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Han Y, Wu P, Tian J, Chen H, Yang C. Diffusion kurtosis imaging and diffusion weighted imaging comparison in diagnosis of early hypoxic-ischemic brain edema. Eur J Med Res 2023; 28:159. [PMID: 37131227 PMCID: PMC10155297 DOI: 10.1186/s40001-023-01090-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 03/05/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND Hypoxic-ischemic encephalopathy (HIE) refers to cerebral hypoxic-ischemic injury caused by asphyxia during perinatal period, which is one of the important causes of neonatal death and sequelae. Early and accurate diagnosis of HIE is of great significance for the prognostic evaluation of patients. The purpose of this study is to explore the efficacy of diffusion-kurtosis imaging (DKI) and diffusion-weighted imaging (DWI) in the diagnosis of early HIE. METHODS Twenty Yorkshire newborn piglets (3-5 days) were randomly divided into control group and experimental group. DWI and DKI scanning were performed at timepoints of 3, 6, 9, 12, 16, and 24 h after hypoxic-ischemic exposure. At each timepoint, the parameter values obtained by each group scan were measured, and the lesion area of the apparent diffusion coefficient (ADC) map and mean diffusion coefficient (MDC) map were measured. (For better interpretation of this study, we replaced the description of MD with MDC). Then, we completely removed the brain for pathological examination, and observed the state of cells and mitochondria in the ADC/MDC matching area (the actual area of the lesion), and the mismatch area (the area around the lesion). RESULTS In the experimental group, the ADC and MDC values decreased with time, but the MDC decreased more significantly and the change rate was higher. Both MDC and ADC values changed rapidly from 3 to 12 h and slowly from 12 to 24 h. The MDC and ADC images showed obvious lesions at 3 h for the first time. At this time, the area of ADC lesions was larger than that of MDC. As the lesions developed, the area of ADC maps was always larger than that of the MDC maps within 24 h. By observing the microstructure of the tissues by light microscopy, we found that the ADC and MDC matching area in the experimental group showed swelling of neurons, infiltration of inflammatory cells, and local necrotic lesions. Consistent with the observation under light microscope, pathological changes were observed in the matching ADC and MDC regions under electron microscopy as well, including collapse of mitochondrial membrane, fracture of partial mitochondrial ridge, and emergence of autophagosomes. In the mismatching region, the above pathological changes were not observed in the corresponding region of the ADC map. CONCLUSIONS DKI's characteristic parameter MDC is better than ADC (parameter of DWI) to reflect the real area of the lesion. Therefore, DKI is superior to DWI in diagnosing early HIE.
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Affiliation(s)
- Yuxuan Han
- Department of Radiology, The Second Affiliated Hospital of Dalian Medical University, No. 467, Zhongshan Road, Shahekou District, Dalian, Liaoning Province China
| | - Peng Wu
- Department of Radiology, The Second Affiliated Hospital of Dalian Medical University, No. 467, Zhongshan Road, Shahekou District, Dalian, Liaoning Province China
| | - Juan Tian
- Department of Radiology, The Second Affiliated Hospital of Dalian Medical University, No. 467, Zhongshan Road, Shahekou District, Dalian, Liaoning Province China
| | - Honghai Chen
- Department of Radiology, The Second Affiliated Hospital of Dalian Medical University, No. 467, Zhongshan Road, Shahekou District, Dalian, Liaoning Province China
| | - Chao Yang
- Department of Radiology, The Second Affiliated Hospital of Dalian Medical University, No. 467, Zhongshan Road, Shahekou District, Dalian, Liaoning Province China
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2
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Bobba PS, Weber CF, Mak A, Mozayan A, Malhotra A, Sheth KN, Taylor SN, Vossough A, Grant PE, Scheinost D, Constable RT, Ment LR, Payabvash S. Age-related topographic map of magnetic resonance diffusion metrics in neonatal brains. Hum Brain Mapp 2022; 43:4326-4334. [PMID: 35599634 PMCID: PMC9435001 DOI: 10.1002/hbm.25956] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 02/22/2022] [Accepted: 05/06/2022] [Indexed: 01/15/2023] Open
Abstract
Accelerated maturation of brain parenchyma close to term-equivalent age leads to rapid changes in diffusion-weighted imaging (DWI) and diffusion tensor imaging (DTI) metrics of neonatal brains, which can complicate the evaluation and interpretation of these scans. In this study, we characterized the topography of age-related evolution of diffusion metrics in neonatal brains. We included 565 neonates who had MRI between 0 and 3 months of age, with no structural or signal abnormality-including 162 who had DTI scans. We analyzed the age-related changes of apparent diffusion coefficient (ADC) values throughout brain and DTI metrics (fractional anisotropy [FA] and mean diffusivity [MD]) along white matter (WM) tracts. Rate of change in ADC, FA, and MD values across 5 mm cubic voxels was calculated. There was significant reduction of ADC and MD values and increase of FA with increasing gestational age (GA) throughout neonates' brain, with the highest temporal rates in subcortical WM, corticospinal tract, cerebellar WM, and vermis. GA at birth had significant effect on ADC values in convexity cortex and corpus callosum as well as FA/MD values in corpus callosum, after correcting for GA at scan. We developed online interactive atlases depicting age-specific normative values of ADC (ages 34-46 weeks), and FA/MD (35-41 weeks). Our results show a rapid decrease in diffusivity metrics of cerebral/cerebellar WM and vermis in the first few weeks of neonatal age, likely attributable to myelination. In addition, prematurity and low GA at birth may result in lasting delay in corpus callosum myelination and cerebral cortex cellularity.
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Affiliation(s)
- Pratheek S. Bobba
- Department of Radiology and Biomedical ImagingYale School of MedicineNew HavenConnecticutUSA
| | - Clara F. Weber
- Department of Radiology and Biomedical ImagingYale School of MedicineNew HavenConnecticutUSA,Social Neuroscience Lab, Department of Psychiatry and PsychotherapyLübeck UniversityLübeckGermany
| | - Adrian Mak
- Department of Radiology and Biomedical ImagingYale School of MedicineNew HavenConnecticutUSA,CLAIM ‐ Charité Lab for Artificial Intelligence in MedicineCharité Universitätsmedizin BerlinBerlinGermany
| | - Ali Mozayan
- Department of Radiology and Biomedical ImagingYale School of MedicineNew HavenConnecticutUSA
| | - Ajay Malhotra
- Department of Radiology and Biomedical ImagingYale School of MedicineNew HavenConnecticutUSA
| | - Kevin N. Sheth
- Department of NeurologyYale University School of MedicineNew HavenConnecticutUSA
| | - Sarah N. Taylor
- Department of PediatricsYale University School of MedicineNew HavenConnecticutUSA
| | - Arastoo Vossough
- Department of RadiologyChildren's Hospital of PennsylvaniaPhiladelphiaPennsylvaniaUSA,Department of RadiologyUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Patricia Ellen Grant
- Division of Newborn Medicine, Department of MedicineBoston Children's Hospital, Harvard Medical SchoolBostonMassachusettsUSA,Department of Radiology, Boston Children's HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Dustin Scheinost
- Department of Radiology and Biomedical ImagingYale School of MedicineNew HavenConnecticutUSA
| | - Robert Todd Constable
- Department of Radiology and Biomedical ImagingYale School of MedicineNew HavenConnecticutUSA
| | - Laura R. Ment
- Department of NeurologyYale University School of MedicineNew HavenConnecticutUSA,Department of PediatricsYale University School of MedicineNew HavenConnecticutUSA
| | - Seyedmehdi Payabvash
- Department of Radiology and Biomedical ImagingYale School of MedicineNew HavenConnecticutUSA
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3
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Beck J, Loron G, Ancel PY, Alison M, Hertz Pannier L, Vo Van P, Debillon T, Bednarek N. An Updated Overview of MRI Injuries in Neonatal Encephalopathy: LyTONEPAL Cohort. CHILDREN 2022; 9:children9040561. [PMID: 35455605 PMCID: PMC9032533 DOI: 10.3390/children9040561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 04/05/2022] [Accepted: 04/11/2022] [Indexed: 11/29/2022]
Abstract
Background: Brain magnetic resonance imaging (MRI) is a key tool for the prognostication of encephalic newborns in the context of hypoxic−ischemic events. The purpose of this study was to finely characterize brain injuries in this context. Methods: We provided a complete, descriptive analysis of the brain MRIs of infants included in the French national, multicentric cohort LyTONEPAL. Results: Among 794 eligible infants, 520 (65.5%) with MRI before 12 days of life, grade II or III encephalopathy and gestational age ≥36 weeks were included. Half of the population had a brain injury (52.4%); MRIs were acquired before 6 days of life among 247 (47.5%) newborns. The basal ganglia (BGT), white matter (WM) and cortex were the three predominant sites of injuries, affecting 33.8% (n = 171), 33.5% (n = 166) and 25.6% (n = 128) of participants, respectively. The thalamus and the periventricular WM were the predominant sublocations. The BGT, posterior limb internal capsule, brainstem and cortical injuries appeared more frequently in the early MRI group than in the late MRI group. Conclusion: This study described an overview of brain injuries in hypoxic−ischemic neonatal encephalopathy. The basal ganglia with the thalamus and the WM with periventricular sublocation injuries were predominant. Comprehensive identification of brain injuries in the context of HIE may provide insight into the mechanism and time of occurrence.
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Affiliation(s)
- Jonathan Beck
- Department of Neonatology, Reims University Hospital Alix de Champagne, 51100 Reims, France; (G.L.); (N.B.)
- EPOPé (Obstetrical Perinatal and Pediatric Epidemiology Research Team), CRESS (Centre of Research in Epidemiology and StatisticS), INSERM (Institut National de la Santé et de la Recherche Médicale), INRAE (Institut National de la Recherche Agronomique), Université de Paris, 75004 Paris, France;
- Correspondence:
| | - Gauthier Loron
- Department of Neonatology, Reims University Hospital Alix de Champagne, 51100 Reims, France; (G.L.); (N.B.)
- CReSTIC EA (Centre de Recherche en Traitement du Signal Informatique) 3804, Université de Reims Champagne Ardenne, 51097 Reims, France
| | - Pierre-Yves Ancel
- EPOPé (Obstetrical Perinatal and Pediatric Epidemiology Research Team), CRESS (Centre of Research in Epidemiology and StatisticS), INSERM (Institut National de la Santé et de la Recherche Médicale), INRAE (Institut National de la Recherche Agronomique), Université de Paris, 75004 Paris, France;
- Assistance Publique—Hôpitaux de Paris, Clinical Investigation Center P1419, 75004 Paris, France
| | - Marianne Alison
- Service d’Imagerie Pédiatrique, Hôpital Robert Debré, APHP (Assistance Publique—Hôpitaux de Paris), 75019 Paris, France;
- Unit 1141 NeuroDiderot, Inserm, CEA (Commissariat à l’Énergie Atomique et aux Énergies Alternatives), Université Paris Cité, 75019 Paris, France;
| | - Lucie Hertz Pannier
- Unit 1141 NeuroDiderot, Inserm, CEA (Commissariat à l’Énergie Atomique et aux Énergies Alternatives), Université Paris Cité, 75019 Paris, France;
- UNIACT (Unité de Recherche en NeuroImagerie Applicative Clinique et Translationnelle), Neurospin, CEA (Commissariat à l’Énergie Atomique et aux Énergies Alternatives)-Saclay, 91191 Gif sur Yvette, France
| | - Philippe Vo Van
- Department of Neonatology, Hospices Civils de Lyon, Femme Mère Enfant Hospital, Pinel, 69500 Bron, France;
| | - Thierry Debillon
- Neonatal Intensive Care Unit CHU (Centre Hospital-Universitaire) Grenoble Alpes, 38000 Grenoble, France;
- Grenoble INP (Institut d’Ingénierie et de Management), TIMC (Techniques de l’Ingénierie Médicale et de la Complexité)-IMAG (Informatique, Mathématiques et Applications, Grenoble), CNRS (Centre National de la Recherche Scientifique), University Grenoble Alpes, 38000 Grenoble, France
| | - Nathalie Bednarek
- Department of Neonatology, Reims University Hospital Alix de Champagne, 51100 Reims, France; (G.L.); (N.B.)
