Application Value Of TMS And DTI By MRI In Brain Injury In Premature Infants With Very Low Birth Weight

Part one: The Correlation of TMS by Magnetic Resonance Imaging in the Evaluation of Brain Injury in Premature Infants with Very Low Birth WeightObjective: This retrospective study analyzed the clinical characteristics and total maturation score(TMS)by magnetic resonance imaging(MRI)at term corrected gestational age(CGA)of BIPI with very low birth weight(VLBW).To study the application value of TMS in evaluating BIPI with VLBW,and to explore and improve early diagnosis,treatment and intervention method in BIPI with VLBW.Methods: In this retrospective study,65 cases of BIPI with VLBW in the control group were collected,40 nomal cases with low birth weight(LBW)in the control group,all cases underwent brain MRI examination and TMS at term CGA,and follow-up datas after birth were complete.Compare the differences in clinical characteristics between the two groups,clinical characteristics included that gestational age,birth weight,mode of delivery(natural delivery/cesarean section),Apgar score 1 minute,first pregnancy(yes/no),Apgar score 5 minute,gender(male/femal),mother's age,and complications during mother's pregnancy(yes/no).Analyze the TMS differences between the BIPI with VLBW and the control group at CGA.Analyze the differences in the sub-items(myelination,cortical infolding,germinal matrix,and bands of migrating glial cells)scores of TMS at CGA.Analysis correlation between TMS total scores and CGA of normal preterm infants with LBW in the control group.Results: The gestational age,birth weight,Apgar score 1 minute,Apgar score 5minute,mode of delivery(natural delivery/cesarean section),first pregnancy(yes/no)maternal complications during pregnancy(yes/no)were statistically different in the BIPI group and the control group(P< 0.05).The mother's age,gender,twins(yes/no),IVF-ET(yes/no)was no statistical difference in two groups(P>0.05).The TMS total score at CGA in BIPI with VLBW was lower than the control group and had a statistically significant difference(P<0.01).The myelination degree score and cortical folding score at CGA in BIPI with VLBW was lower than the control group and had a significant differences between the two groups(P<0.05).There was no significant difference in the embryonic germinal matrix score and the glial cell migration zone score between the two groups at CGA(P>0.05).The TMS total score of normal preterm infants with LBW was positively correlated with the CGA(P<0.01).The linear regression equation is: y=1.164x-28.888,t=8.478,P=0.000.The TMS total score increases with the CGA.Conlusion: The TMS total score,myelination degree score and cortical folding score of BIPI with VLBW at CGA can objectively and quantitatively evaluate the brain injury in BIPI with VLBW.There is a positive correlation between the TMS total score and the CGA of normal preterm infants with low birth weight(LBW),TMS total score can objectively and quantitatively reflect the brain development and maturity of preterm infants with LBW.Part two: Application of Diffusion Tensor Imaging in the Evaluation of Brain Injury in Premature Infants with Low and Very Low Birth WeightObjective: This study analyzed the clinical characteristics,and diffusion tensor imaging(DTI)datas by magnetic resonance imaging(MRI)of BIPI with VLBW and LBW,and explored application and quantitative assessment methods of DTI in the evaluation of BIPI with VLBW and LBW,and to improve the diagnosis and treatment level.Methods: A total of 51 premature infants with LBW and VLBW were collected in this study,including 31 cases in the BIPI case group,and 20 normal cases in the control group.All the cases underwent MRI and DTI examination at term corrected gestational age(CGA),clinical data and(neonatal behaviour neurological assessment,NBNA)follow-up datas after birth were complete.Compare the differences in clinical characteristics between the two groups,clinical characteristics included that gestational age,birth weight,mode of delivery(normal delivery/cesarean section),first pregnancy(yes/no),Apgar score 1 minute,Apgar score 5 minute,gender(male/femal),mother's age,complications during mother's pregnancy(yes/no).Analyze and compare the fractional anisotropy(FA)values and apparent diffusion coefficient(ADC)values in the central white matter of the frontal lobe,the central white matter of the occipital lobe,centrum semiovale,posterior limb of internal capsule(PLIC),and ventral thalamus between the BIPI group and the control group.Compare FA value and ADC value in the central white matter of the frontal lobe,the central white matter of the occipital lobe,centrum semiovale,PLIC,and ventral thalamus between the LBW subgroup and VLBW subgroup in the BIPI group.Analyze the difference of FA value and ADC value in the central white matter of the frontal lobe,the central white matter of the occipital lobe,centrum semiovale,PLIC,and ventral thalamus in the normal control group.Results: There were statistically significant differences between the BIPI group and the control group in complications