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• Clinical Article •
Application of 3D-pCASL in evaluating cerebral perfusion and early prognosis in extremely preterm infants with HIBD
FU Yiwei  DING Tan  QIN Chi  WANG Ning  FENG Zhanqi  LIU Xueyan  ZHOU Tian  LU Lin  ZHAO Xin 

DOI:10.12015/issn.1674-8034.2025.11.007.


[Abstract] Objective This study employed three-dimensional pseudo-continuous arterial spin labeling (3D-pCASL) to evaluate the impact of hypoxic-ischemic brain injury (HIBD) on cerebral blood flow (CBF) in extremely preterm infants, and to explore the clinical value of 3D-pCASL in assessing cerebral perfusion and early prognosis of HIBD in these infants.Materials and Methods A total of 110 extremely preterm infants clinically diagnosed with HIBD and born at the Third Affiliated Hospital of Zhengzhou University between January 2022 and September 2024 were retrospectively enrolled as the study group. Additionally, 83 extremely preterm infants without HIBD born during the same period were selected as the control group. All infants underwent 3D-pCASL sequences and conventional MRI scans at different corrected gestational ages (CGA). Participants were stratified by CGA at MRI into Subgroup 1 [CGA 32 to 36⁺⁶ weeks: HIBD (n = 58), control (n = 60)] and Subgroup 2 [CGA 37 to 41⁺⁶ weeks: HIBD (n = 52), control (n = 23)]. CBF values were compared between HIBD and control infants within each subgroup, and across subgroups at different CGAs; specifically, correlations between CBF values in differential brain regions at CGA 32 to 36⁺⁶ weeks and Apgar scores at 1 min and 5 min after birth, as well as Neonatal Behavioral Neurological Assessment (NBNA) scores at 40 weeks CGA were analyzed.Results (1) At CGA 32 to 36⁺⁶ weeks, CBF values in the HIBD group were significantly higher than controls in bilateral temporal lobes, parietal lobes, occipital lobes, basal ganglia regions, thalami, and the right central sulcus cortex (P < 0.05); however, no statistically significant differences in regional CBF values were observed between the HIBD and control groups at CGA 37 to 41⁺⁶ weeks. (2) Within the HIBD group, CBF values in bilateral central sulcus cortices were significantly higher at CGA 37 to 41⁺⁶ weeks compared to CGA 32 to 36⁺⁶ weeks (P < 0.05), with no significant differences in other regions of interest (P > 0.05). In controls, CBF values in bilateral temporal lobes, occipital lobes, basal ganglia regions, and central sulcus cortices were significantly elevated at CGA 37 to 41⁺⁶ weeks versus CGA 32 to 36⁺⁶ weeks (P < 0.05), while other regions showed no significant changes (P > 0.05). (3) The CBF values in various regions of interest showed no correlation with 1-min and 5-min Apgar scores at birth. Additionally, bilateral thalamic and left basal ganglia region CBF at CGA 32 to 36⁺⁶ weeks negatively correlated with NBNA scores at 40 weeks of CGA (r = -0.284, -0.292, -0.272; P < 0.05).Conclusions The occurrence of HIBD may affect early cerebral perfusion in extremely preterm infants. Altered perfusion in specific brain regions could influence early prognosis, and 3D-pCASL holds potential value in assessing cerebral perfusion changes and early prognosis in these infants following HIBD.
[Keywords] preterm infant；hypoxic-Ischemic brain damage；magnetic resonance imaging；arterial spin labeling；cerebral blood flow；neonatal behavioral neurological assessment；Apgar score

FU Yiwei1, 2, 3   DING Tan1, 2, 3   QIN Chi1, 2, 3   WANG Ning1, 2, 3   FENG Zhanqi1, 2, 3   LIU Xueyan1, 2, 3   ZHOU Tian1, 2, 3   LU Lin1, 2, 3   ZHAO Xin1, 2, 3*  

1 Department of Medical Imaging, the Third Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China

2 Henan International Joint Laboratory of Neuroimaging, Zhengzhou 450052, China

3 Henan Provincial Key Laboratory of Pediatric Neuroimaging Medicine, Zhengzhou 450052, China

Corresponding author: ZHAO X, E-mail: zdsfyzx@zzu.edu.cn

Conflicts of interest   None.

Received  2025-07-01
Accepted  2025-10-09
DOI: 10.12015/issn.1674-8034.2025.11.007
DOI:10.12015/issn.1674-8034.2025.11.007.

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