Background Periventricular leukomalacia (PVL) which is an ischaemic white matter injury is frequently seen in premature infants. Nowadays, PVL incidence has been increased due to the increase of the survival rate of prematures and very low birth weight infants. The development of the more sensitive techniques such as magnetic resonance imaging caused to the increase of the incidence of PVL. In this study, it is aimed to investigate the correlation between the neurological, ophthalmological findings and diffusion tensor imaging (DTI) findings in cases with periventricular leukomalacia. Materials and methodsPatients whose postconceptional ages are under three months having periventricular leukomalacia were included in this study between November 2012 and September 2013 at Ege University Medical Hospital. The patients who had precise or suspected periventricular leukomalacia on cranial ultrasonography, were underwent cranial MRI at the corrected age of three months. The study were performed with eleven preterm and seven healthy term infants. Neurodevelopmental and oftalmological examinations were performed in patients at the corrected age of three and six months. DTI were obtained in PVL patients and control group at corrected age of six months. Voxelwise analysis of the DTI data was performed by using TBSS and ROI to assess the relationship among mean FA, ADC, AD and RD. The procedure was carried out on a 3 Tesla MR system using available protocols for imaging the pediatric brain. Ophthalmological, neurological and radiological results of the patients were compared to each other.ResultsFour patients were male and seven were female (Female 36,6%, Male 63,3%). At the corrected age of six months, eight patients (72%) had cerebral palsy. Oftalmological examination, revealed that light fixation, light and object following were found in all but one patient. But sixty-three percent (63%) of the patients had cerebral visual impairment detected with visual evoked potentials (VEPs). All the patients had PVL on MRI and control group had normal imaging findings on MRI. According to MRI results patients were separated into three groups as mild, moderate and severe PVL. Six (54,5%) cases had mild, two cases (18,1%) had moderate and three cases(27,2%) had severe PVL. Diffusion tensor imaging (DTI) were evaluated with two methods: ROI and TBSS analyses. Fractional anisotropy (FA) values measured by ROI analysis were calculated from different brain regions ( genu and body of corpus callosum, right and left internal capsule, right and left optic radiation). Fractional anisotropy values were lower in patients compared to controls but they were not statistically significant except right optic radiation ( Patients FA: 0,244 ± 0,98 Control group FA: 0,42 ± 0,32, p: 0.01 ). Fractional anisotropy values depending on TBSS analysis were similar in patient and control groups ( p > 0.05 ).ConclusionsIn this study, ophthalmological, neurological findings of patients with PVL were consistent with the findings of the DTI analysis. These findings are in keeping with studies showing a relationship between brain microstructure and function. This study suggests that DTI data at corrected age of six months could be used as a biomarker for the subsequent neurodevelopment. Patients with PVL have cerebral visual impairment although they have normal ophtalmological examination. So those patients must be carefully followed for the cerebral visual impairment.

Giriş ve Amaç:Periventriküler lökomalazi (PVL), özellikle prematüre bebekte görülen iskemik beyaz cevher hasarlanmasıdır. Manyetik rezonans görüntüleme gibi duyarlı tekniklerin geliştirilmesiyle PVL insidansı giderek artmaktadır. Bu çalışmada, PVL'li hastalarda nörolojik ve oftalmolojik bulgular ile Difüzyon Tensör MRG (DTMRG) bulguları arasındaki korelasyonun araştırılması amaçlandı. Gereç ve Yöntem:Çalışma Kasım 2012 - Eylül 2013 tarihleri arasında Ege Üniversitesi Tıp Fakültesi Çocuk hastanesinde izlenilen 11 prematüre PVL'li ve yedi sağlıklı termle tamamlandı. Hastalara postkonsepsiyonel yaş (PKY) üçüncü ve altıncı ayda nörolojik, oftalmolojik değerlendirme yapıldı ve altıncı ayda 3 tesla MRG ile DTMRG çekimleri yapıldı. Sonuçlar:Hastaların sekizinde (%72,7) spastik tip serebral felç geliştiği görüldü. Oftalmolojik muayenede bir olgu dışında normal bulunurken Flash VEP sonuçlarında yedisinde patolojiye (%63,3) rastlanıldı. Görüntüleme sonuçlarıyla olgular hafif, orta ve ağır olmak üzere üç dereceye ayrıldı. Altı olguda (%54,5) hafif, ikisinde (%18,1) orta ve üçünde (%27,2) ağır PVL saptandı. DTMRG iki yöntemle değerlendirildi. Free-hand ROİ analizi ile fraksiyonel anizotropi değerleri, korpus kallozumun genu ve splenium kısımlarında, sağ internal kapsül, sol internal kapsül, sağ optik traktüs ve sol optik traktüslerin birçok yerinde ölçüldü ve ortalama değerleri alındı. Fraksiyonel anizotropi değerleri hasta grubunda, kontrol grubuna kıyasla ölçülen tüm alanlarda düşük saptanırken sadece sağ optik traktüste istatistiksel açıdan anlamlı oranda düşüklük görüldü (p: 0.01). TBSS analizi ile FA, AD, RD ve ADC değerleri kıyaslandı. Hasta ve kontrol grubunda tüm beyaz cevherde ölçülen difüzyon parametreleri arasında anlamlı bir farklılık bulunmadı (p > 0.05).Yorum:Bu bulgular periventriküler lökomalazili olguların erken dönemde yapılan görme muayenesinin normal olsa bile serebral görsel hasarlanma olabileceği ve ileri yaşlara kadar dikkatli izlem gerektiğini gösterdi.