- CReSTIC EA (Centre de Recherche en Traitement du Signal Informatique) 3804, Université de Reims Champagne Ardenne, 51097 Reims, France
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4
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Kushwah S, Kumar A, Verma A, Basu S, Kumar A. Comparison of fractional anisotropy and apparent diffusion coefficient among hypoxic ischemic encephalopathy stages 1, 2, and 3 and with nonasphyxiated newborns in 18 areas of brain. Indian J Radiol Imaging 2021; 27:447-456. [PMID: 29379241 PMCID: PMC5761173 DOI: 10.4103/ijri.ijri_384_16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose To determine the area and extent of injury in hypoxic encephalopathy stages by diffusion tensor imaging (DTI) using parameters apparent diffusion coefficient (ADC) and fractional anisotropy (FA) values and their comparison with controls without any evidence of asphyxia. To correlate the outcome of hypoxia severity clinically and significant changes on DTI parameter. Materials and Methods DTI was done in 50 cases at median age of 12 and 20 controls at median age of 7 days. FA and apparent diffusion coefficient (ADC) were measured in several regions of interest (ROI). Continuous variables were analyzed using Student's t-test. Categorical variables were compared by Fisher's exact test. Comparison among multiple groups was done using analysis of variance (ANOVA) and post hoc Bonferroni test. Results Abnormalities were more easily and accurately determined in ROI with the help of FA and ADC values. When compared with controls FA values were significantly decreased and ADC values were significantly increased in cases, in ROI including both right and left side of thalamus, basal ganglia, posterior limb of internal capsule, cerebral peduncle, corticospinal tracts, frontal, parietal, temporal, occipital with P value < 0.05. The extent of injury was maximum in stage-III. There was no significant difference among males and females. Conclusion Compared to conventional magnetic resonance imaging (MRI), the evaluation of FA and ADC values using DTI can determine the extent and severity of injury in hypoxic encephalopathy. It can be used for early determination of brain injury in these patients.
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Affiliation(s)
- Supriya Kushwah
- Department of Paediatrics, Yenepoya Medical College, Mangalore, Karnataka, India
| | - Ashok Kumar
- Department of Paediatrics, Institute of Medical Sciences, Varanasi, Uttar Pradesh, India
| | - Ashish Verma
- Department of Paediatrics, Institute of Medical Sciences, Varanasi, Uttar Pradesh, India
| | - Sriparna Basu
- Department of Paediatrics, Institute of Medical Sciences, Varanasi, Uttar Pradesh, India
| | - Ashutosh Kumar
- Department of Anaesthesia, KMC, Mangalore, Karnataka, India
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5
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Gao F, Shen X, Zhang H, Ba R, Ma X, Lai C, Zhang J, Zhang Y, Wu D. Feasibility of oscillating and pulsed gradient diffusion MRI to assess neonatal hypoxia-ischemia on clinical systems. J Cereb Blood Flow Metab 2021; 41:1240-1250. [PMID: 32811261 PMCID: PMC8142137 DOI: 10.1177/0271678x20944353] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Diffusion-time- (td) dependent diffusion MRI (dMRI) extends our ability to characterize brain microstructure by measuring dMRI signals at varying td. The use of oscillating gradient (OG) is essential for accessing short td but is technically challenging on clinical MRI systems. This study aims to investigate the clinical feasibility and value of td-dependent dMRI in neonatal hypoxic-ischemic encephalopathy (HIE). Eighteen HIE neonates and six normal term-born neonates were scanned on a 3 T scanner, with OG-dMRI at an oscillating frequency of 33 Hz (equivalent td ≈ 7.5 ms) and pulsed gradient (PG)-dMRI at a td of 82.8 ms and b-value of 700 s/mm2. The td-dependence, as quantified by the difference in apparent diffusivity coefficients between OG- and PG-dMRI (ΔADC), was observed in the normal neonatal brains, and the ΔADC was higher in the subcortical white matter than the deep grey matter. In HIE neonates with severe and moderate injury, ΔADC significantly increased in the basal ganglia (BG) compared to the controls (23.7% and 10.6%, respectively). In contrast, the conventional PG-ADC showed a 12.6% reduction only in the severe HIE group. White matter edema regions also demonstrated increased ΔADC, where PG-ADC did not show apparent changes. Our result demonstrated that td-dependent dMRI provided high sensitivity in detecting moderate-to-severe HIE.
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Affiliation(s)
- Fusheng Gao
- Department of Radiology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Xiaoxia Shen
- Department of Neonatal Intensive Care Unit, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Hongxi Zhang
- Department of Radiology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Ruicheng Ba
- Key Laboratory for Biomedical Engineering of Ministry of Education, Department of Biomedical Engineering, College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, China
| | - Xiaolu Ma
- Department of Neonatal Intensive Care Unit, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Can Lai
- Department of Radiology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Jiangyang Zhang
- Department of Radiology, New York University School of Medicine, New York, NY, USA
| | - Yi Zhang
- Key Laboratory for Biomedical Engineering of Ministry of Education, Department of Biomedical Engineering, College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, China
| | - Dan Wu
- Key Laboratory for Biomedical Engineering of Ministry of Education, Department of Biomedical Engineering, College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, China
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6
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Gotchac J, Cardoit L, Thoby-Brisson M, Brissaud O. A Rodent Model of Mild Neonatal Hypoxic Ischemic Encephalopathy. Front Neurol 2021; 12:637947. [PMID: 34025552 PMCID: PMC8131664 DOI: 10.3389/fneur.2021.637947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 04/08/2021] [Indexed: 11/13/2022] Open
Abstract
In the brain of full-term newborns, Hypoxic Ischemic Encephalopathy (HIE), a consequence of severe hypoxia and ischemia due to low cardiac output, is frequently observed and results in cerebral injuries with dramatic consequences for life. To investigate the physiopathology of HIE, several animal models have been developed, but none closely replicate human cases, mostly because they are based on a single carotid ligation protocol. In the present study we aimed to develop a novel and more accurate HIE model in juvenile (post-natal days (PND) 14–16) rats. For this, we induced a 9 min hypoxic cardiac arrest (CA) by stopping mechanical ventilation of intubated, ventilated and curarized rats followed by a cardiopulmonary resuscitation. To evaluate the consequences of the CA we performed radiological (cerebral MRI), behavioral (Open Field, Elevated Plus Maze, Fear Conditioning), and histological (Cresyl Violet and Fluoro-Jade B) testing on treated animals. We found that rats in the CA group developed an anxiolytic-like behavioral profile in adulthood without any locomotor impairment, nor memory deficits. However, MRI investigation performed early after CA failed to reveal any change in apparent diffusion coefficient (ADC) in brain tissue (including the hippocampus, striatum, and thalamus), suggesting no massive anatomical lesion had occurred. In contrast, signs of neurodegeneration were found in the Dentate Gyrus and the CA1 region of the hippocampus at day 1 post-CA, suggesting that the anxiolytic-like phenotype observed in adulthood could be related to an abnormal degeneration of this brain region beginning immediately after CA. Thus, our model, despite not representing a severe condition of HIE, nonetheless constitutes a potential model for studying mild, yet persistent and region-specific cerebral injury resulting from an acute oxygen deprivation.
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Affiliation(s)
- Julien Gotchac
- Institut des Neurosciences Cognitives et Intégratives d'Aquitaine, CNRS UMR 5287, University of Bordeaux, Bordeaux, France
| | - Laura Cardoit
- Institut des Neurosciences Cognitives et Intégratives d'Aquitaine, CNRS UMR 5287, University of Bordeaux, Bordeaux, France
| | - Muriel Thoby-Brisson
- Institut des Neurosciences Cognitives et Intégratives d'Aquitaine, CNRS UMR 5287, University of Bordeaux, Bordeaux, France
| | - Olivier Brissaud
- Institut des Neurosciences Cognitives et Intégratives d'Aquitaine, CNRS UMR 5287, University of Bordeaux, Bordeaux, France.,Pediatric Intensive Care Unit, Teacher's hospital of Children Pellegrin, Bordeaux, France
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7
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Weiss RJ, Bates SV, Song Y, Zhang Y, Herzberg EM, Chen YC, Gong M, Chien I, Zhang L, Murphy SN, Gollub RL, Grant PE, Ou Y. Mining multi-site clinical data to develop machine learning MRI biomarkers: application to neonatal hypoxic ischemic encephalopathy. J Transl Med 2019; 17:385. [PMID: 31752923 PMCID: PMC6873573 DOI: 10.1186/s12967-019-2119-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 10/31/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Secondary and retrospective use of hospital-hosted clinical data provides a time- and cost-efficient alternative to prospective clinical trials for biomarker development. This study aims to create a retrospective clinical dataset of Magnetic Resonance Images (MRI) and clinical records of neonatal hypoxic ischemic encephalopathy (HIE), from which clinically-relevant analytic algorithms can be developed for MRI-based HIE lesion detection and outcome prediction. METHODS This retrospective study will use clinical registries and big data informatics tools to build a multi-site dataset that contains structural and diffusion MRI, clinical information including hospital course, short-term outcomes (during infancy), and long-term outcomes (~ 2 years of age) for at least 300 patients from multiple hospitals. DISCUSSION Within machine learning frameworks, we will test whether the quantified deviation from our recently-developed normative brain atlases can detect abnormal regions and predict outcomes for individual patients as accurately as, or even more accurately, than human experts. Trial Registration Not applicable. This study protocol mines existing clinical data thus does not meet the ICMJE definition of a clinical trial that requires registration.
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Affiliation(s)
- Rebecca J Weiss
- Division of Newborn Medicine, Department of Pediatrics, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Sara V Bates
- Division of Newborn Medicine, Department of Pediatrics, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Ya'nan Song
- Fetal Neonatal Neuroimaging and Developmental Science Center (FNNDSC), Boston Children's Hospital, Harvard Medical School, 401 Park Drive, Landmark Center 7022, Boston, MA, 02115, USA
| | - Yue Zhang
- Fetal Neonatal Neuroimaging and Developmental Science Center (FNNDSC), Boston Children's Hospital, Harvard Medical School, 401 Park Drive, Landmark Center 7022, Boston, MA, 02115, USA
| | - Emily M Herzberg
- Division of Newborn Medicine, Department of Pediatrics, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Yih-Chieh Chen
- Division of Newborn Medicine, Department of Pediatrics, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Maryann Gong
- Computer Science & Artificial Intelligence Lab (CSAIL), Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Isabel Chien
- Computer Science & Artificial Intelligence Lab (CSAIL), Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Lily Zhang
- Computer Science & Artificial Intelligence Lab (CSAIL), Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Shawn N Murphy
- Laboratory of Computer Science, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Randy L Gollub
- Department of Psychiatry and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - P Ellen Grant
- Fetal Neonatal Neuroimaging and Developmental Science Center (FNNDSC), Boston Children's Hospital, Harvard Medical School, 401 Park Drive, Landmark Center 7022, Boston, MA, 02115, USA.
- Neuroradiology Division, Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, 02115, USA.
| | - Yangming Ou
- Fetal Neonatal Neuroimaging and Developmental Science Center (FNNDSC), Boston Children's Hospital, Harvard Medical School, 401 Park Drive, Landmark Center 7022, Boston, MA, 02115, USA.
- Neuroradiology Division, Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, 02115, USA.
- Computational Health Informatics Program (CHIP), Boston Children's Hospital, Harvard Medical School, Boston, MA, 02115, USA.
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8
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Salas J, Reddy N, Carson KA, Northington FJ, Huisman TA. Ultrasound Predicts White Matter Integrity after Hypothermia Therapy in Neonatal Hypoxic-Ischemic Injury. J Neuroimaging 2019; 29:743-749. [PMID: 31206969 PMCID: PMC6814495 DOI: 10.1111/jon.12644] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 06/01/2019] [Accepted: 06/06/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Hypoxic-ischemic injury (HII) is a major cause of neonatal death and neurodevelopmental disability. Head ultrasounds (HUS) in neonates with HII often show enhanced gray/white matter differentiation. We assessed the significance of this finding in predicting white matter structural integrity measured by diffusion tensor imaging (DTI) in neonates with HII. METHODS We performed a quantitative region of interest-based analysis of white and gray matter echogenicity within the cingulate gyrus on pre- and posthypothermia HUS. We also completed a quantitative analysis of fractional anisotropy (FA) and mean (MD), axial (AD), and radial (RD) diffusivity within the bilateral anterior and posterior centrum semiovale (CSO) on posthypothermia brain magnetic resonance imaging. For HUS studies, we calculated a white-to-gray matter echogenicity ratio (WGR) and subsequently correlated it to DTI measurements. RESULTS Forty-two term neonates with HII who underwent hypothermia therapy were included. Significant correlation was found between prehypothermia WGR and MD, AD, and RD values in the left anterior CSO (r = .38-.40, P = .02). Prehypothermia WGR also correlated with the following: MD and RD in the right anterior CSO (r = .35-.36, P = .04), MD and AD in the right posterior CSO (r = .32-.45, P = .008-.03), and AD in the left posterior CSO (r = .47, P = .005). No significant correlation was found either between prehypothermia WGR and FA values in the bilateral anterior and posterior CSO or between posthypothermia WGR and all DTI scalars in the bilateral anterior and posterior CSO. CONCLUSIONS Prehypothermia HUS WGR may predict posthypothermia white matter structural integrity and is potentially an early and easily obtainable biomarker of severity in neonatal HII.
