1.
Fisher DA. Thyroid system immaturities in very low birth weight premature infants.
Semin Perinatol 2008;32:387-397.
2.
Lee JH, Kim SW, Jeon GW, Sin JB. Thyroid dysfunction in very low birth weight preterm
infants. Korean J Pediatr 2015;58:224-229.
3.
Laurberg P. Thyroid function: Thyroid hormones, iodine and the brain-an important
concern. Nat Rev Endocrinol 2009;5:475-476.
4.
Burrow GN, Fisher DA, Larsen PR. Maternal and fetal thyroid function. N Engl J Med
1994;331:1072-1078.
5.
Williams GR. Neurodevelopmental and neurophysiological actions of thyroid hormone. J
Neuroendocrinol 2008;20:784-794.
6.
Ng SM, Turner MA, Avula S. Ultrasound Measurements of Thyroid Gland Volume at 36
Weeks' Corrected Gestational Age in Extremely Preterm Infants Born before 28 Weeks'
Gestation. Eur Thyroid J 2018;7:21-26.
7.
Yamamoto A, Kawai M, Iwanaga K, et al. Response to thyrotropin-releasing hormone
stimulation tests in preterm infants with transient hypothyroxinemia of prematurity. J
Perinatol 2015;35:725-728.
8.
Reuss ML, Paneth N, Pinto-Martin JA, Lorenz JM, Susser M. The relation of transient
hypothyroxinemia in preterm infants to neurologic development at two years of age. N
Engl J Med 1996;334:821-827.
9.
Murphy N, Hume R, van Toor H, et al. The hypothalamic-pituitary-thyroid axis in
preterm infants; changes in the first 24 hours of postnatal life. J Clin Endocrinol Metab
2004;89:2824-2831.
10.
Walsh JM, Doyle LW, Anderson PJ, Lee KJ, Cheong JL. Moderate and late preterm birth:
effect on brain size and maturation at term-equivalent age. Radiology 2014;273:232-240.
11.
Saigal S, Doyle LW. An overview of mortality and sequelae of preterm birth from infancy
to adulthood. Lancet 2008;371:261-269.
12.
Benavente-Fernández I, Rodríguez-Zafra E, León-Martínez J, et al. Normal Cerebellar
Growth by Using Three-dimensional US in the Preterm Infant from Birth to Termcorrected Age. Radiology 2018;288:254-261.
13.
Cox TD, Elster AD. Normal pituitary gland: changes in shape, size, and signal intensity
during the 1st year of life at MR imaging. Radiology 1991;179:721-724.
14.
Okazaki T, Niwa T, Suzuki K, Shibukawa S, Imai Y. Age related signal changes of the
pituitary stalk on thin-slice magnetic resonance imaging in infants. Brain Dev
2019;41:327-333.
21
15.
Kitamura E, Miki Y, Kawai M, et al. T1 signal intensity and height of the anterior pituitary
in neonates: correlation with postnatal time. AJNR Am J Neuroradiol 2008;29:1257-1260.
16.
Hori S, Taoka T, Ochi T, et al. Structures Showing Negative Correlations of Signal
Intensity with Postnatal Age on T. Magn Reson Med Sci 2017;16:325-331.
17.
Sari S, Sari E, Akgun V, et al. Measures of pituitary gland and stalk: from neonate to
adolescence. J Pediatr Endocrinol Metab 2014;27:1071-1076.
18.
Freire R, Monte O, Tomimori EK, et al. Sonographic evaluation of the thyroid size in
neonates. J Clin Ultrasound 2015;43:224-229.
19.
Aida N, Niwa T, Fujii Y, et al. Quiet T1-Weighted Pointwise Encoding Time Reduction
with Radial Acquisition for Assessing Myelination in the Pediatric Brain. AJNR Am J
Neuroradiol 2016;37:1528-1534.
20.
Yushkevich PA, Piven J, Hazlett HC, et al. User-guided 3D active contour segmentation
of anatomical structures: significantly improved efficiency and reliability. Neuroimage
2006;31:1116-1128.
21.
Delman BN. Imaging of pediatric pituitary abnormalities. Endocrinol Metab Clin North
Am 2009;38:673-698.
