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White Matter Injury of Prematurity
Luke L. Linscott, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            TERMINOLOGY

            • Abbreviations

              • White matter (WM) injury of prematurity
            • Synonyms

              • Periventricular leukomalacia (PVL)
                • Cystic PVL; noncystic PVL
              • Punctate WM lesions
            • Definitions

              • Perinatal WM injury occurring before 34 weeks gestation
                • Affected WM not always periventricular/deep

            IMAGING

            • General Features

              • Ultrasonographic Findings

                • CT Findings

                  • MR Findings

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Staging, Grading, & Classification

                            • Gross Pathologic & Surgical Features

                              • Microscopic Features

                                CLINICAL ISSUES

                                • Presentation

                                  • Demographics

                                    • Natural History & Prognosis

                                      • Treatment

                                        DIAGNOSTIC CHECKLIST

                                        • Consider

                                          • Image Interpretation Pearls

                                            Selected References

                                            1. Barnett ML et al: Exploring the multiple-hit hypothesis of preterm white matter damage using diffusion MRI. Neuroimage Clin. 17:596-606, 2018
                                            2. Back SA: White matter injury in the preterm infant: pathology and mechanisms. Acta Neuropathol. 134(3):331-49, 2017
                                            3. Lee YA: White Matter injury of prematurity: Its mechanisms and clinical features. J Pathol Transl Med. 51(5):449-55, 2017
                                            4. Volpe JJ: Confusions in nomenclature: "Periventricular leukomalacia" and "white matter injury"-identical, distinct, or overlapping? Pediatr Neurol. 73:3-6, 2017
                                            5. Benders MJ et al: Neuroimaging of white matter injury, intraventricular and cerebellar hemorrhage. Clin Perinatol. 41(1):69-82, 2014
                                            6. Kendall GS et al: White matter NAA/Cho and Cho/Cr ratios at MR spectroscopy are predictive of motor outcome in preterm infants. Radiology. 271(1):230-8, 2014
                                            7. Kwon SH et al: The role of neuroimaging in predicting neurodevelopmental outcomes of preterm neonates. Clin Perinatol. 41(1):257-83, 2014
                                            8. Shevell A et al: Chorioamnionitis and cerebral palsy: lessons from a patient registry. Eur J Paediatr Neurol. 18(3):301-7, 2014
                                            9. de Vries LS et al: Value of sequential MRI in preterm infants. Neurology. 81(24):2062-3, 2013
                                            10. de Bruïne FT et al: Clinical implications of MR imaging findings in the white matter in very preterm infants: a 2-year follow-up study. Radiology. 261(3):899-906, 2011
                                            11. van Haastert IC et al: Decreasing incidence and severity of cerebral palsy in prematurely born children. J Pediatr. 159(1):86-91.e1, 2011
                                            12. van Wezel-Meijler G et al: Ultrasound detection of white matter injury in very preterm neonates: practical implications. Dev Med Child Neurol. 53 Suppl 4:29-34, 2011
                                            13. Volpe JJ et al: The developing oligodendrocyte: key cellular target in brain injury in the premature infant. Int J Dev Neurosci. 29(4):423-40, 2011
                                            14. Kato A et al: Relationship between enlargement of the lateral ventricle and periventricular leukomalacia in infants. J Obstet Gynaecol Res. 36(5):984-90, 2010
                                            15. Leijser LM et al: Is sequential cranial ultrasound reliable for detection of white matter injury in very preterm infants? Neuroradiology. 52(5):397-406, 2010
                                            16. Shatrov JG et al: Chorioamnionitis and cerebral palsy: a meta-analysis. Obstet Gynecol. 116(2 Pt 1):387-92, 2010
                                            17. Hagberg H et al: Effect of inflammation on central nervous system development and vulnerability. Curr Opin Neurol. 18(2):117-23, 2005
                                            18. O'Shea TM et al: Magnetic resonance and ultrasound brain imaging in preterm infants. Early Hum Dev. 81(3):263-71, 2005
                                            19. Partridge SC et al: Diffusion tensor imaging: serial quantitation of white matter tract maturity in premature newborns. Neuroimage. 22(3):1302-14, 2004
                                            20. Ment LR et al: Practice parameter: neuroimaging of the neonate: report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology. 58(12):1726-38, 2002
                                            Related Anatomy
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                                            Related Differential Diagnoses
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                                            References
                                            Tables

                                            Tables

                                            KEY FACTS

                                            • Terminology

                                              • Imaging

                                                • Top Differential Diagnoses

                                                  • Pathology

                                                    • Clinical Issues

                                                      TERMINOLOGY

                                                      • Abbreviations

                                                        • White matter (WM) injury of prematurity
                                                      • Synonyms

