The Normal Neonatal Brain: MR Imaging, Diffusion Tensor Imaging, and 3D MR Spectroscopy in Healthy Term Neonates

A.I. Bartha; K.R.L. Yap; S.P. Miller; R.J. Jeremy; M. Nishimoto; D.B. Vigneron; A.J. Barkovich; D.M. Ferriero

doi:10.3174/ajnr.A0521

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Fig 1.
Locations of regions of interest for MRS and DTI measurements are marked by rectangles as follows:) basal ganglia (1), thalami (2), calcarine cortex (3), optic radiations (4), corticospinal tracts (5), posterior white matter (6), frontal white matter (7).
A, Squares showing region of interest locations from which proton spectra ratios were acquired and calculated by automated processing after the MR study of every neonate.
B, Squares showing the regions of interest from which D_av, FA, and eigenvalues were calculated by automated processing.
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Fig 2.
3D MR spectroscopy imaging on a single plane at the level of the basal ganglia illustrates the variation in maturity of metabolites in different regions of a healthy term neonate. Note that the thalami have the most mature spectra, with lowest choline and highest NAA peaks, and the frontal white matter has the least mature spectra.

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Table 1:

Perinatal clinical data

Neonate	GA at Birth (weeks)	Apgar Score (1 min/5 min)	Arterial Cord Gas (pH/Base Deficit)	Perinatal History	Resuscitation Score
1	39.3	7/8	7.08/−6	Mother GBS-positive, repeat CS, clear fluid; no fetal distress, heart rate >100, BBO₂ for 3 minutes	1
2	39.9	8/9	7.14/−5	ROM 2 hours, fetal heart rate 80–90 seconds for 5 minutes, vacuum/forceps-assisted vaginal delivery, nuchal cord, terminal meconium, vigorous baby, BBO₂	1
3	41.1	8/9	NA	Outborn, ROM 5 hours, spontaneous vaginal delivery, no meconium	0
4	40.6	8/9	7.14/−4	Induced labor, ROM 2 hours, fetal distress, failed vacuum delivery, CS for FTP, no meconium, blue baby with good tone and spontaneous cry	0
5	39.3	8/9	7.18/−5	Decreased fetal heart rate for 14 minutes, vacuum assisted vaginal delivery, moderate meconium above the vocal cords, pale baby with good tone and cry	0
6	39.4	9/10	7.28/+1	Mother GBS-positive, induced labor, ROM 2 hours, no meconium, no distress	0
7	39.3	4/9	7.3/−2	Nuchal cord, moderate meconium above vocal cords, baby intubated, suctioned, PPV, stable	4
8	40.3	9/9	7.11/−6	ROM 8 hours, no distress, no meconium	0
9	39.1	7/9	7.24/−3	Mother GBS-positive, took paroxetine for depression/anxiety; ROM 5 hours, no fetal distress, terminal meconium, good saturations, O₂ given	1
10	41.3	9/9	7.22/−7	ROM 9 hours, no fetal distress, forceps-assisted vaginal delivery, thick meconium, vigorous baby	0
11	41	9/10	7.33/−3	Mother GBS-positive, ROM 9 hours, no distress, no meconium	0
12	39.6	7/9	7.3/−2	Mother taking sertraline for depression; ROM 4 hours, no fetal distress, nuchal cord, meconium, suctioned ×2	2
13	40.9	8/9	7.17/0	ROM 1.5 hours, meconium suctioned at perineum, vigorous cry	2
14	40.4	7/8	7.32/−7	ROM 3.5 hours, no distress, no meconium	0
15	40.7	5/9	7.21/−3	ROM 6 hours, nuchal cord, no fetal distress, light meconium above the vocal cords, suctioned, blue floppy baby with no initial respiratory effort, heart rate >100, intubated, PPV for 30 seconds, baby cries, with good color	4
16	39.3	8/9	7.27/−2	Mother taking albuterol for asthma, CS for LGA and 39.5-cm head (cephalopelvic disproportion), blue baby with good cry, terminal meconium, no distress, BBO₂	1

Note:—BBO₂ indicates blow by oxygen; CS, cesarean section; GA, gestational age; FTP, failure to progress; GBS, Group B Streptococcus; LGA, large for gestational age; ROM, rupture of membranes; PPV, positive pressure ventilation; NA, not available.