22.
Wolpert SM, Osborne M, Anderson M, Runge VM. The bright pituitary gland--a normal
MR appearance in infancy. AJNR Am J Neuroradiol 1988;9:1-3.
23.
Hashemipour M, Hovsepian S, Ansari A, Keikha M, Khalighinejad P, Niknam N.
Screening of congenital hypothyroidism in preterm, low birth weight and very low birth
weight neonates: A systematic review. Pediatr Neonatol 2018;59:3-14.
24.
Cabello G, Wrutniak C. Thyroid hormone and growth: relationships with growth hormone
effects and regulation. Reprod Nutr Dev 1989;29:387-402.
25.
van den Hove MF, Beckers C, Devlieger H, de Zegher F, De Nayer P. Hormone synthesis
and storage in the thyroid of human preterm and term newborns: effect of thyroxine
treatment. Biochimie 1999;81:563-570.
26.
Nikoubashman O, Jablawi F, Dekeyzer S, et al. MRI Appearance of Intracerebral Iodinated
Contrast Agents: Is It Possible to Distinguish Extravasated Contrast Agent from
Hemorrhage? AJNR Am J Neuroradiol 2016;37:1418-1421.
27.
Morales H, Lemen L, Samaratunga R, Nguyen P, Tomsick T. Effects of iodinated contrast
on various magnetic resonance imaging sequences and field strength: Implications for
characterization of hemorrhagic transformation in acute stroke therapy. World J Radiol
2016;8:588-593.
28.
Ginat DT, Meyers SP. Intracranial lesions with high signal intensity on T1-weighted MR
images: differential diagnosis. Radiographics 2012;32:499-516.
29.
Klein RZ, Carlton EL, Faix JD, et al. Thyroid function in very low birth weight infants.
22
Clin Endocrinol (Oxf) 1997;47:411-417.
30.
Zava TT, Zava DT. Assessment of Japanese iodine intake based on seaweed consumption
in Japan: A literature-based analysis. Thyroid Res 2011;4:14.
31.
Léger J, Olivieri A, Donaldson M, et al. European Society for Paediatric Endocrinology
consensus guidelines on screening, diagnosis, and management of congenital
hypothyroidism. J Clin Endocrinol Metab 2014;99:363-384.
23
Table 1. Characteristics of the included patients.
Sex [n]
Male
55
Female
47
Age [days]
GA
238 [201.5-261]
CA
34.5 [21-73.5]
GA+CA
280.9 ± 16.0
BW [g]
1791 [1115-2568]
Signal ratio
Anterior pituitary
Posterior pituitary
Thyroid
Tmean/cord mean
broken up by
thyroid function
group
APmean/pons
1.37 [1.25-1.53]
APmax/pons
1.68 ± 0.25
PPmean/pons
1.85 ± 0.26
PPmax/pons
2.34 ± 0.43
Tmean/cord
1.32 [1.20-1.42]
Tmax/cord
1.70 [1.49-1.89]
A (n=6)
1.16 [1.04-1.32]
B (n=31)
1.26 [1.19-1.37]
C (n=40)
1.29 [1.17-1.38]
D (n=25)
1.44 [1.33-1.49]
AP_vol
56.6 [42.2-74.9]
T_vol
634.5 [486.2-798.8]
A (n=6)
397 [220-653]
B (n=31)
564 [437-690]
C (n=40)
614 [493-717]
D (n=25)
827 [640-1009]
Volume [ml]
Anterior pituitary
Thyroid
T_vol
broken up by
thyroid function
group
GA, gestational age; CA, chronological age; BW, birth weight; AP, anterior pituitary;
PP, posterior pituitary; T, thyroid; AP_vol, volume of anterior pituitary; T_vol, volume
24
of thyroid gland. Average ± standard deviation was used when the data shows normal
distribution, otherwise, median value with 25 and 75 percentiles were used.
25
Table 2. Signal ratio and volume of pituitary and thyroid gland in female and male infants.