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Affiliation(s)
- Jacqueline Salas
- Division of Neonatology, Department of Pediatrics, New-York Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA,Neurosciences Intensive Care Nursery Group and Division of Neonatology, Johns Hopkins University School of Medicine
| | - Nihaal Reddy
- Neurosciences Intensive Care Nursery Group and Division of Neonatology, Johns Hopkins University School of Medicine,Division of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kathryn A. Carson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Frances J. Northington
- Neurosciences Intensive Care Nursery Group and Division of Neonatology, Johns Hopkins University School of Medicine,Division of Neonatology, Department of Pediatrics, Johns Hopkins School of Medicine
| | - Thierry A.G.M. Huisman
- Neurosciences Intensive Care Nursery Group and Division of Neonatology, Johns Hopkins University School of Medicine,Division of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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9
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Detection of occult abnormalities in the deep gray matter nuclei of neonates with punctate white matter lesions by magnetic resonance spectroscopy. Neuroradiology 2019; 61:1447-1456. [PMID: 31511919 DOI: 10.1007/s00234-019-02291-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 09/02/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Punctate white matter lesions (PWML) are common in preterm neonates and have also been reported in the full term. While most studies focus on white matter abnormalities, gray matter (GM) alterations are generally ignored due to the lack of abnormalities on conventional MRI. This study aims to investigate whether magnetic resonance spectroscopy is a sensitive and practical method to detect occult alterations of deep GM nuclei in these neonates. METHODS Neonates with PWML and controls with no MRI abnormalities were retrospectively studied. Apparent diffusion coefficient values and metabolic ratios (Cho/Cr, NAA/Cho, and NAA/Cr) in the lenticular nucleus and the thalamus were compared between the PWML and control groups. RESULTS Forty-two neonates with PWML (grades I, II, and III contained 14, 21, and 7 subjects, respectively) and 50 controls were enrolled. Apparent diffusion coefficient values in the lenticular nucleus and the thalamus were not significantly different between the PWML and the control groups. The NAA/Cho ratio was significantly lower in the PWML group than in the control group in both regions, whereas a lower NAA/Cr ratio was only observed in the thalamus. Significantly lower ratios of NAA/Cho in both regions and NAA/Cr in the thalamus were detected in the grade II and III subgroup, whereas the thalamic NAA/Cho ratio was decreased in the grade I group compared with controls. CONCLUSIONS Magnetic resonance spectroscopy is a sensitive method for detecting the occult deep GM abnormalities for the study cohort of neonates with PWML when compared with subjects without PWML.
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MR Imaging of hypoxic ischemic encephalopathy - Distribution Patterns and ADC value correlations. Eur J Radiol Open 2018; 5:215-220. [PMID: 30480058 PMCID: PMC6240807 DOI: 10.1016/j.ejro.2018.08.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 08/05/2018] [Accepted: 08/05/2018] [Indexed: 11/23/2022] Open
Abstract
Background and purpose Neonatal hypoxic-ischemic encephalopathy causes hypoxic brain injury. Due to differences in brain maturity at time of insult, severity of hypotension and duration of insult, there are four distinct patterns of brain injury. Magnetic resonance imaging is the most sensitive modality for evaluating these patterns of brain injury. Additional role of Diffusion weighted imaging and ADC values can be useful in the evaluation of such cases. We conducted this study to analyse the usefulness of ADC values in the brain tissue affected by hypoxic-ischemic injury. Materials and Methods We conducted a prospective study of all the patients referred to our department for magnetic resonance scanning of brain with history of hypoxic ischemic encephalopathy and clinical features cerebral palsy. 23 Cases with imaging manifestations of hypoxic ischemic encephalopathy were included in the study. We studied distribution patterns of HIE in our cases and calculated the ADC values of involved as well as normal grey and white matter. Further, sensitivity, specificity, predictive values, and likelihood ratios for each dichotomized diffusion and ADC values were obtained Wilson Score method. Results The most common distribution pattern in our study was involvement of peri-rolandic area (15 cases, 65%). ADC values were significantly (p < 0.005) increased in abnormal white matter. No significant changes (p = 0.8) were seen in ADC values of normal and abnormal grey matter. Conclusions Due to significant increase in ADC values of affected white matter, ADC value can be used as a marker to detect chronic sequel of hypoxic ischaemic brain injury. Another observation was the perirolandic brain tissue being most common area of involvement in the cases with cerebral palsy.
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Debillon T, Bednarek N, Ego A. LyTONEPAL: long term outcome of neonatal hypoxic encephalopathy in the era of neuroprotective treatment with hypothermia: a French population-based cohort. BMC Pediatr 2018; 18:255. [PMID: 30068301 PMCID: PMC6090887 DOI: 10.1186/s12887-018-1232-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 07/19/2018] [Indexed: 11/28/2022] Open
Abstract
Background Hypoxic-ischemic encephalopathy (HIE) is a rare neonatal condition affecting about 1‰ births. Despite a significant improvement in the management of this condition in the last ten years, HIE remains associated with high rates of death and severe neurological disability. From September 2015 to March 2017, a French national cohort of HIE cases was conducted to estimate the extent of long-term moderate and severe neurodevelopmental disability at 3 years and its determinants. Methods This prospective population-based cohort includes all moderate or severe cases of HIE, occurring in newborns delivered between 34 and 42 completed weeks of gestation and admitted to a neonatal intensive care unit. Detailed data on the pregnancy, delivery, and newborn until hospital discharge was collected from the medical records in maternity and neonatology units. All clinical examinations including biomarkers, EEG, and imaging were recorded. To ensure the completeness of HIE registration, a registry of non-included eligible neonates was organized, and the exhaustiveness of the cohort is currently checked using the national hospital discharge database. Follow-up is organized by the regional perinatal network, and 3 medical visits are planned at 18, 24 and 36 months. One additional project focused on early predictors, in particular early biomarkers, involves a quarter of the cohort. Discussion This cohort study aims to improve and update our knowledge about the incidence, the prognosis and the etiology of HIE, and to assess medical care. Its final objective is to improve the definition of this condition and develop prevention and management strategies for high-risk infants. Trial registration NCT02676063. Date of registration (Retrospectively Registered): February 8, 2016.
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Affiliation(s)
- Thierry Debillon
- Neonatology Department, University Hospital Grenoble Alpes, Grenoble, France. .,TIMC-IMAG, Grenoble Institute of Engineering, CNRS, Grenoble Alpes University, Grenoble, France.
| | - Nathalie Bednarek
- Neonatology Department, University Hospital Alix de Champagne, Reims, France.,CReSTIC, Champagne-Ardennes University, EA3804, Reims, France
| | - Anne Ego
- TIMC-IMAG, Grenoble Institute of Engineering, CNRS, Grenoble Alpes University, Grenoble, France.,Public Health Department, University Hospital Grenoble Alpes, Grenoble, France
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Sanz Cortes M, Rivera AM, Yepez M, Guimaraes CV, Diaz Yunes I, Zarutskie A, Davila I, Shetty A, Mahadev A, Serrano SM, Castillo N, Lee W, Valentine G, Belfort M, Parra G, Mohila C, Aagaard K, Parra Saavedra M. Clinical assessment and brain findings in a cohort of mothers, fetuses and infants infected with ZIKA virus. Am J Obstet Gynecol 2018; 218:440.e1-440.e36. [PMID: 29353032 DOI: 10.1016/j.ajog.2018.01.012] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 01/04/2018] [Accepted: 01/08/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND Congenital Zika virus (ZIKV) infection can be detected in both the presence and absence of microcephaly and manifests as a number of signs and symptoms that are detected clinically and by neuroimaging. However, to date, qualitative and quantitative measures for the purpose of diagnosis and prognosis are limited. OBJECTIVES Main objectives of this study conducted on fetuses and infants with confirmed congenital Zika virus infection and detected brain abnormalities were (1) to assess the prevalence of microcephaly and the frequency of the anomalies that include a detailed description based on ultrasound and magnetic resonance imaging in fetuses and ultrasound, magnetic resonance imaging, and computed tomography imaging postnatally, (2) to provide quantitative measures of fetal and infant brain findings by magnetic resonance imaging with the use of volumetric analyses and diffusion-weighted imaging, and (3) to obtain additional information from placental and fetal histopathologic assessments and postnatal clinical evaluations. STUDY DESIGN This is a longitudinal cohort study of Zika virus-infected pregnancies from a single institution in Colombia. Clinical and imaging findings of patients with laboratory-confirmed Zika virus infection and fetal brain anomalies were the focus of this study. Patients underwent monthly fetal ultrasound scans, neurosonography, and a fetal magnetic resonance imaging. Postnatally, infant brain assessment was offered by the use of ultrasound imaging, magnetic resonance imaging, and/or computed tomography. Fetal head circumference measurements were compared with different reference ranges with <2 or <3 standard deviations below the mean for the diagnosis of microcephaly. Fetal and infant magnetic resonance imaging images were processed to obtain a quantitative brain volumetric assessment. Diffusion weighted imaging sequences were processed to assess brain microstructure. Anthropometric, neurologic, auditory, and visual assessments were performed postnatally. Histopathologic assessment was included if patients opted for pregnancy termination. RESULTS All women (n=214) had been referred for Zika virus symptoms during pregnancy that affected themselves or their partners or if fetal anomalies that are compatible with congenital Zika virus syndrome were detected. A total of 12 pregnant patients with laboratory confirmation of Zika virus infection were diagnosed with fetal brain malformations. Most common findings that were assessed by prenatal and postnatal imaging were brain volume loss (92%), calcifications (92%), callosal anomalies (100%), cortical malformations (89%), and ventriculomegaly (92%). Results from fetal brain volumetric assessment by magnetic resonance imaging showed that 1 of the most common findings associated with microcephaly was reduced supratentorial brain parenchyma and increased subarachnoid cerebrospinal fluid. Diffusion weighted imaging analyses of apparent diffusion coefficient values showed microstructural changes. Microcephaly was present in 33.3-58.3% of the cases at referral and was present at delivery in 55.6-77.8% of cases. At birth, most of the affected neonates (55.6-77.8%) had head circumference measurements >3 standard deviations below the mean. Postnatal imaging studies confirmed brain malformations that were detected prenatally. Auditory screening results were normal in 2 cases that were assessed. Visual screening showed different anomalies in 2 of the 3 cases that were examined. Pathologic results that were obtained from 2 of the 3 cases who opted for termination showed similar signs of abnormalities in the central nervous system and placental analyses, including brain microcalcifications. CONCLUSION Congenital microcephaly is not an optimal screening method for congenital Zika virus syndrome, because it may not accompany other evident and preceding brain findings; microcephaly could be an endpoint of the disease that results from progressive changes that are related to brain volume loss. Long-term studies are needed to understand the clinical and developmental relevance of these findings.
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Al Amrani F, Kwan S, Gilbert G, Saint-Martin C, Shevell M, Wintermark P. Early Imaging and Adverse Neurodevelopmental Outcome in Asphyxiated Newborns Treated With Hypothermia. Pediatr Neurol 2017; 73:20-27. [PMID: 28619376 DOI: 10.1016/j.pediatrneurol.2017.04.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 04/26/2017] [Accepted: 04/29/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND Brain injury can be identified as early as day two of life in asphyxiated newborns treated with hypothermia, when using diffusion magnetic resonance imaging (MRI). However, it remains unclear whether these diffusion changes can predict future neurodevelopment. This study aimed to determine whether abnormal early diffusion changes in newborns treated with hypothermia are associated with adverse neurodevelopmental outcome at age two years. METHODS Asphyxiated newborns treated with hypothermia were enrolled prospectively. They underwent magnetic resonance imaging (MRI) at specific time points over the first month of life, including diffusion-weighted imaging and diffusion-tensor imaging. Apparent diffusion coefficient (ADC) and fractional anisotropy (FA) values were measured in different regions of interest. Adverse neurodevelopmental outcome was defined as cerebral palsy, global developmental delay, and/or seizure disorder around age two years. ADC and FA values were compared between the newborns developing or not developing adverse outcome. RESULTS Twenty-nine asphyxiated newborns treated with hypothermia were included. Among the newborns developing adverse outcome, ADC values were significantly decreased on days two to three of life and increased around day ten of life in the thalamus, posterior limb of the internal capsule, and the lentiform nucleus. FA values decreased in the same regions around day 30 of life. These newborns also had increased ADC around day ten of life and around day 30 of life, and decreased FA around day 30 of life in the anterior and posterior white matter. CONCLUSIONS Diffusion changes that were evident as early as day two of life, when the asphyxiated newborns were still treated with hypothermia, were associated with later abnormal neurodevelopmental outcome.
