Date of Award


Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

First Advisor

Laura Ment

Second Advisor

Todd Constable


Very low birth weight preterm (PT) children are at high risk for brain injury. This study investigates microstructural differences in the brains of PT adolescents relative to term control subjects using diffusion tensor imaging (DTI), as well as studying their neurodevelopmental outcomes. Forty-four PT subjects (600 - 1250 grams birth weight) without neonatal brain injury and 41 term controls were evaluated at age 16 years with DTI, the Wechsler Intelligence Scale for Children - III (WISC), the Peabody Picture Vocabulary Test - Revised (PPVT), and the Comprehensive Test of Phonological Processing (CTOPP). PT subjects scored lower than term subjects on WISC full scale (p = 0.002), verbal (p = 0.027), and performance IQ tests (p = 0.001), as well as CTOPP phonological awareness (p = 0.005), but scored comparably to term subjects on PPVT and CTOPP Rapid Naming tests. PT subjects had lower fractional anisotropy (FA) values, suggestive of white matter disorganization, in multiple regions including bilateral uncinate fasciculi (left: p = 0.004; right: p = 0.002), bilateral external capsules (left: p < 0.0001; right: p = 0.001), the splenium of the corpus callosum (p = 0.014), and white matter serving the inferior frontal gyrus bilaterally (left: p < 0.0001; right: p = 0.005). FA values in both the left and right uncinate fasciculi correlated with PPVT scores (a semantic language task) in the PT subjects (left: R = 0.314, p = 0.038; right: R = 0.336, p = 0.026). FA values in the left and right arcuate fasciculi correlated with CTOPP Rapid Naming scores (a phonologic task) in the PT subjects (left: R = 0.424, p = 0.004; right: R = 0.301, p = 0.047). These data support for the first time that the recently proposed concept of dual pathways underlying language function are present in PT adolescents. These include a left-sided dorsal pathway associated with phonological and articulatory processing (arcuate fasciculus), and a bilateral ventral pathway for semantic, receptive language processing (uncinate fasciculus). The striking bilateral dorsal correlations for the PT group suggest that prematurely born subjects rely more heavily on the right hemisphere than typically developing adolescents for performance of phonological language tasks. These findings may represent either a delay in maturation or the engagement of alternative neural pathways for language in the developing PT brain.