The Spectrum Of Cystic Periventricular Leukomalacia Based On MRI Findings In The Preterm Infants With Brain Injury

Objective:The epidemiology,distribution and lesion types of cystic periventricular leukomalacia leukomalacia were analyzed on the basis of Magnetic Resonance Imaging(MRI)and Diffusion Weighted Imaging(DWI)data.Methods: A retrospective study was conducted on premature infants who were admitted to Shengjing Hospital affiliated of China Medical University from January 2008.1through December 12,2015.The infants who completed the examination of Magnetic Resonance Imaging(T1W1-T2W1)and Diffusion Weighted Imaging(DWI)were reviewed.According to the evaluation criteria of brain injury,the patterns of brain injury and the origins of cPVL were further studied,and the characteristics of different injuries among the gestational stages were analyzed.Results: A total of 2688 preterm infants were enrolled in the study,920 preterm infants with brain injury were diagnosed,including 736 cases of white matter injury,the incidence rate was 27.59%,233 ones with intracanialhemorrhage.The incidence rate of white matter injury was 8.73%,which ranked the highest in all types of brain injury.Focal and diffusive white matter injury have been shown an increasing trend with the increasing gestational ages.Severe intracranial hemorrhage and diffuse white matter injury were more common in premature infants with smaller gestational age,and in 106 cases with cPVL,78 cases were caused by non-hemorrhagic injury,The correlation between CWMD and cPVL was analyzed by spearman,the correlation coefficient was1.0,p < 0.01,there was a significant positive correlation.There were 12 cases of cPVL,caused by hemorrhagic factors and 16 cases of cPVL with combination of IVH and CWMD.The incidence of cPVL,in preterms with cPVL was 13.21%(7/53)、6.54%(17/260)、2.66%(15/563)、2.08%(19/915)、4.33%(38/877)at gestational age <28 weeks,28 weeks,30 weeks,32 weeks,32 weeks,34 weeks and 37 weeks,respectively,and there was a significant difference in the incidence of cPVL between them(but for the group of late preterm infant).The smaller the gestational age,the higher the proportion of cPVL caused by severe intracranial hemorrhage,while the cPVL caused by severe CWMD had no obvious relationship with gestational age.Conclusion: According to the study based on MRI as the diagnostic standard,cPVL was mainly derived from intracranial hemorrhage and CWMD.The smaller the gestational age,the higher the proportion of cPVL caused by severe intracranial hemorrhage,which showed obvious maturity dependence,and most of the lesions were unilateral;The cPVL caused by CWMD was closely related to the severity of injury,and the focus was mainly symmetrical,the two types of lesions could exist simultaneously.