Normal Brain Histopathology

doi:10.1016/B978-0-443-06982-6.00002-X

Practical Surgical Neuropathology

A Diagnostic Approach

2010, Pages 15-33

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MR diffusion changes in the perimeter of the lateral ventricles demonstrate periventricular injury in post-hemorrhagic hydrocephalus of prematurity
2019, NeuroImage: Clinical
Citation Excerpt :
Liu et al., 2016; Stoll et al., 2015) Unfortunately, up to 40% of these infants sustain intracranial hemorrhage within their germinal matrix, (Stoll et al., 2015) a periventricular region where the neural stem cells for cortical development reside. ( Brat, 2010; du Plessis, 2009) Commonly, germinal matrix hemorrhage extends into the cerebral ventricles to cause intraventricular hemorrhage (IVH, Inder et al., 2018, Mukerji et al., 2015) which is classified into four grades of severity. ( Inder et al., 2018; Papile et al., 1978) Grades I and II are considered ‘low-grade’, associated with neuromotor impairment in up to 33% of affected infants (Ancel et al., 2006; Sherlock et al., 2005) and carry a two-fold risk of poor cognitive outcomes. (
Injury to the preterm lateral ventricular perimeter (LVP), which contains the neural stem cells responsible for brain development, may contribute to the neurological sequelae of intraventricular hemorrhage (IVH) and post-hemorrhagic hydrocephalus of prematurity (PHH). This study utilizes diffusion MRI (dMRI) to characterize the microstructural effects of IVH/PHH on the LVP and segmented frontal-occipital horn perimeters (FOHP).
Prospective study of 56 full-term infants, 72 very preterm infants without brain injury (VPT), 17 VPT infants with high-grade IVH without hydrocephalus (HG-IVH), and 13 VPT infants with PHH who underwent dMRI at term equivalent. LVP and FOHP dMRI measures and ventricular size-dMRI correlations were assessed.
In the LVP, PHH had consistently lower FA and higher MD and RD than FT and VPT (p<.050). However, while PHH FA was lower, and PHH RD was higher than their respective HG-IVH measures (p<.050), the MD and AD values did not differ. In the FOHP, PHH infants had lower FA and higher RD than FT and VPT (p<.010), and a lower FA than the HG-IVH group (p<.001). While the magnitude of AD in both the LVP and FOHP were consistently less in the PHH group on pairwise comparisons to the other groups, the differences were not significant (p>.050). Ventricular size correlated negatively with FA, and positively with MD and RD (p<.001) in both the LVP and FOHP. In the PHH group, FA was lower in the FOHP than in the LVP, which was contrary to the observed findings in the healthy infants (p<.001). Nevertheless, there were no regional differences in AD, MD, and RD in the PHH group.
HG-IVH and PHH results in aberrant LVP/FOHP microstructure, with prominent abnormalities among the PHH group, most notably in the FOHP. Larger ventricular size was associated with greater magnitude of abnormality. LVP/FOHP dMRI measures may provide valuable biomarkers for future studies directed at improving the management and neurological outcomes of IVH/PHH.
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