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Table 2:

Average diffusivity data (D_av; 10⁻³mm²/s) and fractional anisotropy (FA) from automated processing

Neonate	Age After Birth at MRI (days)	GA at MRI (weeks)	Gray Matter						White Matter
			Basal Ganglia		Thalami		Calcarine Cortex		Optic Radiation		Corticospinal Tracts		Posterior White Matter		Frontal White Matter
			D_av	FA	D_av	FA	D_av	FA	D_av	FA	D_av	FA	D_av	FA	D_av	FA
1	2	39.57	1.29	0.16	1.02	0.15	1.26	0.15	1.46	0.32	1.24	0.19	1.52	0.14	1.55	0.14
2	1	40	1.20	0.19	0.92	0.27	1.25	0.12	1.53	0.18	1.43	0.23	1.58	0.17	1.56	0.17
3	3	41.57	1.14	0.18	0.95	0.22	1.21	0.16	1.37	0.32	1.13	0.31	1.35	0.17	1.28	0.21
4	3	41	1.19	0.19	0.97	0.21	1.19	0.16	1.49	0.21	1.10	0.21	1.47	0.26	1.44	0.25
5	8	40.43	1.29	0.13	1.05	0.17	1.19	0.14	1.40	0.27	1.26	0.28	1.44	0.16	1.51	0.14
6	5	40.14	1.17	0.20	0.99	0.28	1.28	0.14	1.44	0.22	1.25	0.25	1.52	0.15	1.48	0.21
7	7	40.29	1.16	0.20	0.94	0.29	1.26	0.12	1.54	0.26	1.19	0.21	1.50	0.18	1.42	0.20
8	7	41.29	1.20	0.15	1.02	0.19	1.23	0.14	1.45	0.33	1.24	0.22	1.62	0.21	1.53	0.18
9	10	40.57	1.20	0.14	1.02	0.19	1.20	0.12	1.41	0.31	1.10	0.18	1.51	0.18	1.59	0.13
10	9	42.57	1.14	0.18	1.07	0.20	1.26	0.17	1.33	0.37	1.16	0.34	1.21	0.20	1.48	0.19
11	13	42.86	1.13	0.15	0.95	0.20	1.21	0.12	1.23	0.37	1.10	0.26	1.36	0.18	1.26	0.20
12	8	40.71	1.22	0.13	0.92	0.34	1.21	0.11	1.39	0.31	1.26	0.26	1.43	0.16	1.44	0.15
13	6	41.71	1.13	0.19	0.94	0.24	1.17	0.13	1.50	0.33	1.19	0.33	1.50	0.12	1.63	0.19
14	10	41.86	1.17	0.18	0.90	0.29	1.22	0.18	1.25	0.39	1.18	0.35	1.47	0.16	1.51	0.15
15	12	42.43	1.15	0.20	0.97	0.27	1.25	0.14	1.46	0.24	1.24	0.24	1.77	0.14	1.58	0.16
16	2	39.57	1.37	0.14	1.14	0.32	1.36	0.19	1.61	0.19	1.68	0.16	1.84	0.21	1.72	0.25
Mean^*	6.8	40.5	1.19	0.17	0.98	0.23	1.22	0.14	1.41	0.30	1.20	0.26	1.46	0.17	1.48	0.18
SD^*	3.5	0.8	0.05	0.03	0.05	0.05	0.03	0.02	0.10	0.06	0.09	0.06	0.10	0.03	0.11	0.04

Note:—GA indicates gestational age.
* The mean and SD calculations do not include values for neonate 16 with abnormal findings on conventional MRI and for neonate 15 with mild developmental delay at the 14-month exam.

