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Volumetric Brain Differences in Children with Periventricular T2-Signal Hyperintensities

A Grouping by Gestational Age at Birth

¹ Department of Radiological Sciences, University of California at Los Angeles Medical Center, 10833 Le Conte Ave., Los Angeles, CA 90095-1721.
² Department of Radiology, Lucile Salter Packard Children's Hospital, Stanford University Medical Center, 725 Welch Rd., Palo Alto, CA 94304.
³ Department of Radiology, Children's Hospital Boston, 300 Longwood Ave., Boston, MA 02115.
⁴ Department of Pediatrics, Oregon Health Science University, 707 S.W. Gaines Rd., Portland, OR 97201.
⁵ New England Research Institute, 9 Galen St., Watertown, MA 02472.
⁶ Department of Biostatistics, University of California at Los Angeles Medical Center, Los Angeles, CA 90095.
⁷ Department of Pathology, Children's Hospital, Boston, MA 02115.
⁸ Department of Neurology, Children's Hospital, Boston, MA 02115.

OBJECTIVE. The purpose of this study was to compare both the volumes of the lateral ventricles and the cerebral white matter with gestational age at birth of children with periventricular white matter (PVWM) T2-signal hyperintensities on MR images. The spectrum of neuromotor abnormalities associated with these hyperintensities was also determined.

MATERIALS AND METHODS. We retrospectively reviewed the MR images of 70 patients who were between the ages of 1 and 5 years and whose images showed PVWM T2-signal hyperintensities. The patients were divided into premature (n = 35 children) and term (n = 35) groups depending on their gestational age at birth. Volumetric analysis was performed on four standardized axial sections using T2-weighted images. Volumes of interest were digitized on the basis of gray-scale densities of signal intensities to define the hemispheric cerebral white matter and lateral ventricles. Age-adjusted comparisons of volumetric measurements between the premature and term groups were performed using analysis of covariance.

RESULTS. The volume of the cerebral white matter was smaller in the premature group (54 ± 2 cm³) than in the term group (79 ± 3 cm³, p < 0.0001). The volume of the lateral ventricles was greater among the patients in the premature group (30 ± 2 cm³) than among those in the term group (13 ± 1 cm³, p < 0.0001). Fifty percent of all the premature children had spastic diplegia or quadriplegia. Thirty-two percent of all the term children had hypotonia. There were patients in both groups whose PVWM T2-signal hyperintensities did not correlate with any neuromotor abnormalities but were associated with seizures or developmental delays.

CONCLUSION. The differences in volumetric measurements of cerebral white matter and lateral ventricles in children with PVWM T2-signal hyperintensities are related to their gestational age at birth. Several neurologic motor abnormalities are found in children with such hyperintensities.

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