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Affiliation(s)
- Fatema Al Amrani
- Division of Pediatric Neurology, Department of Pediatrics, Montreal Children's Hospital, McGill University, Montreal, Canada
| | - Saskia Kwan
- Division of Newborn Medicine, Department of Pediatrics, Montreal Children's Hospital, McGill University, Montreal, Canada
| | | | - Christine Saint-Martin
- Division of Pediatric Radiology, Montreal Children's Hospital, McGill University, Montreal, Canada
| | - Michael Shevell
- Division of Pediatric Neurology, Department of Pediatrics, Montreal Children's Hospital, McGill University, Montreal, Canada
| | - Pia Wintermark
- Division of Newborn Medicine, Department of Pediatrics, Montreal Children's Hospital, McGill University, Montreal, Canada.
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Can cerebellar and brainstem apparent diffusion coefficient (ADC) values predict neuromotor outcome in term neonates with hypoxic-ischemic encephalopathy (HIE) treated with hypothermia? PLoS One 2017; 12:e0178510. [PMID: 28686592 PMCID: PMC5501430 DOI: 10.1371/journal.pone.0178510] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 05/14/2017] [Indexed: 11/24/2022] Open
Abstract
Background and purpose To determine the apparent diffusion coefficient (ADC) in specific infratentorial brain structures during the first week of life and its relation with neuromotor outcome for Hypoxic-ischemic encephalopathy (HIE) in term neonates with and without whole-body hypothermia (TH). Materials and methods We retrospectively evaluated 45 MRI studies performed in the first week of life of term neonates born between 2010 and 2013 at Boston Children's Hospital. Selected cases were classified into three groups: 1) HIE neonates who underwent TH, 2) HIE normothermics (TN), and 3) controls. The neuromotor outcome was categorized as normal, abnormal and death. The ADCmean was calculated for six infratentorial brain regions. Results A total of 45 infants were included: 28 HIE TH treated, 8 HIE TN, and 9 controls. The mean gestational age was 39 weeks; 57.8% were male; 11.1% were non-survivors. The median age at MRI was 3 days (interquartile range, 1–4 days). A statistically significant relationship was shown between motor outcome or death and the ADCmean in the vermis (P = 0.002), cerebellar left hemisphere (P = 0.002), midbrain (P = 0.009), pons (P = 0.014) and medulla (P = 0.005). In patients treated with TH, the ADC mean remained significantly lower than that in the controls only in the hemispheres (P = 0.01). In comparison with abnormal motor outcome, ADCmean was lowest in the left hemisphere (P = 0.003), vermis (P = 0.003), pons (P = 0.0036) and medulla (P = 0.008) in case of death. Conclusion ADCmean values during the first week of life in the left hemisphere, vermis, pons and medulla are related to motor outcome or death in infants with HIE either with or without hypothermic therapy. Therefore, this objective tool can be assessed prospectively to determine if it can be used to establish prognosis in the first week of life, particularly in severe cases of HIE.
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Ou Y, Zöllei L, Retzepi K, Castro V, Bates SV, Pieper S, Andriole KP, Murphy SN, Gollub RL, Grant PE. Using clinically acquired MRI to construct age-specific ADC atlases: Quantifying spatiotemporal ADC changes from birth to 6-year old. Hum Brain Mapp 2017; 38:3052-3068. [PMID: 28371107 PMCID: PMC5426959 DOI: 10.1002/hbm.23573] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 03/03/2017] [Accepted: 03/07/2017] [Indexed: 12/19/2022] Open
Abstract
Diffusion imaging is critical for detecting acute brain injury. However, normal apparent diffusion coefficient (ADC) maps change rapidly in early childhood, making abnormality detection difficult. In this article, we explored clinical PACS and electronic healthcare records (EHR) to create age-specific ADC atlases for clinical radiology reference. Using the EHR and three rounds of multiexpert reviews, we found ADC maps from 201 children 0-6 years of age scanned between 2006 and 2013 who had brain MRIs with no reported abnormalities and normal clinical evaluations 2+ years later. These images were grouped in 10 age bins, densely sampling the first 1 year of life (5 bins, including neonates and 4 quarters) and representing the 1-6 year age range (an age bin per year). Unbiased group-wise registration was used to construct ADC atlases for 10 age bins. We used the atlases to quantify (a) cross-sectional normative ADC variations; (b) spatiotemporal heterogeneous ADC changes; and (c) spatiotemporal heterogeneous volumetric changes. The quantified age-specific whole-brain and region-wise ADC values were compared to those from age-matched individual subjects in our study and in multiple existing independent studies. The significance of this study is that we have shown that clinically acquired images can be used to construct normative age-specific atlases. These first of their kind age-specific normative ADC atlases quantitatively characterize changes of myelination-related water diffusion in the first 6 years of life. The quantified voxel-wise spatiotemporal ADC variations provide standard references to assist radiologists toward more objective interpretation of abnormalities in clinical images. Our atlases are available at https://www.nitrc.org/projects/mgh_adcatlases. Hum Brain Mapp 38:3052-3068, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Yangming Ou
- Psychiatric Neuroimaging, Department of PsychiatryMassachusetts General Hospital, Harvard Medical SchoolCharlestownMassachusetts
- Laboratory for Computational NeuroimagingAthinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical SchoolCharlestownMassachusetts
- Quantitative Tumor Imaging at Martinos, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical SchoolCharlestownMassachusetts
- Fetal‐Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Harvard Medical SchoolBostonMassachusetts
| | - Lilla Zöllei
- Laboratory for Computational NeuroimagingAthinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical SchoolCharlestownMassachusetts
| | - Kallirroi Retzepi
- Psychiatric Neuroimaging, Department of PsychiatryMassachusetts General Hospital, Harvard Medical SchoolCharlestownMassachusetts
- Laboratory for Computational NeuroimagingAthinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical SchoolCharlestownMassachusetts
| | - Victor Castro
- Research Computing, Partners Healthcare, 1 Constitution CenterCharlestownMassachusetts
- Laboratory of Computer ScienceMassachusetts General Hospital, Harvard Medical SchoolBostonMassachusetts
| | - Sara V. Bates
- Division of Newborn Medicine, Department of PediatricsMassachusetts General Hospital for Children, Harvard Medical SchoolBostonMassachusetts
| | | | - Katherine P. Andriole
- Department of RadiologyBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusetts
| | - Shawn N. Murphy
- Research Computing, Partners Healthcare, 1 Constitution CenterCharlestownMassachusetts
- Laboratory of Computer ScienceMassachusetts General Hospital, Harvard Medical SchoolBostonMassachusetts
| | - Randy L. Gollub
- Psychiatric Neuroimaging, Department of PsychiatryMassachusetts General Hospital, Harvard Medical SchoolCharlestownMassachusetts
- Laboratory for Computational NeuroimagingAthinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical SchoolCharlestownMassachusetts
| | - Patricia Ellen Grant
- Fetal‐Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Harvard Medical SchoolBostonMassachusetts
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Cahill AG, Macones GA, Smyser CD, López JD, Inder TE, Mathur AM. Umbilical Artery Lactate Correlates with Brain Lactate in Term Infants. Am J Perinatol 2017; 34:535-540. [PMID: 27788532 PMCID: PMC5530875 DOI: 10.1055/s-0036-1593844] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Objective The objective of this study was to determine the correlation between umbilical artery lactate with brain lactate in nonanomalous term infants. Study Design We performed a nested case-control study within an on-going prospective cohort of more than 8,000 consecutive singleton term (≥ 37 weeks) nonanomalous infants. Neonates underwent cerebral magnetic resonance imaging (MRI) within the first 72 hours of life. Cases (umbilical artery pH ≤ 7.10) were gender and race matched 1:3 to controls (umbilical artery pH > 7.20). Single voxel magnetic resonance spectroscopy (MRS), lactate, and N-acetyl aspartate (NAA) for normalization were calculated using Siemens software (Plano, TX). Linear regression estimated the association between incremental change in umbilical artery lactate and brain lactate, both directly and as a ratio with NAA. Results Of 175 infants who underwent MRI with spectral sequencing, 52 infants had detectable brain lactate. The 52 infants with brain lactate peaks had umbilical artery lactate values of 1.6 to 11.4 mmol/L. For every 1.0 mmol/L increase in umbilical artery lactate, there was an increase in brain lactate of 0.02, which remained significant even when corrected for NAA. Conclusion MRS measured brain lactate is significantly correlated with umbilical artery lactate in nonanomalous term infants, which may help explain the observed association between umbilical artery lactate and neurologic morbidity.
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Affiliation(s)
- Alison G. Cahill
- Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri
| | - George A. Macones
- Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri
| | - Christopher D. Smyser
- Division of Neurology, Department of Pediatrics, Washington University in St. Louis, St. Louis, Missouri
| | - Julia D. López
- Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri
| | - Terrie E. Inder
- Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Amit M. Mathur
- Department of Pediatrics, Washington University in St. Louis, St. Louis, Missouri
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Murphy K, van der Aa NE, Negro S, Groenendaal F, de Vries LS, Viergever MA, Boylan GB, Benders MJ, Išgum I. Automatic quantification of ischemic injury on diffusion-weighted MRI of neonatal hypoxic ischemic encephalopathy. Neuroimage Clin 2017; 14:222-232. [PMID: 28180081 PMCID: PMC5288491 DOI: 10.1016/j.nicl.2017.01.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 12/22/2016] [Accepted: 01/07/2017] [Indexed: 11/27/2022]
Abstract
A fully automatic method for detection and quantification of ischemic lesions in diffusion-weighted MR images of neonatal hypoxic ischemic encephalopathy (HIE) is presented. Ischemic lesions are manually segmented by two independent observers in 1.5 T data from 20 subjects and an automatic algorithm using a random forest classifier is developed and trained on the annotations of observer 1. The algorithm obtains a median sensitivity and specificity of 0.72 and 0.99 respectively. F1-scores are calculated per subject for algorithm performance (median = 0.52) and observer 2 performance (median = 0.56). A paired t-test on the F1-scores shows no statistical difference between the algorithm and observer 2 performances. The method is applied to a larger dataset including 54 additional subjects scanned at both 1.5 T and 3.0 T. The algorithm findings are shown to correspond well with the injury pattern noted by clinicians in both 1.5 T and 3.0 T data and to have a strong relationship with outcome. The results of the automatic method are condensed to a single score for each subject which has significant correlation with an MR score assigned by experienced clinicians (p < 0.0001). This work represents a quantitative method of evaluating diffusion-weighted MR images in neonatal HIE and a first step in the development of an automatic system for more in-depth analysis and prognostication.
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Affiliation(s)
- Keelin Murphy
- Irish Centre for Fetal and Neonatal Translational Research, Dept. of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Niek E. van der Aa
- Dept of Neonatology, Wilhelmina Children's Hospital, University Medical Center, Utrecht, The Netherlands
| | - Simona Negro
- Dept of Neonatology, Wilhelmina Children's Hospital, University Medical Center, Utrecht, The Netherlands
- Dept of Molecular and Developmental Medicine, University of Siena, Italy
| | - Floris Groenendaal
- Dept of Neonatology, Wilhelmina Children's Hospital, University Medical Center, Utrecht, The Netherlands
| | - Linda S. de Vries
- Dept of Neonatology, Wilhelmina Children's Hospital, University Medical Center, Utrecht, The Netherlands
| | - Max A. Viergever
- Image Sciences Institute, University Medical Center, Utrecht, The Netherlands
| | - Geraldine B. Boylan
- Irish Centre for Fetal and Neonatal Translational Research, Dept. of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Manon J.N.L. Benders
- Dept of Neonatology, Wilhelmina Children's Hospital, University Medical Center, Utrecht, The Netherlands
| | - Ivana Išgum
- Image Sciences Institute, University Medical Center, Utrecht, The Netherlands
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Lee YK, Penn A, Patel M, Pandit R, Song D, Ha BY. Hypothermia-treated neonates with hypoxic-ischemic encephalopathy: Optimal timing of quantitative ADC measurement to predict disease severity. Neuroradiol J 2016; 30:28-35. [PMID: 27881816 DOI: 10.1177/1971400916678229] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
To determine the optimal time window for MR imaging with quantitative ADC measurement in neonatal HIE after hypothermia treatment, a retrospective review was performed on consecutive hypothermia-treated term neonates with HIE, with an initial and follow-up MR imaging within the first two weeks of life. Three neuroradiologists categorized each set of MR imaging as normal, mild, moderate or severe HIE based on a consensus review of the serial imaging. The lowest ADC values from the white matter, corpus callosum, and basal ganglia/thalamus were measured. The ADC values between mild-moderate and severe HIE were compared using a Student's t-test over a range of different time windows. A total of 33 MR imaging examinations were performed on 16 neonates that included three normal, four mild, five moderate, and four severe HIE. The time window of 3-10 days showed a statistically significant decrease in ADC value in severe HIE compared to mild-moderate HIE in all three locations, respectively: white matter 0.5 ± 0.22 versus 0.83 ± 0.27 ( p value 0.01), corpus callosum 0.69 ± 0.19 versus 0.91 ± 0.17 ( p value 0.01), and basal ganglia/thalamus 0.63 ± 0.16 versus 0.98 ± 0.06 ( p value <0.01). The range of 3-10 days is the optimal time window for MR imaging with quantitative ADC after hypothermia treatment.