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Table 3:

Diffusion eigenvalues (EV1, EV2, EV3; 10⁻³mm²/s) from automated processing

Neonate	Gray Matter									White Matter
	Basal Ganglia			Thalami			Calcarine Cortex			Optic Radiation			Corticospinal Tracts			Posterior White Matter			Frontal White Matter
	EV1	EV2	EV3	EV1	EV2	EV3	EV1	EV2	EV3	EV1	EV2	EV3	EV1	EV2	EV3	EV1	EV2	EV3	EV1	EV2	EV3
1	1.51	1.24	1.11	1.18	1.01	0.87	1.45	1.25	1.07	2.00	1.30	1.09	1.47	1.25	1.01	1.74	1.53	1.30	1.75	1.55	1.35
2	1.45	1.14	1.01	1.17	0.92	0.68	1.39	1.24	1.10	1.82	1.48	1.27	1.74	1.46	1.10	1.86	1.53	1.34	1.82	1.53	1.31
3	1.35	1.14	0.94	1.16	0.94	0.75	1.41	1.20	1.03	1.84	1.29	0.97	1.46	1.17	0.76	1.57	1.37	1.10	1.52	1.31	1.00
4	1.43	1.17	0.97	1.18	0.97	0.78	1.37	1.19	1.01	1.81	1.45	1.20	1.33	1.10	0.88	1.88	1.40	1.14	1.81	1.40	1.09
5	1.46	1.26	1.13	1.24	1.04	0.88	1.36	1.17	1.03	1.82	1.31	1.07	1.63	1.24	0.91	1.67	1.44	1.23	1.71	1.50	1.31
6	1.43	1.11	0.96	1.26	0.99	0.71	1.45	1.28	1.09	1.78	1.40	1.14	1.55	1.27	0.93	1.74	1.51	1.31	1.81	1.41	1.21
7	1.42	1.12	0.94	1.23	0.91	0.67	1.41	1.25	1.11	1.95	1.51	1.15	1.42	1.24	0.92	1.79	1.47	1.25	1.69	1.45	1.14
8	1.37	1.19	1.03	1.21	1.00	0.83	1.39	1.25	1.04	1.99	1.31	1.05	1.49	1.28	0.96	2.01	1.54	1.33	1.79	1.52	1.28
9	1.37	1.18	1.05	1.22	0.99	0.84	1.35	1.19	1.06	1.89	1.30	1.05	1.28	1.12	0.91	1.78	1.49	1.25	1.80	1.59	1.40
10	1.36	1.10	0.95	1.29	1.05	0.88	1.48	1.23	1.05	1.88	1.21	0.91	1.58	1.11	0.79	1.44	1.24	0.96	1.76	1.47	1.22
11	1.31	1.09	0.98	1.15	0.92	0.77	1.35	1.20	1.07	1.74	1.11	0.83	1.38	1.10	0.80	1.61	1.35	1.13	1.52	1.25	1.01
12	1.38	1.19	1.07	1.28	0.86	0.63	1.34	1.21	1.08	1.89	1.23	1.04	1.55	1.35	0.89	1.78	1.52	1.29	1.64	1.46	1.21
13	1.37	1.07	0.95	1.18	0.89	0.75	1.32	1.17	1.03	2.06	1.34	1.09	1.63	1.11	0.85	1.83	1.63	1.44	1.80	1.45	1.26
14	1.38	1.15	0.97	1.19	0.84	0.66	1.45	1.20	1.00	1.82	1.12	0.81	1.63	1.12	0.78	1.71	1.45	1.25	1.73	1.48	1.31
15	1.39	1.12	0.94	1.27	0.91	0.74	1.43	1.24	1.08	1.82	1.42	1.13	1.52	1.24	0.95	2.03	1.73	1.55	1.84	1.54	1.36
16	1.57	1.37	1.18	1.53	1.10	0.79	1.62	1.36	1.09	1.93	1.57	1.33	1.97	1.65	1.43	2.23	1.81	1.48	2.15	1.72	1.29
Mean^*	1.40	1.15	1.01	1.21	0.95	0.77	1.40	1.22	1.06	1.88	1.31	1.05	1.51	1.21	0.89	1.74	1.46	1.24	1.73	1.46	1.22
SD^*	0.05	0.06	0.06	0.05	0.07	0.09	0.05	0.03	0.03	0.09	0.12	0.13	0.13	0.11	0.09	0.14	0.10	0.12	0.10	0.09	0.12

* The mean and SD calculations do not include diffusion values for neonate 16 with abnormal findings on conventional MRI and for neonate 15 with mild developmental delay at the 14-month exam.

