RESUMEN
OBJECTIVES: To evaluate white matter (WM) microstructural changes in preterm neonates (PN) with mild germinal matrix-intraventricular haemorrhage (mGMH-IVH) (grades I and II) and no other associated MRI abnormalities, and correlate them with gestational age (GA) and neurodevelopmental outcome. METHODS: Tract-based spatial-statistics (TBSS) was performed on DTI of 103 patients studied at term-equivalent age, to compare diffusional parameters (fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD), axial diffusivity (AD)) between mGMH-IVH neonates (24/103) and controls matched by GA at birth and sex. The relationship between DTI abnormalities, GA and neurodevelopmental outcome assessed with Griffiths' Developmental Scale-Revised:0-2 was explored using TBSS and Spearman-correlation analysis (p < .05). RESULTS: Affected neonates had lower FA, higher RD and MD of the corpus callosum, limbic pathways and cerebellar tracts. Extremely preterm neonates (GA < 29 weeks) presented more severe microstructural impairment (higher RD and MD) in periventricular regions. Neonates of GA ≥ 29 weeks had milder WM alterations (lower FA), also in subcortical WM. DTI abnormalities were associated with poorer locomotor, eye-hand coordination and performance outcomes at 24 months. CONCLUSIONS: WM microstructural changes occur in PN with mGMH-IVH with a GA-dependent selective vulnerability of WM regions, and correlate with adverse neurodevelopmental outcome at 24 months. KEY POINTS: ⢠DTI-TBSS analysis identifies WM microstructural changes in preterm neonates with mGMH-IVH. ⢠Extremely preterm neonates with mGMH-IVH presented more severe impairment of WM microstructure. ⢠Extremely preterm neonates with mGMH-IVH presented microstructural impairment of periventricular WM. ⢠mGMH-IVH affects subcortical WM in preterm neonates with gestational age ≥ 29 weeks. ⢠WM microstructural alterations are related to neurodevelopmental impairments at 24 months.
Asunto(s)
Hemorragia Cerebral/diagnóstico por imagen , Imagen de Difusión Tensora/métodos , Enfermedades del Prematuro/diagnóstico por imagen , Sustancia Blanca/diagnóstico por imagen , Anisotropía , Cerebelo/diagnóstico por imagen , Desarrollo Infantil , Cuerpo Calloso/diagnóstico por imagen , Femenino , Estudios de Seguimiento , Edad Gestacional , Humanos , Recién Nacido , Recien Nacido Prematuro , Imagen por Resonancia Magnética , MasculinoRESUMEN
Mucolipidosis type IV (MLIV) is a very rare disorder of late endosome/lysosome transport, characterized by neurodevelopmental abnormalities and progressive visual impairment owing to corneal clouding and retinal dystrophy. Greater than 70 % of MLIV patients are of Ashkenazi Jewish ancestry. Here we report a novel MCOLN1double mutant allele [c.395_397delCTG;c.468_474dupTTGGACC] which introduces a premature stop codon [p.Ala132del; p.Asn159LeufsX27] leading to almost complete abrogation of the region coding mucolipin-1, a member of the transient receptor potential (TRP) cation channel family. The genomic lesion was identified in homozygous state, in a non-Jewish Italian MLIV patient, who also presented abnormal serum gastrin levels. Conventional and advanced MRI sequences, including diffusion tensor imaging and tractography, were used for the assessment of white matter involvement in the patient.