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Affiliation(s)
- Yauk K Lee
- 1 Department of Radiology, Santa Clara Valley Medical Center, USA
| | - Alex Penn
- 1 Department of Radiology, Santa Clara Valley Medical Center, USA
| | - Mahesh Patel
- 1 Department of Radiology, Santa Clara Valley Medical Center, USA
| | - Rajul Pandit
- 1 Department of Radiology, Santa Clara Valley Medical Center, USA
| | - Dongli Song
- 2 Department of Pediatrics, Santa Clara Valley Medical Center, USA
| | - Bo Yoon Ha
- 1 Department of Radiology, Santa Clara Valley Medical Center, USA
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Evolution of Apparent Diffusion Coefficient and Fractional Anisotropy in the Cerebrum of Asphyxiated Newborns Treated with Hypothermia over the First Month of Life. Neural Plast 2015; 2015:653727. [PMID: 26229690 PMCID: PMC4503577 DOI: 10.1155/2015/653727] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Revised: 06/14/2015] [Accepted: 06/15/2015] [Indexed: 11/23/2022] Open
Abstract
The objective of this study was to assess the evolution of diffusion-weighted imaging (DWI) and diffusion-tensor imaging (DTI) over the first month of life in asphyxiated newborns treated with hypothermia and to compare it with that of healthy newborns. Asphyxiated newborns treated with hypothermia were enrolled prospectively; and the presence and extent of brain injury were scored on each MRI. Apparent diffusion coefficient (ADC) and fractional anisotropy (FA) values were measured in the basal ganglia, in the white matter and in the cortical grey matter. Sixty-one asphyxiated newborns treated with hypothermia had a total of 126 ADC and FA maps. Asphyxiated newborns developing brain injury eventually had significantly decreased ADC values on days 2-3 of life and decreased FA values around day 10 and 1 month of life compared with those not developing brain injury. Despite hypothermia treatment, asphyxiated newborns may develop brain injury that still can be detected with advanced neuroimaging techniques such as DWI and DTI as early as days 2-3 of life. A study of ADC and FA values over time may aid in the understanding of how brain injury develops in these newborns despite hypothermia treatment.
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Goergen SK, Ang H, Wong F, Carse EA, Charlton M, Evans R, Whiteley G, Clark J, Shipp D, Jolley D, Paul E, Cheong JLY. Early MRI in term infants with perinatal hypoxic-ischaemic brain injury: interobserver agreement and MRI predictors of outcome at 2 years. Clin Radiol 2013; 69:72-81. [PMID: 24210250 DOI: 10.1016/j.crad.2013.09.001] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Accepted: 08/22/2013] [Indexed: 11/29/2022]
Abstract
AIM To compare diffusion-weighted imaging (DWI) and non-DWI magnetic resonance imaging (MRI), proton MR spectroscopy (1H-MRS), and clinical biomarkers for prediction of 2 year developmental outcome in term infants with perinatal hypoxic-ischaemic encephalopathy (HIE). MATERIALS AND METHODS Nineteen infants ≥36 weeks gestation with HIE were recruited and MRI performed day 3-7 (mean = 5). MRI was scored independently by three radiologists using a standardized scoring system. Lactate-to-N-acetylaspartate ratio (Lac:NAA) in the lentiform nucleus was calculated. Developmental assessment was performed at 2 years using the Bayley Scales of Infant and Toddler Development (BSID-III). Interobserver agreement about abnormality in 10 brain regions was measured. Univariate analysis was performed to determine variables associated with adverse outcome (i.e., death or Bayley score for any domain <70). RESULTS Good interobserver agreement (kappa = 0.61-0.69) on scores for DWI was obtained for the cortex, putamen, and brainstem, but not for any region on non-DWI. A significant association was found between outcome and Lac:NAA (p < 0.003) and DWI scores for lentiform nucleus, thalamus, cortex, posterior limb of the internal capsule (PLIC), and paracentral white matter (p = 0.001-0.013), but for non-DWI score only in the vermis or brainstem. A combination of Lac:NAA ≥0.25 or DWI/apparent diffusion coefficient (ADC) signal abnormality in the PLIC had 100% specificity and sensitivity for poor outcome. CONCLUSION Interobserver agreement for non-DWI performed during the first week is poor. Agreement by three radiologists about the presence of abnormal signal within the PLIC on ADC/DWI images or elevation of Lac:NAA above 0.25 improved sensitivity without reducing the prognostic specificity of MRS in the 19 patients, but this requires validation in a larger group of infants with HIE who have been treated with hypothermia.
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Affiliation(s)
- S K Goergen
- Department of Diagnostic Imaging, Monash Health, Clayton, Victoria, Australia; Southern Clinical School, Monash University, Clayton, Victoria, Australia.
| | - H Ang
- Monash Children's and Monash Newborn, Clayton, Victoria, Australia; Department of Pediatrics, Chinese General Hospital and Medical Center, Manila, Phillipines
| | - F Wong
- Monash Children's and Monash Newborn, Clayton, Victoria, Australia; Department of Paediatrics, Monash University, Clayton, Victoria, Australia
| | - E A Carse
- Monash Children's and Monash Newborn, Clayton, Victoria, Australia
| | - M Charlton
- Monash Children's and Monash Newborn, Clayton, Victoria, Australia; Department of Paediatrics, Monash University, Clayton, Victoria, Australia; Department of Developmental Medicine, Royal Children's Hospital, Parkville, Victoria, Australia
| | - R Evans
- Department of Diagnostic Imaging, Monash Health, Clayton, Victoria, Australia
| | - G Whiteley
- Department of Diagnostic Imaging, Monash Health, Clayton, Victoria, Australia
| | - J Clark
- Department of Diagnostic Imaging, Monash Health, Clayton, Victoria, Australia
| | - D Shipp
- Department of Diagnostic Imaging, Monash Health, Clayton, Victoria, Australia
| | - D Jolley
- School of Public Health and Preventative Medicine, Monash University, Prahran, Victoria, Australia
| | - E Paul
- School of Public Health and Preventative Medicine, Monash University, Prahran, Victoria, Australia
| | - J L Y Cheong
- Neonatal Services, Royal Women's Hospital, Parkville, Victoria, Australia; Victorian Infant Brain Studies, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Obstetrics & Gynaecology, University of Melbourne, Parkville, Victoria, Australia
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Tanoue K, Aida N, Matsui K. Apparent diffusion coefficient values predict outcomes of abusive head trauma. Acta Paediatr 2013; 102:805-8. [PMID: 23631484 DOI: 10.1111/apa.12281] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Revised: 01/31/2013] [Accepted: 04/25/2013] [Indexed: 11/30/2022]
Abstract
AIM To evaluate the apparent diffusion coefficient (ADC) values for predicting the long-term neurodevelopmental outcomes of patients with abusive head trauma (AHT). METHODS Apparent diffusion coefficient maps were retrospectively reviewed for 14 patients who presented with AHT at a mean age of 6.7 months (range 1-18 months), and the clinical outcomes of the survivors were based on the Glasgow Outcome Score. RESULTS One of 14 infants died, and two were severely disabled. One had mild impairment and four had moderate disability. In the 4 days after admission, the ADC values in all brain regions were strongly associated with a poor neurodevelopmental outcome (p < 0.05): basal ganglia, thalamus, brain stem, corpus callosum, frontal white matter, central white matter, parietal white matter, frontal grey matter, parietal grey matter, cerebellar vermis, cerebellar cortex and mean total brain. CONCLUSION Apparent diffusion coefficient values during the acute phase of AHT were significantly associated with poor long-term neurodevelopmental outcomes.
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Affiliation(s)
- Koji Tanoue
- Department of General Medicine; Kanagawa Children's Medical Center; Kanagawa Japan
| | - Noriko Aida
- Department of Radiology; Kanagawa Children's Medical Center; Kanagawa Japan
| | - Kiyoshi Matsui
- Department of General Medicine; Kanagawa Children's Medical Center; Kanagawa Japan
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Prognostic value of brain proton MR spectroscopy and diffusion tensor imaging in newborns with hypoxic-ischemic encephalopathy treated by brain cooling. Neuroradiology 2013; 55:1017-1025. [PMID: 23703033 DOI: 10.1007/s00234-013-1202-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2013] [Accepted: 05/02/2013] [Indexed: 01/20/2023]
Abstract
INTRODUCTION MRI, proton magnetic resonance spectroscopy (¹H-MRS), and diffusion tensor imaging (DTI) have been shown to be of great prognostic value in term newborns with moderate-severe hypoxic-ischemic encephalopathy (HIE). Currently, no data are available on ¹H-MRS and DTI performed in the subacute phase after hypothermic treatment. The aim of the present study was to assess their prognostic value in newborns affected by moderate-severe HIE and treated with selective brain cooling (BC). METHODS Twenty infants treated with BC underwent conventional MRI and (1)H-MRS at a mean (SD) age of 8.3 (2.8) days; 15 also underwent DTI. Peak area ratios of metabolites and DTI variables, namely mean diffusivity (MD), axial and radial diffusivity, and fractional anisotropy (FA), were calculated. Clinical outcome was monitored until 2 years of age. RESULTS Adverse outcome was observed in 6/20 newborns. Both ¹H-MRS and DTI variables showed higher prognostic accuracy than conventional MRI. N-acetylaspartate/creatine at a basal ganglia localisation showed 100% PPV and 93% NPV for outcome. MD showed significantly decreased values in many regions of white and gray matter, axial diffusivity showed the best predictive value (PPV and NPV) in the genu of corpus callosum (100 and 91%, respectively), and radial diffusivity was significantly decreased in fronto white matter (FWM) and fronto parietal (FP) WM. The decrement of FA showed the best AUC (0.94) in the FPWM. CONCLUSION Selective BC in HIE neonates does not affect the early and accurate prognostic value of ¹H-MRS and DTI, which outperform conventional MRI.
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Prediction of neurodevelopmental outcome after hypoxic-ischemic encephalopathy treated with hypothermia by diffusion tensor imaging analyzed using tract-based spatial statistics. Pediatr Res 2012; 72:63-9. [PMID: 22447318 DOI: 10.1038/pr.2012.40] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Objective biomarkers are needed to assess neuroprotective therapies after perinatal hypoxic-ischemic encephalopathy (HIE). We tested the hypothesis that, in infants who underwent therapeutic hypothermia after perinatal HIE, neurodevelopmental performance was predicted by fractional anisotropy (FA) values in the white matter (WM) on early diffusion tensor imaging (DTI) as assessed by means of tract-based spatial statistics (TBSS). METHODS We studied 43 term infants with HIE. Developmental assessments were carried out at a median (range) age of 24 (12-28) mo. RESULTS As compared with infants with favorable outcomes, those with unfavorable outcomes had significantly lower FA values (P < 0.05) in the centrum semiovale, corpus callosum (CC), anterior and posterior limbs of the internal capsule, external capsules, fornix, cingulum, cerebral peduncles, optic radiations, and inferior longitudinal fasciculus. In a second analysis in 32 assessable infants, the Griffiths Mental Development Scales (Revised) (GMDS-R) showed a significant linear correlation (P < 0.05) between FA values and developmental quotient (DQ) and all its component subscale scores. DISCUSSION DTI analyzed by TBSS provides a qualified biomarker that can be used to assess the efficacy of additional neuroprotective therapies after HIE.
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Bednarek N, Mathur A, Inder T, Wilkinson J, Neil J, Shimony J. Impact of therapeutic hypothermia on MRI diffusion changes in neonatal encephalopathy. Neurology 2012; 78:1420-7. [PMID: 22517107 DOI: 10.1212/wnl.0b013e318253d589] [Citation(s) in RCA: 112] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The objective of this work was to determine the impact of therapeutic hypothermia (TH) on the magnitude and time course of mean diffusivity (MD) changes following hypoxic-ischemic encephalopathy (HIE) in newborns. METHODS Cerebral MRI scans of infants undergoing whole body TH for HIE from 2007 to 2010 were retrospectively reviewed. The data were analyzed identically to a control group of newborns with HIE previously published, prior to the development of TH. Anatomic injury was defined on T1- and T2-weighted ("late") MRI obtained after the fifth day of life. Since MD values vary regionally, the ratios of MD values for injured and normal tissue were calculated for areas of injury. Normal values were obtained from corresponding brain regions of 12 infants undergoing TH who had no injury on MRI studies. RESULTS Twenty-three of 59 infants who underwent TH and MRI displayed cerebral injury on late MRI and were included in the study. MD ratios were decreased in all injured infants within the first 7 days of life. The return of MD to normal (pseudonormalization) occurred after the tenth day as compared to 6-8 days in the control group. Infants with severest injury demonstrated greater reduction in MD, but no difference in time to pseudonormalization. CONCLUSION TH slows the evolution of diffusion abnormalities on MRI following HIE in term infants.
