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Abstract
Periventricular white matter injury (WMI) is a major cause of cerebral palsy in preterm infants, yet mechanisms remain unclear. Using a fetal sheep ischemia-reperfusion model, we combined cerebral blood flow mapping, histopathology, and high-field MRI to study WMI evolution. Injury localized to regions enriched in late oligodendrocyte progenitors (preOLs), which degenerated acutely but later proliferated without maturing, leading to gliotic lesions. MRI identified four lesion types, including two novel T2 hypo-intense signals correlating with necrosis or gliosis. Axonal structure remained intact in diffuse gliosis. Findings suggest ischemia triggers WMI via preOL vulnerability and maturation arrest, highlighting MRI’s potential for early detection.