during mother's pregnancy(yes/no)(P<0.01).There were no differences in g gestational age,birth weight,mode of delivery(normal delivery/cesarean section),first pregnancy(yes/no),Apgar score 1 minute,Apgar score 5 minute,gender(male/femal),and mother's age(P>0.05).The FA values of central white matter of frontal lobe,central white matter of occipital lobe,centrum semiovale,PLIC,and ventral thalamus in the BIPI group were significantly lower than those of the control group(P<0.05);ADC values were higher compared with the control group,there was a statistical difference(P<0.05).Comparison of FA and ADC values in central white matter of frontal lobe,central white matter of occipital lobe,centrum semiovale,PLIC,and ventral thalamus with BIPI between LBW and VLBW groups,FA and ADC values did not show statistically significant difference(P>0.05).The FA value of the normal control group is different in different part,PLIC is larger than the ventral thalamus,centrum semiovale,the central white matter of the occipital lobe,and the central white matter of the frontal lobe.The ADC value of each brain part is also different in the normal control group,ventral thalamus is lower PLIC,centrum semiovale,the central white matter of the occipital lobe,and the central white matter of the frontal lobe.Conlusion: The FA and ADC value of DTI can be used for quantitative evaluation of BIPI with LBW and VLBW,the FA value is more accurate than the ADC value.Different FA values in different areas of normal premature infants reflect the differences in brain development.Part three: Correlation between TMS by MRI and Prognosis in Brain Injury in Premature Infants with Very Low Birth WeightObjective: This retrospective collected the clinical characteristics,total maturation score(TMS)at term corrected gestational age(CGA)by magnetic resonance imaging(MRI),and Gesell developmental scale follow-up score datas of BIPI with VLBW.To explore the application and prognosis value of TMS by MRI at CGA in evaluating the growth and development of BIPI with VLBW,futher to improve the methods and approaches for early diagnosis,treatment and intervention of BIPI with VLBW.Methods: Respective collected 57 BIPI with VLBW and Gesell developmental scale showed mental retardation in the case group,38 normal premature infants with low birth weight(LBW)in the control group.All the cases underwent MRI scans and TMS at CGA.The data and Gessell growth and development score follow-up data were complete.The differences in clinical characteristics between the two groups were analyzed and compared.The clinical characteristics included that gestational age,birth weight,mode of delivery(natural delivery/cesarean section),Apgar score 1 minute,first pregnancy(yes/no),Apgar score 5 minute,gender,twins(yes/no),in vitro fertilization and embryo transfer(IVF-ET)(yes/no),mother's age,maternal comorbidities during pregnancy(yes/no).TMS total score at CGA between the case group and the control group were analyzed and compared.Statistical differences in each sub-score(degree of myelination,cortical folding,embryonic germinal matrix,glial cell migration zone)TMS score at CGA between the two group were analyzed and compared.Logistic regression was used to analyze gestational age,birth weight,mode of delivery(natural delivery/cesarean section),Apgar score 1 minute,first pregnancy(yes/no),Apgar score 5 minute,gender,twins(yes/no),IVF-ET(yes/no),maternal age,maternal comorbidities during pregnancy(yes/no),TMS score and TMS sub-score and analyzed early predictors related to brain development prognosis.Results: There was a statistical difference in the gestational age,birth weight,Apgar score 1 minute,Apgar score 5 minute,mother's age,first pregnancy(yes/no),maternal combined pregnancy between the case and control groups(P<0.05).The weight at CGA,gender,mode of delivery(natural delivery/cesarean section),twins(yes/no),IVF-ET(yes/no)had no statistical difference(P>0.05).TMS total score of BIPI with VLBW at CGA was lower than that of the control group with a significant statistically difference(P<0.01).The myelination degree score at case group was lower than the control group and had a a statistically differences between the two groups(P<0.05).The cortical folding score at case group was lower than the control group and had a significant statistically between the two groups(P<0.01).There was no significant difference in the embryonic germinal matrix score and the glial cell migration zone score between the brain injury group and the control group(P>0.01).Logistic regression analysis showed that cortical folding(C)score by MRI at GCA(OR=5.50,95% CI: 1.65-18.42)and maternal comorbidities during pregnancy(OR=9.19,95% CI: 2.81-30.02)were were early predictors of brain development in BIPI with VLBW.Conlusion: The TMS total score,myelination degree score and cortical folding score at term CGA can objectively and quantitatively evaluate the brain development and damage of BIPI with VLBW.The cortical folding score and maternal comorbidities can be used as an early indicator for evaluating the prognosis of BIPI with VLBW.