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Affiliation(s)
- N Bednarek
- Neonatology Unit, Alix de Champagne, Reims, France
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Epelman M, Daneman A, Halliday W, Whyte H, Blaser SI. Abnormal corpus callosum in neonates after hypoxic-ischemic injury. Pediatr Radiol 2012; 42:321-30. [PMID: 21935701 DOI: 10.1007/s00247-011-2238-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2011] [Revised: 07/30/2011] [Accepted: 08/05/2011] [Indexed: 11/25/2022]
Abstract
BACKGROUND Literature regarding callosal injury after hypoxic-ischemic injury (HII) is scant. OBJECTIVE To present the MRI and US findings of callosal injury after HII. MATERIALS AND METHODS MRI and US studies of 76 neonates were evaluated for HII and 53 were considered positive. RESULTS Of the 53 neonates with HII, 40 demonstrated restricted diffusion on DWI; of these, 30 revealed callosal involvement. Nine of the 13 neonates with normal DWI, whose routine MRI images were compatible with HII, were imaged after 1 week of age. Five out of ten neonates imaged during the 1st week of life who did not show callosal restriction on DWI had predominantly basal ganglia injury. Callosal US images were regarded as abnormal in 16 out of the 53 neonates with HII, 15 of which revealed concomitant restricted diffusion on DWI. CONCLUSION Callosal injuries are common after HII. DWI is effective in confirming these injuries and easily demonstrates injury if performed prior to 1 week of age. The restricted diffusion demonstrated after this time could be attributed to continued injury. US is not a sensitive modality for callosal injury detection; however, abnormally increased callosal echogenicity might be a specific marker of injury in this setting.
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Affiliation(s)
- Monica Epelman
- Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Canada.
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Longitudinal change detection in diffusion MRI using multivariate statistical testing on tensors. Neuroimage 2012; 60:2206-21. [PMID: 22387171 DOI: 10.1016/j.neuroimage.2012.02.049] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Revised: 02/09/2012] [Accepted: 02/13/2012] [Indexed: 11/23/2022] Open
Abstract
This paper presents a longitudinal change detection framework for detecting relevant modifications in diffusion MRI, with application to neuromyelitis optica (NMO) and multiple sclerosis (MS). The core problem is to identify image regions that are significantly different between two scans. The proposed method is based on multivariate statistical testing which was initially introduced for tensor population comparison. We use this method in the context of longitudinal change detection by considering several strategies to build sets of tensors characterizing the variability of each voxel. These strategies make use of the variability existing in the diffusion weighted images (thanks to a bootstrap procedure), or in the spatial neighborhood of the considered voxel, or a combination of both. Results on synthetic evolutions and on real data are presented. Interestingly, experiments on NMO patients highlight the ability of the proposed approach to detect changes in the normal-appearing white matter (according to conventional MRI) that are related with physical status outcome. Experiments on MS patients highlight the ability of the proposed approach to detect changes in evolving and non-evolving lesions (according to conventional MRI). These findings might open promising prospects for the follow-up of NMO and MS pathologies.
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Alderliesten T, de Vries LS, Benders MJNL, Koopman C, Groenendaal F. MR Imaging and Outcome of Term Neonates with Perinatal Asphyxia: Value of Diffusion-weighted MR Imaging and H MR Spectroscopy. Radiology 2011; 261:235-42. [DOI: 10.1148/radiol.11110213] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
There is controversy in the literature about the value of brain imaging in neonates regarding the prediction of cerebral palsy (CP). The aim of this review was to unravel the myth that CP cannot be predicted by neuroimaging in neonates. Major intracranial lesions in the preterm infant should be recognized with sequential cranial ultrasound and will predict those with non-ambulatory CP. Magnetic resonance imaging (MRI) at term-equivalent age will refine the prediction by assessment of myelination of the posterior limb of the internal capsule. Prediction of motor outcome in preterm infants with subtle white matter injury remains difficult, even with conventional MRI. MRI is a better tool to predict outcome in the term infant with hypoxic-ischaemic encephalopathy or neonatal stroke. The use of diffusion-weighted imaging as an additional sequence adds to the predictive value for motor outcome. Sequential and dedicated neuroimaging should enable us to predict motor outcome in high risk newborns infants.
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Wachtel EV, Hendricks-Muñoz KD. Current management of the infant who presents with neonatal encephalopathy. Curr Probl Pediatr Adolesc Health Care 2011; 41:132-53. [PMID: 21458747 DOI: 10.1016/j.cppeds.2010.12.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Neonatal encephalopathy after perinatal hypoxic-ischemic insult is a major contributor to global child mortality and morbidity. Brain injury in term infants in response to hypoxic-ischemic insult is a complex process evolving over hours to days, which provides a unique window of opportunity for neuroprotective treatment interventions. Advances in neuroimaging, brain monitoring techniques, and tissue biomarkers have improved the ability to diagnose, monitor, and care for newborn infants with neonatal encephalopathy as well as predict their outcome. However, challenges remain in early identification of infants at risk for neonatal encephalopathy, determination of timing and extent of hypoxic-ischemic brain injury, as well as optimal management and treatment duration. Therapeutic hypothermia is the most promising neuroprotective intervention to date for infants with moderate to severe neonatal encephalopathy after perinatal asphyxia and has currently been incorporated in many neonatal intensive care units in developed countries. However, only 1 in 6 babies with encephalopathy will benefit from hypothermia therapy; many infants still develop significant adverse outcomes. To enhance the outcome, specific diagnostic predictors are needed to identify patients likely to benefit from hypothermia treatment. Studies are needed to determine the efficacy of combined therapeutic strategies with hypothermia therapy to achieve maximal neuroprotective effect. This review focuses on important concepts in the pathophysiology, diagnosis, and management of infants with neonatal encephalopathy due to perinatal asphyxia, including an overview of recently introduced novel therapies.
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Affiliation(s)
- Elena V Wachtel
- Department of Pediatrics, Division of Neonatology, New York University School of Medicine, New York, NY, USA
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Utsunomiya H. Diffusion MRI abnormalities in pediatric neurological disorders. Brain Dev 2011; 33:235-42. [PMID: 20880644 DOI: 10.1016/j.braindev.2010.08.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2010] [Revised: 08/22/2010] [Accepted: 08/31/2010] [Indexed: 12/22/2022]
Abstract
Diffusion-weighted imaging (DWI) makes it possible to measure early changes in cellular function in the central nervous system. The purpose of this article is to discuss the diagnostic value of diffusion-weighted and diffusion tensor imaging (DTI) in different pediatric cerebral disorders. First, the principles of DWI and DTI are briefly reviewed. The clinical usefulness of these imaging techniques is then discussed using cases with pediatric neurological disorders, such as hypoxic-ischemic encephalopathy in neonates, trauma (shaken baby syndrome), encephalopathy or encephalitis in infants, posterior reversible encephalopathy syndrome and congenital brain anomaly (callosal dysgenesis). In addition, using DTI, we evaluate normal brain development, particularly in the corpus callosum and cortico-spinal tract, and discuss the application of DTI to the study of white matter in the developing brain.
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Affiliation(s)
- Hidetsuna Utsunomiya
- Department of Radiological Sciences, International University of Health and Welfare, Graduate School, Japan.
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Boichot C, Mejean N, Gouyon JB, Brunotte F, Walker PM. Biphasic time course of brain water ADC observed during the first month of life in term neonates with severe perinatal asphyxia is indicative of poor outcome at 3 years. Magn Reson Imaging 2011; 29:194-201. [DOI: 10.1016/j.mri.2010.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2010] [Accepted: 09/15/2010] [Indexed: 11/30/2022]
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Azzopardi D, Edwards AD. Magnetic resonance biomarkers of neuroprotective effects in infants with hypoxic ischemic encephalopathy. Semin Fetal Neonatal Med 2010; 15:261-9. [PMID: 20359970 DOI: 10.1016/j.siny.2010.03.001] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Evaluation of infants with hypoxic ischemic encephalopathy by magnetic resonance spectroscopy and imaging is useful to direct clinical care, and may assist the evaluation of candidate neuroprotective therapies. Cerebral metabolites measured by magnetic resonance spectroscopy, and visual analysis of magnetic resonance images during the first 30 days after birth accurately predict later neurological outcome and are valid biomarkers of the key physiological processes underlying brain injury in neonatal hypoxic ischemic encephalopathy. Visual assessment of magnetic resonance images may also be a suitable surrogate outcome in studies of neuroprotective therapies but current magnetic resonance methods are relatively inefficient for use in early phase, first in human infant studies of novel neuroprotective therapies. However, diffusion tensor imaging and analysis of fractional anisotropy with tract-based spatial statistics promises to be a highly efficient biomarker and surrogate outcome for rapid preliminary evaluation of promising therapies for neonatal hypoxic ischemic injury. Standardisation of scanning protocols and data analysis between different scanners is essential.
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Affiliation(s)
- Denis Azzopardi
- Institute of Clinical Sciences, Imperial College London and MRC Clinical Sciences Centre, Hammersmith Hospital, London, UK.
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Massaro AN, Kadom N, Chang T, Glass P, Nelson K, Baumgart S. Quantitative analysis of magnetic resonance images and neurological outcome in encephalopathic neonates treated with whole-body hypothermia. J Perinatol 2010; 30:596-603. [PMID: 20182435 DOI: 10.1038/jp.2010.7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To evaluate whether quantitative measures from magnetic resonance imaging (MRI) performed in hypothermia-treated encephalopathic newborns can differentiate patients with unfavorable neurological outcome. STUDY DESIGN Retrospective analysis of clinical data and MRI studies was performed in 47 full-term infants treated with whole-body hypothermia for neonatal encephalopathy. Apparent diffusion coefficients (ADCs) and T1 and T2 intensity ratios were measured in the basal ganglia and thalamus on axial MRI images. Unfavorable outcome was defined as (1) death or severe neurological deficits at discharge and (2) death or cerebral palsy/severe motor deficit at follow-up through age 9 months. Differences between groups with favorable versus unfavorable neurological outcome at each time point were compared. Optimal cutoff values for significant MR variables were determined with receiver operating curve analyses. Sensitivity and specificity of these cutoff values for predicting unfavorable outcome were calculated and results were compared with qualitative MRI interpretation. RESULT Infants presented with a median pH of 6.86, base deficit of 20 and Apgar scores of 1, 3 and 4 at 1, 5 and 10 min, respectively. Severe encephalopathy was present in 38%. Unfavorable outcome was present in 9 patients at discharge and in 13 of 26 patients with available follow-up data through 9 months. ADC values and T1 ratios were not significantly different between groups at either time point. T2 ratios in both the basal ganglia and thalamus were significantly higher in patients with unfavorable outcome, both at discharge and in follow-up. T2 intensity ratio in the basal ganglia and thalamus remained significantly associated with death or severe neurological deficit at discharge, after controlling for covariates in logistic regression analysis. Sensitivity and specificity of T2 intensity ratio for predicting unfavorable outcome at discharge were comparable to qualitative grading of injury in the basal ganglia and thalamus by a neuroradiologist. CONCLUSION Increased T2 signal intensity in the basal ganglia or thalamus in patients with hypothermia-treated neonatal encephalopathy is associated with unfavorable neurological outcome at discharge and later with motor deficit/cerebral palsy. Quantitative methods to assess MRI evidence of brain injury are important for providing objective measures to predict outcome in this high-risk population.
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Affiliation(s)
- A N Massaro
- Department of Neonatology, Children's National Medical Center, Washington, DC, USA.
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Takenouchi T, Heier LA, Engel M, Perlman JM. Restricted diffusion in the corpus callosum in hypoxic-ischemic encephalopathy. Pediatr Neurol 2010; 43:190-6. [PMID: 20691941 DOI: 10.1016/j.pediatrneurol.2010.04.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2009] [Revised: 03/31/2010] [Accepted: 04/26/2010] [Indexed: 11/28/2022]
Abstract
Restricted diffusion within the splenium of the corpus callosum was described in various conditions, but is not a prominent finding in magnetic resonance imaging after neonatal hypoxic-ischemic encephalopathy. Perinatal characteristics were reviewed in 42 term neonates with hypoxic-ischemic encephalopathy treated with selective head cooling. Neonatal images of 34 infants were reviewed. Ten of 34 (29%) infants demonstrated restricted diffusion changes within the splenium of the corpus callosum, with a significantly higher incidence of death or severe developmental delay, compared with infants without changes in the splenium of the corpus callosum (n = 24) (P = 0.002). The positive predictive value of changes in the splenium of the corpus callosum regarding poor outcomes or death was 90%. Changes in the splenium of the corpus callosum were also associated with lower birth weights, larger base deficits in cord arterial gas, and more severe encephalopathy during enrollment in selective head cooling. Restricted diffusion within the splenium of the corpus callosum of term infants with hypoxic-ischemic encephalopathy is often associated with extensive brain injury, and in these circumstances appears to be an early neuroradiologic marker of adverse neurologic outcomes.