Female (n=47)
Male (n=55)
P value
Signal ratio
Anterior pituitary
Posterior pituitary
Thyroid
APmean/pons
1.39 ± 0.18
1.4 ± 0.17
0.77
APmax/pons
1.68 ± 0.25
1.69 ± 0.25
0.78
PPmean/pons
1.9 [1.55-2.02]
1.87 ± 0.26
0.71
PPmax/pons
2.30 ± 0.43
2.38 ± 0.42
0.32
Tmean/cord
1.29 [1.17-1.42]
1.34 ± 0.20
0.41
Tmax/cord
1.68 [1.43-1.86]
1.70 [1.50-1.95]
0.37
AP_vol
61.2 ± 20.0
52.9 [39.2-76.9]
0.41
T_vol
650.8 ± 228.6
661.1 [483.6-806.4]
0.95
Volume [ml]
Anterior pituitary
Thyroid
AP, anterior pituitary; PP, posterior pituitary; T, thyroid; AP_vol, volume of anterior
pituitary; T_vol, volume of thyroid gland. Average ± standard deviation was used when
the data shows normal distribution, otherwise, median value with 25 and 75 percentiles
were used.
26
Table 3. Signal ratio and volume of pituitary and thyroid gland in term and preterm
infants.
Term (n=27)
Preterm (n=75)
P value
APmean/pons
1.49 ± 0.15
1.34 [1.20-1.50]
0.001
APmax/pons
1.84 ± 0.21
1.58 [1.43-1.84]
<.001
PPmean/pons
1.95 [1.80-2.03]
1.81 ± 0.27
0.07
PPmax/pons
2.50 [2.28-2.60]
2.28 ± 0.45
0.10
Tmean/cord
1.38 ± 0.16
1.28 [1.17-1.41]
0.06
Tmax/cord
1.79 [1.68-2.00]
1.62 [1.43-1.84]
0.001
AP_vol
81.8 ± 15.7
51.7 ± 17.8
<.001
T_vol
803.5 [666.5-955.8]
593.1 ± 202.2
<.001
Signal ratio
Anterior pituitary
Posterior pituitary
Thyroid
Volume [ml]
Anterior pituitary
Thyroid
AP, anterior pituitary; PP, posterior pituitary; T, thyroid; AP_vol, volume of anterior
pituitary; T_vol, volume of thyroid gland. Average ± standard deviation was used when
the data shows normal distribution, otherwise, median value with 25 and 75 percentiles
were used.
27
Figures
Figure 1.
Representative images of volumes of interest for the anterior pituitary (red), pons (yellow),
thyroid (blue), and cord (yellow). Enlarged view of pituitary gland (a, b, c) and thyroid
gland (d, e) on multiplanar reconstructed (MPR) images of T1-weighte Pointwise
Encoding Time Reduction with Radial Acquisition (PETRA) : axial, a, e; sagittal, b; and
coronal, c, d.
28
Figure 2.
A male term infant, gestational age (GA) 263 days, chronological age (CA) 8 days (a, b,
c, and d). Both the anterior (white arrow) and posterior pituitary (black arrow) are
hyperintense on T1-weighted Pointwise Encoding Time Reduction with Radial
Acquisition (T1-PETRA). The thyroid (arrowheads) is also hyperintense on T1-PETRA.
A female preterm infant, GA 177 days, CA 102 days (e, f, g, and h). Anterior pituitary
(white arrow) is slightly hyperintense and posterior pituitary (black arrow) is slightly
hyperintense on T1-PETRA compared with pons. Thyroid (arrowheads) is relatively
hyperintense on T1-PETRA compared with spinal cord. The signals of pituitary gland
and thyroid gland are lower intense and the volumes are smaller compared with those of
term infant. Enlarged view of pituitary gland (a, b, e, and f) and thyroid gland (c, d, g,
and h) on multiplanar reconstructed (MPR) images of T1-PETRA: axial, a, c, e, and g;
sagittal, b, f; and coronal, d, h.
29
Figure 3.
Scatter plots of mean signal ratios of pituitary gland (APmean/pons, PPmean/pons) and
thyroid gland (Tmean/cord) vs. GA, CA, GA+CA, and BW. AP=anterior pituitary,
PP=posterior pituitary, BW=birth weight, GA=gestational age, CA=chronological age.
