Altered Gray Matter Cortical and Subcortical T1-Weighted/T2-Weighted Ratio in Premature-Born Adults

BACKGROUND: Microscopic studies in newborns and animal models indicate impaired myelination after premature birth, particularly for cortical myelination; however, it remains unclear whether such myelination impairments last into adulthood and, if so, are relevant for impaired cognitive performance. It has been suggested that the ratio of T1-weighted (T1w) and T2-weighted (T2w) magnetic resonance imaging signal intensity (T1w/T2w ratio) is a proxy for myelin content. We hypothesized altered gray matter (GM) T1w/T2w ratio in premature-born adults, which is associated with lower cognitive performance after premature birth.METHODS: We analyzed GM T1w/T2w ratio in 101 adults born very premature (VP) and/or at very low birth weight (VLBW) (<32 weeks of gestation and/or birth weight <1500 g) and 109 full-term control subjects at 26 years of age, controlled for voxelwise volume alterations. Cognitive performance was assessed by verbal, performance, and full scale IQ using the Wechsler Adult Intelligence Scale.RESULTS: Significantly higher T1w/T2w ratio in VP/VLBW subjects was found bilaterally in widespread cortical areas, particularly in frontal, parietal, and temporal cortices, and in putamen and pallidum. In these areas, T1w/T2w ratio was not related to birth variables, such as gestational age, or IQ scores. In contrast, significantly lower T1w/T2w ratio in VP/VLBW subjects was found in bilateral clusters in superior temporal gyrus, which was associated with birth weight in the VP/VLBW group. Furthermore, lower T1w/T2w ratio in left superior temporal gyrus was associated with lower full scale and verbal IQ. CONCLUSIONS: Results demonstrate GM T1w/T2w ratio alterations in premature-born adults and suggest altered GM myelination development after premature birth with lasting and functionally relevant effects into early adulthood.

Automated summary

Microscopic studies have shown impaired myelination after premature birth, but it is unclear whether these impairments last into adulthood and affect cognitive performance. This study used magnetic resonance imaging to analyze the T1w/T2w ratio in the gray matter of adults born prematurely, and found alterations in widespread cortical areas. These alterations were associated with lower cognitive performance.