Preterm birth affects the developmental synergy between cortical folding and cortical connectivity observed on multimodal MRI.

Abstract The survival rates of infants born prematurely have improved as a result of advances in neonatal care, although there remains an increased risk of subsequent disability. Accurate measurement of the shape and appearance of the very preterm brain at term-equivalent age may guide the development of predictive biomarkers of neurological outcome. We demonstrate in 92 preterm infants (born at an average gestational age of 27.0 ± 2.7 weeks) scanned at term equivalent age (scanned at 40.4 ± 1.74 weeks) that the cortical sulcation ratio varies spatially over the cortical surface at term equivalent age and correlates significantly with gestational age at birth ( r  = 0.49,  p r  = 0.26,  p  = 0.02 and for the splenium r  = 0.52,  p r  = {0.67,0.61,0.86}, p  = {0.004,0.01,0.00002}) for tract systems emanating from the left and right corticospinal tracts and the corpus callosum respectively). Combined, these results suggest a close relationship between the cortical surface phenotype and underlying white matter structure assessed by diffusion weighted MRI. The spatial surface pattern may allow inference on the connectivity and developmental trajectory of the underlying white matter complementary to diffusion imaging and this result may guide the development of biomarkers of functional outcome.