                                                        • Periventricular leukomalacia (PVL)
                                                          • Cystic PVL; noncystic PVL
                                                        • Punctate WM lesions
                                                      • Definitions

                                                        • Perinatal WM injury occurring before 34 weeks gestation
                                                          • Affected WM not always periventricular/deep

                                                      IMAGING

                                                      • General Features

                                                        • Ultrasonographic Findings

                                                          • CT Findings

                                                            • MR Findings

                                                              • Imaging Recommendations

                                                                DIFFERENTIAL DIAGNOSIS

                                                                  PATHOLOGY

                                                                  • General Features

                                                                    • Staging, Grading, & Classification

                                                                      • Gross Pathologic & Surgical Features

                                                                        • Microscopic Features

                                                                          CLINICAL ISSUES

                                                                          • Presentation

                                                                            • Demographics

                                                                              • Natural History & Prognosis

                                                                                • Treatment

                                                                                  DIAGNOSTIC CHECKLIST

                                                                                  • Consider

                                                                                    • Image Interpretation Pearls

                                                                                      Selected References

                                                                                      1. Barnett ML et al: Exploring the multiple-hit hypothesis of preterm white matter damage using diffusion MRI. Neuroimage Clin. 17:596-606, 2018
                                                                                      2. Back SA: White matter injury in the preterm infant: pathology and mechanisms. Acta Neuropathol. 134(3):331-49, 2017
                                                                                      3. Lee YA: White Matter injury of prematurity: Its mechanisms and clinical features. J Pathol Transl Med. 51(5):449-55, 2017
                                                                                      4. Volpe JJ: Confusions in nomenclature: "Periventricular leukomalacia" and "white matter injury"-identical, distinct, or overlapping? Pediatr Neurol. 73:3-6, 2017
                                                                                      5. Benders MJ et al: Neuroimaging of white matter injury, intraventricular and cerebellar hemorrhage. Clin Perinatol. 41(1):69-82, 2014
                                                                                      6. Kendall GS et al: White matter NAA/Cho and Cho/Cr ratios at MR spectroscopy are predictive of motor outcome in preterm infants. Radiology. 271(1):230-8, 2014
                                                                                      7. Kwon SH et al: The role of neuroimaging in predicting neurodevelopmental outcomes of preterm neonates. Clin Perinatol. 41(1):257-83, 2014
                                                                                      8. Shevell A et al: Chorioamnionitis and cerebral palsy: lessons from a patient registry. Eur J Paediatr Neurol. 18(3):301-7, 2014
                                                                                      9. de Vries LS et al: Value of sequential MRI in preterm infants. Neurology. 81(24):2062-3, 2013
                                                                                      10. de Bruïne FT et al: Clinical implications of MR imaging findings in the white matter in very preterm infants: a 2-year follow-up study. Radiology. 261(3):899-906, 2011
                                                                                      11. van Haastert IC et al: Decreasing incidence and severity of cerebral palsy in prematurely born children. J Pediatr. 159(1):86-91.e1, 2011
                                                                                      12. van Wezel-Meijler G et al: Ultrasound detection of white matter injury in very preterm neonates: practical implications. Dev Med Child Neurol. 53 Suppl 4:29-34, 2011
                                                                                      13. Volpe JJ et al: The developing oligodendrocyte: key cellular target in brain injury in the premature infant. Int J Dev Neurosci. 29(4):423-40, 2011
                                                                                      14. Kato A et al: Relationship between enlargement of the lateral ventricle and periventricular leukomalacia in infants. J Obstet Gynaecol Res. 36(5):984-90, 2010
                                                                                      15. Leijser LM et al: Is sequential cranial ultrasound reliable for detection of white matter injury in very preterm infants? Neuroradiology. 52(5):397-406, 2010
                                                                                      16. Shatrov JG et al: Chorioamnionitis and cerebral palsy: a meta-analysis. Obstet Gynecol. 116(2 Pt 1):387-92, 2010
                                                                                      17. Hagberg H et al: Effect of inflammation on central nervous system development and vulnerability. Curr Opin Neurol. 18(2):117-23, 2005
                                                                                      18. O'Shea TM et al: Magnetic resonance and ultrasound brain imaging in preterm infants. Early Hum Dev. 81(3):263-71, 2005
                                                                                      19. Partridge SC et al: Diffusion tensor imaging: serial quantitation of white matter tract maturity in premature newborns. Neuroimage. 22(3):1302-14, 2004
                                                                                      20. Ment LR et al: Practice parameter: neuroimaging of the neonate: report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology. 58(12):1726-38, 2002