Brain volumetric MRI study of extremely low gestational age newborns (ELGANs) at 9 to 10 years of age

PURPOSE: Extremely low gestation age newborns (ELGANs) are at high risk for developmental brain abnormalities, which can lead to cognitive, physical, emotional and behavioral deficits. This study is to determine potential brain volumetric abnormalities of ELGAN children at 9 to 10 years of age. METHODS: High-resolution magnetic resonance imaging (MRI) scans were obtained from 82 ELGAN children using a dual-echo turbo spin-echo (DE-TSE) pulse sequence at 3.0T (or 1.5T at only one site). The DICOM MR images were processed with quantitative MRI algorithms programmed in Mathcad. The brain gray matter (GM), white matter (WM) and cerebrospinal fluid (CSF) volumes were quantified using semi-automated clustering segmentation algorithms. RESULTS: Total brain volumes (GM+WM) of ELGAN children showed a large distribution range from 400 to 1500 mL. About 63% of the children had smaller brain volumes while 5% of them had larger brain volumes compared to the published data from normal children at the same ages1. Smaller brain volumes were observed more often in males (74%) than in females (50%). WM reduction was the major change in ELGANs with over 90% of them (86% of males and 92% of females) having reduced WM volumes. GM volumes were either reduced (15%) or enlarged (32%); GM reduction was observed more often in males (31%) than in females (4.8%), while GM enlargement was more frequently observed in females (35%) than in males (28%). Intracranial CSF volumes range from 25 mL to 600 mL, with 16% of ELGAN children (9% of males and 21% of females) having smaller CSF volume, while 38% of them (53% of males and 27% of females) having larger CSF volume. Correlation analysis revealed a positive correlation between total intracranial matter (ICM) and CSF volumes (male: r = 0.4972, p = 0.0014 and female: r = 0.3233, p = 0.0125), but a negative correlation was found between brain volumes and CSF volumes (male: r = - 0.2998, p = 0.0424 and female: r = - 0.2279, p = 0.0596). Further analysis demonstrated a negative correlation between GM and CSF both in absolute (male: r = - 0.4489, p = 0.0039 and female: r = - 0.3769, p = 0.0041) and in relative (male: r = - 0.8675, p = 0.0000 and female: r = - 0.8350, p = 0.0000) volumes, while WM volumes did not correlate with CSF volumes. CONCLUSION: ELGAN children had mostly smaller brain volumes while some of them displayed larger brain volumes at ages of 9 to 10 years. The reduction of WM was a characteristic change in ELGAN children and contributed to smaller brain volumes. GM volumes either increased or decreased. Larger intracranial CSF volumes were associated with larger intracranial matter (ICM) volume