APmean/pons, PPmean/pons, and Tmean/cord =mean signal ratios of AP, PP, and thyroid,
respectively.
30
Figure 4.
Scatter plots of maximum signal ratios of pituitary gland (APmax/pons, PPmax/pons) and
thyroid gland (Tmax/cord) vs. GA, CA, GA+CA, and BW. AP=anterior pituitary,
PP=posterior pituitary, BW=birth weight, GA=gestational age, CA=chronological age.
APmax/pons, PPmax/pons, and Tmax/cord = maximum signal ratios of AP, PP, and thyroid,
respectively.
31
Figure 5.
Scatter plots of the volume of the pituitary gland (AP_vol) and the thyroid gland (T_vol)
vs. GA, CA, GA+CA, and BW.
32
Figure 6.
Scatter plots of volume of the signal ratios of anterior pituitary gland (APmean/pons,
APmax/pons) and thyroid gland (Tmean/cord, Tmax/cord) vs. pituitary gland (AP_vol) and
thyroid gland (T_vol) volume. Scatter plots of signal ratio of APmean/pons and Tmean/cord ,
APmax/pons and Tmax/cord are also shown.
33
Figure 7.
Signal ratios for maximum thyroid gland (Tmax/cord) from the four thyroid function
groups (A–D). Note that Group A represents patients diagnosed with hypothyroidism
(thyroid stimulating hormone (TSH) > 10 μIU/ml) and receiving L-thyroxine. Group B
represents patients with TSH level > 5 μIU/ml, Group C represents patients with TSH
5 μIU/ml, and Group D represents patients assessed as healthy (no TSH measurement
performed). Volumes of thyroid gland (T_vol) for the four thyroid function groups are
also shown (Groups A–D).
34
Supplementary Material 1
Inclusion and exclusion criteria for this study.
35
Supplementary Material 2
ICCs between two raters were shown.
Signal ratio
APmean/pons
0.9974
APmax/pons
0.9849
PPmean/pons
0.9868
PPmax/pons
0.9998
Tmean/cord
0.9991
Tmax/cord
0.9988
Volume [ml]
AP_vol
0.9868
T_vol
0.9930
36
Supplementary Material 3
We have also performed statistical analysis of APmean/pons, PPmean/pons and
Tmean/cord with gender, and no statistically significant difference was seen between
genders. The distribution plots with gender are shown as below.
37
Supplementary Material 4
We have also performed statistical analysis of AP_vol and T_vol with gender,
and no statistically significant difference was seen between genders. The distribution
plots with gender are shown as below.
38
Supplementary Material 5
Days of each thyroid function group (A, B, C and D) are shown as below.
[days]
GA
CA
GA+CA
191 [179.3-207]
89 [64.3-99]
276.5 [271.3-282]
238 [201-247]
44 [26-75]
278 [265-295]
227 [197.3-253.5] 38.5 [25.5-85.5] 278.5 [269.3-293.8]
261 [245.5-272]
20 [14-28.5]
281 [267.3-292.8]
39
Supplementary Material 6
T1-PETRA is mainly used for pediatric patients for whom quiet scan is
preferable. As far as we know, there is no phantom study on T1-PETRA, we conducted
phantom study on T1-PETRA. We scanned T1-PETRA for ISMRM-NIST phantom
because the phantom contained spheres with known theoretical T1 values. The results are
shown below. Signal intensity of AP, PP, T, pons, and cord on T1-PETRA [AU] of our
cohort were shown.
mean
286.17 ± 96.46 [AU]
max
347.06 ± 131.79 [AU]
mean
376.49 ± 127.97 [AU]
max
474.90 ± 161.71 [AU]
mean
298.27 ± 75.96 [AU]
max
387.84 ± 108.94 [AU]
pons
mean
206.68 ± 65.89 [AU]
cord
mean
226.76 ± 60.90 [AU]
AP
PP
The plots of measured signal intensity on T1-PETRA and theoretical T1 values
are shown. Markers in orange color represent signal intensity between 200 and 680 [AU]
which correspond to the signals of AP, PP, T, pons, and cord on T1-PETRA. The
regression linear analysis showed high correlation (R2=0.9862) between measured signal
intensity on T1-PETRA and theoretical T1 values. Thus, signal intensity of measured our
VOIs on T1-PETRA are considered to be parallel to T1 value.
