-given-names">M</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Groenendaal</span>  <span class="cit-name-given-names">F</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Kersbergen</span>  <span class="cit-name-given-names">KJ</span></span>, <span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">MRI based preterm white matter injury classification: the importance of sequential imaging in determining severity of injury</span>. <abbr class="cit-jnl-abbrev">PLoS One</abbr> <span class="cit-pub-date">2016</span>;<span class="cit-vol">11</span>:<span class="cit-fpage">e0156245</span><span class="cit-pub-id-sep cit-pub-id-doi-sep"> </span><span class="cit-pub-id cit-pub-id-doi"><span class="cit-pub-id-scheme-doi">doi:</span>10.1371/journal.pone.0156245</span><span class="cit-pub-id-sep cit-pub-id-pmid-sep"> </span><span class="cit-pub-id cit-pub-id-pmid"><span class="cit-pub-id-scheme-pmid">pmid:</span>27257863</span></cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.1371/journal.pone.0156245&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=27257863&amp;link_type=MED&amp;atom=%2Fajnr%2F45%2F6%2FE16.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><span class="ref-label">4.</span><a class="rev-xref-ref" href="#xref-ref-4-1" title="View reference 4. in text" id="ref-4">↵</a><div class="cit ref-cit ref-journal" id="cit-45.6.E16.4" data-doi="10.1016/j.eclinm.2023.102253"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Cawley</span>  <span class="cit-name-given-names">P</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Padormo</span>  <span class="cit-name-given-names">F</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Cromb</span>  <span class="cit-name-given-names">D</span></span>, <span class="cit-etal">et al</span></li></ol><cite>; <span class="cit-auth cit-collab">UNITY Consortium</span>. <span class="cit-article-title">Development of neonatal-specific sequences for portable ultralow field magnetic resonance brain imaging: a prospective, single-centre, cohort study</span>. <abbr class="cit-jnl-abbrev">EClinicalMedicine</abbr> <span class="cit-pub-date">2023</span>;<span class="cit-vol">65</span>:<span class="cit-fpage">102253</span><span class="cit-pub-id-sep cit-pub-id-doi-sep"> </span><span class="cit-pub-id cit-pub-id-doi"><span class="cit-pub-id-scheme-doi">doi:</span>10.1016/j.eclinm.2023.102253</span><span class="cit-pub-id-sep cit-pub-id-pmid-sep"> </span><span class="cit-pub-id cit-pub-id-pmid"><span class="cit-pub-id-scheme-pmid">pmid:</span>38106560</span></cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.1016/j.eclinm.2023.102253&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=38106560&amp;link_type=MED&amp;atom=%2Fajnr%2F45%2F6%2FE16.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li></ol></div><ul class="copyright-statement"><li class="fn" id="copyright-statement-1">© 2024 by American Journal of Neuroradiology</li></ul><span class="highwire-journal-article-marker-end"></span></div><span class="related-urls"></span></div></div>  </div>

  
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        	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-volume highwire-cite-metadata">Vol. 45</span>, <span  class="highwire-cite-metadata-issue highwire-cite-metadata">Issue 6 </span><div  class="highwire-cite-metadata-pubdate highwire-cite-metadata">1 Jun 2024 </div></div>
      
      
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