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Affiliation(s)
- Toshiki Takenouchi
- Division of Pediatric Neurology, Department of Pediatrics, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, New York 10021, USA.
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Li YK, Liu GR, Zhou XG, Cai AQ. Experimental hypoxic-ischemic encephalopathy: comparison of apparent diffusion coefficients and proton magnetic resonance spectroscopy. Magn Reson Imaging 2010; 28:487-94. [PMID: 20071123 DOI: 10.1016/j.mri.2009.12.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2009] [Revised: 10/09/2009] [Accepted: 12/06/2009] [Indexed: 02/05/2023]
Abstract
This study aims to compare the apparent diffusion coefficients (ADCs) and proton magnetic resonance spectroscopy ((1)H-MRS) in the first 24 h of acute hypoxic-ischemic brain damage (HIBD) in piglets. Twenty-five 7-day-old piglets were subjected to transient bilateral common carotid artery occlusion followed by ventilation with 4% oxygen for 1 h. Diffusion-weighted imaging (DWI) and (1)H-MRS were performed on cessation of the insult or at 3, 6, 12 or 24 h after resuscitation (all n=5). ADCs, N-acetylaspartate/choline (NAA/Cho), NAA/creatine (NAA/Cr), lactate/NAA (Lac/NAA), Lac/Cho and Lac/Cr were calculated. Cerebral injury was evaluated by pathological study and Hsp70 immunohistochemical analysis. On cessation of the insult, ADCs, NAA/Cho and NAA/Cr reduced, Lac/NAA, Lac/Cho and Lac/Cr increased. From 3 to 12 h after resuscitation, ADCs, Lac/NAA, Lac/Cho and Lac/Cr recovered, NAA/Cho and NAA/Cr reduced. Twenty-four hours after resuscitation, ADCs reduced once more, Lac/NAA, Lac/Cho and Lac/Cr increased again, whereas NAA/Cho and NAA/Cr decreased continuously. Pathological study revealed mild cerebral edema on cessation of the insult and more and more severe cerebral injury after resuscitation. No Hsp70-positive cells were detected on cessation of the insult. From 3 to 12 hours after resuscitation, Hsp70-positive cells gradually increased. Twenty-four hours after resuscitation, Hsp70-positive cells decreased. Throughout the experiment, changes in NAA/Cho and pathology had the best correlation (R=-0.729). In conclusion, NAA/Cho is the most precise ratio to reflect the pathological changes of early HIBD. Transient ADCs and Lac ratios recovery do not predict the reversal of histological damage of early HIBD. Reducing astrocytic swelling is of great clinical significance.
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Affiliation(s)
- Yang-Kang Li
- Department of Radiology, Cancer Hospital, Shantou University Medical College, Shantou, Guangdong 515041, China.
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Brissaud O, Amirault M, Villega F, Periot O, Chateil JF, Allard M. Efficiency of fractional anisotropy and apparent diffusion coefficient on diffusion tensor imaging in prognosis of neonates with hypoxic-ischemic encephalopathy: a methodologic prospective pilot study. AJNR Am J Neuroradiol 2010; 31:282-7. [PMID: 19959775 DOI: 10.3174/ajnr.a1805] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The DTI parameters (FA and ADC) reflect the properties of the brain microstructure. Decreased anisotropy is a common feature of cerebral tissue abnormalities. Our study investigates the neurologic prognostic efficiency of these parameters in white (PLIC, CP) and gray matter (PP) in the first days of life in term neonates with HIE. We hypothesize that lesions in related brain areas could be part of a physiopathologic substratum supporting neurologic deficiencies in this population. MATERIALS AND METHODS A total of 22 neonates (13 girls and 9 boys; mean gestational age, 40 weeks +/- 9 days; birth weight, 3203 +/- 584 g) underwent brain MR imaging between day 1 and day 6 after birth; 6-noncollinear direction DTI was performed. FA and ADC were measured on specific brain areas. Amiel-Tison score was performed on day 8.5 +/- 4 (group A, favorable outcome [n = 16]; group B, unfavorable outcome [n = 6]). RESULTS Intraobserver and interobserver comparison in DTI parameter measurements showed a coefficient of variability of less than 5%. In PLIC and PP, the ADC values were lower in group B compared with group A (P = .000027), whereas in PLIC and CP, the FA values were lower in group B compared with group A (P < .02). CONCLUSIONS These findings indicate that a poor early neurologic outcome in neonates with HIE is associated with lower FA or ADC values in specific areas of white or gray matter. The difference in ADC/FA changes in the different brain areas explored may support possibly different pathologic processes.
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Affiliation(s)
- O Brissaud
- Université de Bordeaux, Bordeaux, France.
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Iwasaki S, Morokuma S, Yumoto Y, Hiwatashi A, Tsukimori K, Wake N. Acute onset antenatal fetal neurological injury suspected prenatally based on abnormalities in antenatal testing: a case report. J Matern Fetal Neonatal Med 2009; 22:1207-10. [PMID: 19916720 DOI: 10.3109/14767050903019619] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This report discusses the case of a fetus with previously normal findings of cardiotocograph that experienced an acute neurologic insult antenatally. The fetus presented with abnormalities of its heart rate tracing and its movement patterns on ultrasound. Following delivery, the infant was diagnosed with hypoxic ischemic encephalopathy by DWI in the first 24 h after birth, despite having a normal postnatal brain ultrasound.
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Affiliation(s)
- Satomi Iwasaki
- Department of Gynecology and Obstetrics, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
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38
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Meta-analysis of apparent diffusion coefficients in the newborn brain. Pediatr Neurol 2009; 41:263-74. [PMID: 19748046 DOI: 10.1016/j.pediatrneurol.2009.04.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2008] [Revised: 03/30/2009] [Accepted: 04/13/2009] [Indexed: 01/24/2023]
Abstract
Diffusion-weighted imaging and its quantitative apparent diffusion coefficient can assess severity in newborn hypoxic-ischemic injuries. A meta-analysis established normative values in term newborns, in comparison to those values in hypoxic-ischemic newborns with good versus poor outcomes. Measurements from 14 reports were stratified into three levels of increasing specificity: tissue type (gray matter, white matter, or cerebellum), tissue distribution (e.g., cortex or white-matter tracts), and anatomic structures (e.g., frontal white matter or posterior limb of the internal capsule). Normative apparent diffusion coefficients constituted white matter > gray matter = cerebellum, with lowest values in the posterior limb of the internal capsule and thalamus, and the highest in frontal and occipital white matter. Differences between normative and hypoxic-ischemic injury good-outcome groups were not evident. Values in the poor outcome group were significantly lower than normative data in white matter, gray matter, cortical gray matter, white matter tracts, posterior limb of the internal capsule, and cortical, frontal, and occipital white matter. Comparisons between injury groups found that coefficients were only significantly lower in the occipital cortex among poor outcomes. Coefficient values were lower in deep brain compared with cortical structures, reflecting tissue maturation and myelination. Differences between normative and hypoxic-ischemic injury poor-outcome groups suggest pathologies associated with neurologic sequelae. This meta-analysis provides the basis for normative apparent diffusion coefficient values in the newborn brain.
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39
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Liauw L. Hypoxic-ischaemic Brain Injury in Young Infants. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2009. [DOI: 10.47102/annals-acadmedsg.v38n9p788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Many imaging techniques are available for the detection of hypoxic-ischaemic brain injury in young infants.This paper presents an overview of the imaging findings in hypoxic-ischaemic brain injury with an emphasis on MR imaging.
Key words: Hypoxia-ischaemia, Infants, Imaging, MR imaging, Neonates, Ultrasonography
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40
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Advanced neuroimaging techniques for the term newborn with encephalopathy. Pediatr Neurol 2009; 40:181-8. [PMID: 19218031 DOI: 10.1016/j.pediatrneurol.2008.09.012] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2008] [Revised: 08/08/2008] [Accepted: 08/29/2008] [Indexed: 11/23/2022]
Abstract
Neonatal encephalopathy is associated with a high risk of morbidity and mortality in the neonatal period and of long-term neurodevelopmental disability in survivors. Advanced magnetic resonance techniques now play a major role in the clinical care of newborns with encephalopathy and in research addressing this important condition. From conventional magnetic resonance imaging, typical patterns of injury have been defined in neonatal encephalopathy. When applied in contemporary cohorts of newborns with encephalopathy, the patterns of brain injury on magnetic resonance imaging distinguish risk factors, clinical presentation, and risk of abnormal outcome. Advanced magnetic resonance techniques such as magnetic resonance spectroscopy, diffusion-weighted imaging, and diffusion tensor imaging provide novel perspectives on neonatal brain metabolism, microstructure, and connectivity. With the application of these imaging tools, it is increasingly apparent that brain injury commonly occurs at or near the time of birth and evolves over the first weeks of life. These observations have complemented findings from trials of emerging strategies of brain protection, such as hypothermia. Application of these advanced magnetic resonance techniques may enable the earliest possible identification of newborns at risk of neurodevelopmental impairment, thereby ensuring appropriate follow-up with rehabilitation and psychoeducational resources.
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41
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Liauw L, van Wezel-Meijler G, Veen S, van Buchem MA, van der Grond J. Do apparent diffusion coefficient measurements predict outcome in children with neonatal hypoxic-ischemic encephalopathy? AJNR Am J Neuroradiol 2009; 30:264-70. [PMID: 18842756 DOI: 10.3174/ajnr.a1318] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Diffusion-weighted imaging (DWI) permits early detection and quantification of hypoxic-ischemic (HI) brain lesions. Our aim was to assess the predictive value of DWI and apparent diffusion coefficient (ADC) measurements for outcome in children with perinatal asphyxia. MATERIALS AND METHODS Term neonates underwent MR imaging within 10 days after birth because of asphyxia. MR imaging examinations were retrospectively evaluated for HI brain damage. ADC was measured in 30 standardized brain regions and in visibly abnormal areas on DWI. In survivors, developmental outcome until early school age was graded into the following categories: 1) normal, 2) mildly abnormal, and 3) definitely abnormal. For analysis, category 3 and death (category 4) were labeled "adverse," 1 and 2 were "favorable," and 2-3 and death were "abnormal" outcome. Differences in outcome between infants with and without DWI abnormalities were analyzed by using chi(2) tests. The nonparametric Mann-Whitney U test analyzed whether ADC values in visible DWI abnormalities correlated with age at imaging. Logistic regression analysis tested the predictive value for outcome of the ADC in each standardized brain region. Receiver operating characteristic analysis was used to find optimal ADC cutoff values for each region for the various outcome scores. RESULTS Twenty-four infants (13 male) were included. Mean age at MR imaging was 4.3 days (range, 1-9 days). Seven infants died. There was no difference in outcome between infants with and without visible DWI abnormalities. Only ADC of the posterior limb of the internal capsule correlated with age. ADC in visibly abnormal DWI regions did not have a predictive value for outcome. Of all measurements performed, only the ADC in the normal-appearing basal ganglia and brain stem correlated significantly with outcome; low ADC values were associated with abnormal/adverse outcome, and higher ADC values, with normal/favorable outcome (basal ganglia: P = .03 for abnormal, P = .01 for adverse outcome; brain stem: P = .006 for abnormal, P = .03 for adverse outcome). CONCLUSIONS ADC values in normal-appearing basal ganglia and brain stem correlated with outcome, independently of all MR imaging findings including those of DWI. ADC values in visibly abnormal brain tissue on DWI did not show a predictive value for outcome.
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Affiliation(s)
- L Liauw
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands.