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Table 4:

Metabolite ratios from 3D MR spectroscopy automated processing

Neonate	Gray Matter						White Matter
	Basal Ganglia		Thalami		Calcarine Cortex		Optic Radiation		Corticospinal Tracts		Posterior White Matter		Frontal White Matter
	NAA/Cho	Lac/Cho	NAA/Cho	Lac/Cho	NAA/Cho	Lac/Cho	NAA/Cho	Lac/Cho	NAA/Cho	Lac/Cho	NAA/Cho	Lac/Cho	NAA/Cho	Lac/Cho
1	0.51	0.09	0.53	0.04	0.72	0.16	0.70	0.12	NA	NA	0.69	0.18	0.81	0.17
2	0.53	0.12	0.64	0.05	0.65	0.15	0.83	0.01	0.60	0.15	0.46	0.09	NA	NA
3	0.67	0.14	0.64	0.11	0.66	0.13	0.53	0.03	0.66	0.04	0.65	0.07	NA	NA
4	0.61	0.07	0.73	0.09	0.88	0.17	0.91	0.10	NA	NA	0.76	0.19	0.84	0.04
5	0.61	0.09	0.71	0.06	0.66	0.12	0.57	0.04	0.85	0.20	0.69	0.14	0.71	0.12
6	0.50	0.12	0.66	0.07	0.56	0.10	0.70	0.07	NA	NA	0.79	0.08	0.55	0.18
7	0.61	NA	0.79	NA	0.87	NA	0.83	NA	0.75	NA	0.93	NA	0.46	NA
8	0.58	NA	0.67	NA	0.64	NA	0.56	NA	0.73	NA	NA	NA	NA	NA
9	0.47	0.13	0.65	0.12	0.67	0.14	0.47	0.15	0.65	0.11	0.56	0.13	0.63	0.28
10	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA
11	0.74	0.09	0.84	0.05	0.68	0.15	0.67	0.06	0.70	0.03	0.81	0.09	0.79	0.10
12	0.54	0.07	0.61	0.04	0.62	0.10	0.43	0.15	NA	NA	0.90	0.13	NA	NA
13	0.57	0.07	0.68	0.02	0.65	0.20	0.33	0.00	0.95	0.11	0.57	0.02	0.67	0.07
14	0.61	0.13	0.88	0.09	0.76	0.15	0.74	0.05	NA	NA	0.68	0.12	NA	NA
15	0.63	0.03	0.72	0.06	1.30	NA	1.25	0.38	NA	NA	NA	NA	0.88	0.07
16	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA
Mean	0.58	0.10	0.69	0.07	0.69	0.14	0.63	0.07	0.73	0.10	0.70	0.11	0.68	0.14
SD	0.07	0.03	0.09	0.03	0.09	0.03	0.17	0.05	0.11	0.06	0.14	0.05	0.13	0.08

Note:—The mean and SD calculations do not include metabolite values for neonate #15 with mild developmental delay. NA indicates data not available; NAA, N-acetylaspartate; Lac, lactate; Cho, choline.

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Table 5:

Neurodevelopmental exam summary at 3 and 14 months of age

Neonate	Exam at 3 Months	Exam at 14 Months
Neonate	Neuromotor Score	Neuromotor Score	Bayley MDI
1	0		NA
2	0	0	89
3	1 (slight active hypertonia)	0	101
4	1 (active hypertonia, legs passive hypertonia)	0	109
5	0	0	93
6	0	0	103
7	0	0	102
8	0	0	97
9	0	0	97
10	0	0	103
11	0	0	86
12	0	0	103
13	0		NA
14	0		NA
15	1 (brisk reflexes)	1 (mild palmar thumbing)	75
16	1 (hypotonia in torso)	1 (plantar grasp reflex)	80