Diffusion-weighted imaging and magnetic resonance proton spectroscopy following preterm birth

•ADC values around term corrected age from a wide area of the brain are not associated with developmental outcome.•NAA ratios from the posterior white matter are associated with adverse outcome.•No relationship between MRS data and ADC values exist when measured from the same region of the cerebral white matter.•The presence of a patent ductus arterious was associated with NAA ratios from the posterior white matter, but not outcome.

AimTo study the associations between magnetic resonance proton spectroscopy (MRS) data and apparent diffusion coefficients (ADC) from the preterm brain with developmental outcome at 18 months corrected age and clinical variables.Materials and methodsA prospective observational cohort study of 67 infants born before 35 weeks gestational age who received both magnetic resonance imaging of the brain between 37 and 44 weeks corrected gestational age and developmental assessment around 18 months corrected age.ResultsNo relationships were found between ADC values and MRS results or outcome. MRS ratios involving N-acetyl aspartate (NAA) from the posterior white matter were associated with "severe" and "moderate to severe" difficulties, and fine motor scores were significantly lower in participants with a visible lactate doublet in the posterior white matter. The presence of a patent ductus arteriosus (PDA) was the only clinical factor related to NAA ratios.ConclusionAltered NAA levels in the posterior white matter may reflect subtle white matter injury associated with neuro-developmental difficulties, which may be related to a PDA. Further work is needed to assess the longer-term neuro-developmental implications of these findings, and to study the effect of PDAs on developmental outcome in later childhood/adolescence.