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42
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Chau V, Poskitt KJ, Sargent MA, Lupton BA, Hill A, Roland E, Miller SP. Comparison of computer tomography and magnetic resonance imaging scans on the third day of life in term newborns with neonatal encephalopathy. Pediatrics 2009; 123:319-26. [PMID: 19117898 DOI: 10.1542/peds.2008-0283] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Our goal was to compare the patterns of brain injury detected by computed tomography, conventional MRI (T1- and T2-weighted sequences), and diffusion-weighted MRI in a cohort of term newborns with neonatal encephalopathy studied uniformly with all 3 modalities on the third day of life. METHODS Term newborns (> or =36 weeks' gestation) admitted to our center with neonatal encephalopathy were scanned with computed tomography, MRI, and diffusion-weighted MRI at 72 (+/-12) hours of life (n = 48). Each modality was scored independently of the other with previously validated scoring systems. The predominant pattern of brain injury was classified as: normal, watershed, basal nuclei, total (maximal basal nuclei and watershed), and focal-multifocal (presence of strokes and/or white matter injury alone). RESULTS The agreement for the predominant pattern of injury was excellent between MRI and diffusion-weighted MRI (77% agreement). The agreement for the pattern of injury was also good for computed tomography and diffusion-weighted MRI (67% agreement). The extent of cortical injury and focal-multifocal lesions, such as strokes and white matter injury, were less apparent on computed tomography than diffusion-weighted MRI. In 19 newborns with a repeat MRI in the second week of life, the predominant pattern seen on the day 3 diffusion-weighted MRI was confirmed. CONCLUSIONS Diffusion-weighted MRI is the most sensitive technique with which to assess brain injury on day 3 of life in term newborns with neonatal encephalopathy, particularly for cortical injury and focal-multifocal lesions such as stroke and white matter injury. All 3 modalities identify the most serious patterns of brain injury similarly.
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Affiliation(s)
- Vann Chau
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
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Vermeulen RJ, van Schie PEM, Hendrikx L, Barkhof F, van Weissenbruch M, Knol DL, Pouwels PJW. Diffusion-weighted and Conventional MR Imaging in Neonatal Hypoxic Ischemia: Two-year Follow-up Study. Radiology 2008; 249:631-9. [DOI: 10.1148/radiol.2492071581] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Liauw L, van der Grond J, van den Berg-Huysmans AA, Palm-Meinders IH, van Buchem MA, van Wezel-Meijler G. Hypoxic-Ischemic Encephalopathy: Diagnostic Value of Conventional MR Imaging Pulse Sequences in Term-born Neonates. Radiology 2008; 247:204-12. [DOI: 10.1148/radiol.2471070812] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Meyer-Witte S, Brissaud O, Brun M, Lamireau D, Bordessoules M, Chateil JF. [Prognostic value of MR in term neonates with neonatal hypoxic-ischemic encephalopath: MRI score and spectroscopy. About 26 cases]. Arch Pediatr 2007; 15:9-23. [PMID: 18164915 DOI: 10.1016/j.arcped.2007.08.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2006] [Revised: 07/20/2007] [Accepted: 08/28/2007] [Indexed: 10/22/2022]
Abstract
UNLABELLED Neonatal hypoxic-ischemic encephalopathy remains a major cause of chronic disability in childhood. Early diagnosis and prognosis are necessary for the clinician to adapt the treatment. However, there is yet no reliable test to predict the patient's evolution. OBJECTIVE The aim of our study was to evaluate the predictive value of a personal magnetic resonance imaging (MRI) scoring system and of magnetic resonance spectroscopy (MRS). MATERIAL AND METHODS We included 26 term newborns in condition of neonatal brain suffering. MR examination was performed during the first week of life for all patients and MRI and MRS data were collected. Standardised follow-up visits were made for all patients. Finally, prognostic value of the different criteria was evaluated with statistical tests. RESULTS Our MRI scoring system proved to be linked to prognosis. A high MRI score, abnormal signal in the internal capsule, white matter or basal ganglia abnormalities with diffusion imaging were associated with unfavourable outcome. These results confirmed the data of the literature concerning the MRI predictive value. Our study also confirmed prognostic interest of MR: particularly, ratios using lactate were significantly linked to prognosis in our study. Specificity of the elevation of these ratios was interesting but sensibility was less optimal. CONCLUSION We suggest using our MRI scoring system which associates standard MRI and diffusion imaging, which is significantly related to outcome. We confirm the prognostic value of MRS in this pathological situation. MR with diffusion sequence and spectroscopy, performed three to four days after birth appears to be an essential tool to manage these patients.
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Affiliation(s)
- S Meyer-Witte
- Service de neuropédiatrie, hôpital Pellegrin, 33076 Bordeaux, France.
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Asao C, Hirai T, Yoshimatsu S, Matsukawa T, Imuta M, Sagara K, Yamashita Y. Human cerebral cortices: signal variation on diffusion-weighted MR imaging. Neuroradiology 2007; 50:205-11. [PMID: 18058093 DOI: 10.1007/s00234-007-0327-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2007] [Accepted: 10/05/2007] [Indexed: 11/29/2022]
Abstract
INTRODUCTION We have often encountered high signal intensity (SI) of the cingulate gyrus and insula during diffusion-weighted magnetic resonance imaging (DW-MRI) on neurologically healthy adults. To date, cortical signal heterogeneity on DW images has not been investigated systematically. The purpose of our study was to determine whether there is regional signal variation in the brain cortices of neurologically healthy adults on DW-MR images. METHODS The SI of the cerebral cortices on DW-MR images at 1.5 T was evaluated in 50 neurologically healthy subjects (34 men, 16 women; age range 33-84 years; mean age 57.6 years). The cortical SI in the cingulate gyrus, insula, and temporal, occipital, and parietal lobes was graded relative to the SI of the frontal lobe. Contrast-to-noise ratios (CNRs) on DW-MR images were compared for each cortical area. Diffusion changes were analyzed by visually assessment of the differences in appearance among the cortices on apparent diffusion coefficient (ADC) maps. RESULTS Increased SI was frequently seen in the cingulate gyrus and insula regardless of patient age. There were no significant gender- or laterality-related differences. The CNR was significantly higher in the cingulate gyrus and insula than in the other cortices (p< .01) , and significant differences existed among the cortical regions (p< .001). There were no apparent ADC differences among the cortices on ADC maps. CONCLUSION Regional signal variation of the brain cortices was observed on DW-MR images of healthy subjects, and the cingulate gyrus and insula frequently manifested high SI. These findings may help in the recognition of cortical signal abnormalities as visualized on DW-MR images.
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Affiliation(s)
- Chiaki Asao
- Department of Radiology, Kumamoto Regional Medical Center, 5-16-10 Honjo, Kumamoto 860-0811, Japan.
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D'Arceuil H, Liu C, Levitt P, Thompson B, Kosofsky B, de Crespigny A. Three-dimensional high-resolution diffusion tensor imaging and tractography of the developing rabbit brain. Dev Neurosci 2007; 30:262-75. [PMID: 17962716 DOI: 10.1159/000110503] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2006] [Accepted: 04/26/2007] [Indexed: 01/19/2023] Open
Abstract
Diffusion tensor imaging (DTI) is sensitive to structural ordering in brain tissue particularly in the white matter tracts. Diffusion anisotropy changes with disease and also with neural development. We used high-resolution DTI of fixed rabbit brains to study developmental changes in regional diffusion anisotropy and white matter fiber tract development. Imaging was performed on a 4.7-tesla Bruker Biospec Avance scanner using custom-built solenoid coils and DTI was performed at various postnatal ages. Trace apparent diffusion coefficient, fractional diffusion anisotropy maps and fiber tracts were generated and compared across the ages. The brain was highly anisotropic at birth and white matter anisotropy increased with age. Regional DTI tractography of the internal capsule showed refinement in regional tract architecture with maturation. Interestingly, brains with congenital deficiencies of the callosal commissure showed selectively strikingly different fiber architecture compared to age-matched brains. There was also some evidence of subcortical to cortical fiber connectivity. DTI tractography of the anterior and posterior limbs of the internal capsule showed reproducibly coherent fiber tracts corresponding to known corticospinal and corticobulbar tract anatomy. There was some minor interanimal tract variability, but there was remarkable similarity between the tracts in all animals. Therefore, ex vivo DTI tractography is a potentially powerful tool for neuroscience investigations and may also reveal effects (such as fiber tract pruning during development) which may be important targets for in vivo human studies.
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Affiliation(s)
- Helen D'Arceuil
- Neuroradiology Section, Massachusetts General Hospital, Boston, Mass., USA.
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48
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Winter JD, Lee DS, Hung RM, Levin SD, Rogers JM, Thompson RT, Gelman N. Apparent diffusion coefficient pseudonormalization time in neonatal hypoxic-ischemic encephalopathy. Pediatr Neurol 2007; 37:255-62. [PMID: 17903669 DOI: 10.1016/j.pediatrneurol.2007.06.005] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2006] [Revised: 02/15/2007] [Accepted: 06/06/2007] [Indexed: 11/30/2022]
Abstract
The apparent diffusion coefficient changes with time after hypoxic-ischemic brain injury. In this study, we quantitatively examined the relationship between the apparent diffusion coefficient and postnatal age for neonates with hypoxic-ischemic encephalopathy and poor outcome, and determined the postnatal age at which these values cannot be distinguished from those of neonates without hypoxic-ischemic encephalopathy (pseudonormalization time). Diffusion-weighted brain images were obtained from clinical scans of term neonates with hypoxic-ischemic encephalopathy and poor outcome (12 neonates, 23 scans) and from control subjects (30 neonates, 31 scans). The correlation between apparent diffusion coefficient and postnatal age was investigated for several brain regions. Pseudonormalization times were determined (1) from the intersection of the regression lines for the hypoxic-ischemic encephalopathy and control groups, as well as (2) from intrasubject apparent diffusion coefficient changes between two scans within a small subgroup. Pseudonormalization times from the regression ranged from 8.3 +/- 1.9 days to 10.1 +/- 2.1 days. Slightly (approximately 1 day) longer values were obtained from the intrasubject analysis. The results suggest that, although abnormally decreased apparent diffusion coefficient values may be evident from approximately 2 days to almost 1 week of postnatal age, abnormally elevated values may not be apparent until late in the second week of life.
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Affiliation(s)
- Jeff D Winter
- Imaging Division, Lawson Health Research Institute, University of Western Ontario, London, Ontario, Canada
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Moxon-Lester L, Sinclair K, Burke C, Cowin GJ, Rose SE, Colditz P. Increased cerebral lactate during hypoxia may be neuroprotective in newborn piglets with intrauterine growth restriction. Brain Res 2007; 1179:79-88. [PMID: 17936737 DOI: 10.1016/j.brainres.2007.08.037] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2007] [Revised: 08/08/2007] [Accepted: 08/10/2007] [Indexed: 01/07/2023]
Abstract
Intrauterine growth restriction (IUGR) can increase susceptibility to perinatal hypoxic brain injury for reasons that are unknown. Previous studies of the neonatal IUGR brain have suggested that the cerebral mitochondrial capacity is reduced but the glycolytic capacity increased relative to normal weight (NW) neonates. In view of these two factors, we hypothesized that the generation of brain lactate during a mild hypoxic insult would be greater in neonatal IUGR piglets compared to NW piglets. Brain lactate/N-acetylaspartate (NAA) ratios and apparent diffusion coefficients (ADCs) were determined by proton magnetic resonance spectroscopy and imaging of the brain before, during and after hypoxia in seven neonatal piglets with asymmetric IUGR and six NW piglets. During hypoxia, IUGR piglets had significantly higher brain lactate/NAA ratios than NW piglets (P=0.046). The lactate response in the IUGR piglets correlated inversely with apoptosis in the thalamus and frontal cortex of the brain measured 4 h post hypoxia (Pearson's r=0.86, P<0.05). Apoptosis in IUGR piglets with high brain lactate was similar to that in the NW piglets whereas IUGR piglets with low brain lactate had significantly higher apoptosis than NW piglets (P=0.019). ADCs in the high lactate IUGR piglets were significantly lower during hypoxia than in all the other piglets. This signifies increased diffusion of water into brain cells during hypoxia, possibly in response to increased intracellular osmolality caused by high intracellular lactate concentrations. These findings support previous studies showing increased susceptibility to hypoxic brain injury in IUGR neonates but suggest that increased glycolysis during hypoxia confers neuroprotection in some IUGR piglets.
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Affiliation(s)
- Leith Moxon-Lester
- Perinatal Research Centre, University of Queensland, Royal Brisbane and Women's Hospital, Level 6 Ned Hanlon Building, Brisbane, Australia.
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Zimmerman RA, Bilaniuk LT, Farina L. Non-accidental brain trauma in infants: diffusion imaging, contributions to understanding the injury process. J Neuroradiol 2007; 34:109-14. [PMID: 17445894 DOI: 10.1016/j.neurad.2007.01.124] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Analysis of MRI diffusion images from 33 infants suffering from non-accidental trauma reveals five patterns of injury. These are diffuse supratentorial hypoxic ischemic, watershed hypoxic ischemic, venous infarction, diffuse axonal injury and contusion.
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Affiliation(s)
- R A Zimmerman
- Department of Radiology, Wood Room 2115, The Children's Hospital of Philadelphia, 34th Street and Civic Center boulevard, Philadelphia, PA 19104, USA.
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