Tract shape modeling detects changes associated with preterm birth and neuroprotective treatment effects

• Probabilistic neighborhood tractography models tract shape from neonatal dMRI.
• The shape of major fasciculi is altered in association with preterm birth.
• Developing neural systems are separable based on dMRI parameters.
• Tract-averaged dMRI parameters are sensitive to neuroprotective treatment effects.

Preterm birth is associated with altered connectivity of neural circuits. We developed a tract segmentation method that provides measures of tract shape and integrity (probabilistic neighborhood tractography, PNT) from diffusion MRI (dMRI) data to test the hypotheses: 1) preterm birth is associated with alterations in tract topology (R), and tract-averaged mean diffusivity (〈D〉) and fractional anisotropy (FA); 2) neural systems are separable based on tract-averaged dMRI parameters; and 3) PNT can detect neuroprotective treatment effects.dMRI data were collected from 87 preterm infants (mean gestational age 29+1 weeks, range 23+2 –34+6) at term equivalent age and 24 controls (mean gestational age 39+6 weeks). PNT was used to segment eight major fasciculi, characterize topology, and extract tract-averaged 〈D〉 and FA.Tract topology was altered by preterm birth in all tracts except the splenium (p < 0.05, false discovery rate [FDR] corrected). After adjustment for age at scan, tract-averaged 〈D〉 was increased in the genu and splenium, right corticospinal tract (CST) and the left and right inferior longitudinal fasciculi (ILF) in preterm infants compared with controls (p < 0.05, FDR), while tract-averaged FA was decreased in the splenium and left ILF (p < 0.05, FDR). Specific fasciculi were separable based on tract-averaged 〈D〉 and FA values. There was a modest decrease in tract-averaged 〈D〉 in the splenium of preterm infants who had been exposed to antenatal MgSO4 for neuroprotection (p = 0.002).Tract topology is a biomarker of preterm brain injury. The data provide proof of concept that tract-averaged dMRI parameters have utility for evaluating tissue effects of perinatal neuroprotective strategies.