40
Supplementary Material 7
The posterior lobe of the pituitary gland (PP) is very small structure compared
with the resolution of MRI, and 3D VOI of PP was chosen to a few voxels, therefore, we
avoided the volume calculation for PP. On the other hand, we considered the signal
intensity calculation of 3D VOI to be reliable because we found the high correlation of
signal intensity of PP between 2D ROI created from the 3D VOI and the original 3D VOI
(R2=0.988).
41
Supplementary Material 8
The equations of the regression lines used in Figure 3,4,5 and 6 are shown as
below.
Figure 3. Scatter plots of GA, CA, GA+CA, BW and signal ratios of pituitary gland
(APmean/pons, PPmean/pons) and thyroid gland (Tmean/cord).
APmean/pons = 0.588966 + 0.0034395×GA
PPmean/pons = 0.6563685 + 0.0050725×GA
Tmean/cord = 0.758997 + 0.0024562×GA
APmean/pons = 1.5991587 - 0.0043678×CA
PPmean/pons = 2.1467469 - 0.0066009×CA
Tmean/cord = 1.4676774 - 0.0029196×CA
APmean/pons = 2.7629515 - 0.0048827×(GA+CA)
PPmean/pons = 3.6399187 - 0.0063876×(GA+CA)
Tmean/cord = 2.151058 - 0.0029166×(GA+CA)
APmean/pons = 1.1332142 + 0.0001413×BW
PPmean/pons = 1.4831383 + 0.0001953×BW
Tmean/cord = 1.1440677 + 0.000101×BW
Figure 4. Scatter plots of GA, CA, GA+CA, BW and signal ratios of pituitary gland
(APmax/pons , PPmax/pons) and thyroid gland (Tmax/cord).
APmax/pons = 0.4317123 + 0.0053534×GA
PPmax/pons = 0.3132611 + 0.0086233×GA
Tmax/cord = 0.5415191 + 0.0051134×GA
APmax/pons = 1.9838315 - 0.0063202×CA
42
PPmax/pons = 2.8278925 - 0.010843×CA
Tmax/cord = 2.0143122 - 0.0059674×CA
APmax/pons = 3.1598216 - 0.0052658×(GA+CA)
PPmax/pons = 5.0297778 - 0.0095906×(GA+CA)
Tmax/cord = 3.213345 - 0.0052662×(GA+CA)
APmax/pons = 1.3143833 + 0.0002018×BW
PPmax/pons = 1.4831383 + 0.0001953×BW
Tmax/cord = 1.3457346 + 0.0002104×BW
Figure 5. Scatter plots of GA, CA, GA+CA, BW and volume of pituitary gland (AP_vol)
and thyroid gland (T_vol).
AP_vol = -44.59464 + 0.4465435×GA
T_vol = -195.9376 + 3.6497413×GA
AP_vol = 79.650317 - 0.4224301×CA
T_vol = 821.49605 - 3.5512543×CA
AP_vol = 65.234878 - 0.0201368×(GA+CA)
T vol = 831.82723 - 0.6276834×(GA+CA)
AP_vol = 25.522053 + 0.0186052×BW
T_vol = 343.29188 + 0.1691712×BW
Figure 6. Scatter plots of volume of pituitary gland (AP_vol) and thyroid gland (T_vol)
and signal ratios of anterior pituitary gland (APmean/pons, APmax/pons) and thyroid gland
(Tmean/cord, Tmax/cord).
APmean/pons = 1.1422312 + 0.0041938×AP_vol
43
APmax/pons = 1.3313356 + 0.005923×AP_vol
Tmean/cord = 1.129946 + 0.0003063×T_vol
Tmax/cord = 1.3651711 + 0.0005631×T_vol
Scatter plots of signal ratio of anterior pituitary gland (APmean/pons, APmax/pons) and
thyroid gland (Tmean/cord, Tmax/cord).
APmean/pons = 0.6996148 + 0.5224815×Tmean/cord
APmax/pons = 0.9044524 + 0.4520407×Tmax/cord
44
...
論文の公開元へ
