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Tuura RO, Kottke R, Brotschi B, Sabandal C, Hagmann C, Latal B. Elevated cerebral perfusion in neonatal encephalopathy is associated with neurodevelopmental impairments. Pediatr Res 2025; 97:1597-1604. [PMID: 39289590 PMCID: PMC12119360 DOI: 10.1038/s41390-024-03553-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 07/19/2024] [Accepted: 08/27/2024] [Indexed: 09/19/2024]
Abstract
BACKGROUND Neonatal encephalopathy (NE) represents a primary cause of neonatal death and neurodevelopmental impairments. In newborns with NE, cerebral hyperperfusion is related to an increased risk of severe adverse outcomes, but less is known about the link between perfusion and mild to moderate developmental impairments or developmental delay. METHODS Using arterial spin labelling perfusion MRI, we investigated the link between perfusion in 36 newborns with NE and developmental outcome at 2 years. RESULTS 53% of the infants demonstrated a normal outcome at 24 months, while two had cerebral palsy with impairments in cognitive, motor, and language domains, and three infants died. The remaining infants showed mild or moderate delays in development in one or two domains. Hyperperfusion across the whole brain was associated with more adverse outcome, including an increased risk of death or severe disability such as cerebral palsy. Among the surviving infants, higher perfusion in the bilateral basal ganglia, thalamus, hippocampus and cerebellum during the neonatal period was related to a poorer cognitive outcome at 2 years. CONCLUSION Hyperperfusion in infants with NE was associated with a more adverse outcome and lower cognitive outcome scores. In addition to severe adverse outcomes, altered perfusion is also related to mild to moderate impairment following HIE. IMPACT STATEMENT Neonates with neonatal encephalopathy (NE) show increased cerebral perfusion globally, which is linked to a more adverse outcome. Higher perfusion in the bilateral basal ganglia, thalamus, hippocampus and cerebellum during the neonatal period was related to a poorer cognitive outcome at 2 years. In addition to severe adverse outcomes altered perfusion is related to mild to moderate impairment following NE. To improve neurodevelopmental outcomes, it is important to improve our understanding of the factors influencing cerebral perfusion in infants with NE.
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Affiliation(s)
- Ruth O'Gorman Tuura
- Center for MR Research, University Children's Hospital Zürich, University of Zürich (UZH), Zürich, Switzerland.
- Children's Research Center, University Children's Hospital Zürich, University of Zürich (UZH), Zürich, Switzerland.
| | - Raimund Kottke
- Children's Research Center, University Children's Hospital Zürich, University of Zürich (UZH), Zürich, Switzerland
- Department of Diagnostic Imaging, University Children's Hospital Zürich, University of Zürich (UZH), Zürich, Switzerland
| | - Barbara Brotschi
- Children's Research Center, University Children's Hospital Zürich, University of Zürich (UZH), Zürich, Switzerland
- Department of Neonatology and Paediatric Intensive Care, University Children's Hospital Zürich, University of Zurich (UZH), Zürich, Switzerland
| | - Carola Sabandal
- Children's Research Center, University Children's Hospital Zürich, University of Zürich (UZH), Zürich, Switzerland
- Department of Anaesthesia, University Children's Hospital Zürich, University of Zurich (UZH), Zürich, Switzerland
| | - Cornelia Hagmann
- Children's Research Center, University Children's Hospital Zürich, University of Zürich (UZH), Zürich, Switzerland
- Department of Neonatology and Paediatric Intensive Care, University Children's Hospital Zürich, University of Zurich (UZH), Zürich, Switzerland
| | - Beatrice Latal
- Children's Research Center, University Children's Hospital Zürich, University of Zürich (UZH), Zürich, Switzerland
- Child Development Center, University Children's Hospital Zurich, University of Zürich (UZH), Zürich, Switzerland
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Charlton JK, Kanwal K. Cerebral blood flow in neonatal encephalopathy: biomarker or potential target? Pediatr Res 2025; 97:1416-1417. [PMID: 39496875 DOI: 10.1038/s41390-024-03684-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2024] [Accepted: 10/14/2024] [Indexed: 11/06/2024]
Affiliation(s)
- Julia K Charlton
- Department of Pediatrics, University of British Columbia, Vancouver, Canada.
- Neonatal Program, British Columbia Women's Hospital, Vancouver, Canada.
- Department of Paediatrics, University of Melbourne, Melbourne, Australia.
| | - Khushboo Kanwal
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
- Neonatal Program, British Columbia Women's Hospital, Vancouver, Canada
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Hu Z, Jiang D, Shepard J, Uchida Y, Oishi K, Shi W, Liu P, Lin D, Yedavalli V, Tekes A, Golden WC, Lu H. High-Fidelity MRI Assessment of Cerebral Perfusion in Healthy Neonates Less Than 1 Week of Age. J Magn Reson Imaging 2025. [PMID: 39945520 DOI: 10.1002/jmri.29740] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2024] [Revised: 01/24/2025] [Accepted: 01/28/2025] [Indexed: 03/19/2025] Open
Abstract
BACKGROUND Perfusion imaging of the brain has important clinical applications in detecting neurological abnormalities in neonates. However, such tools have not been available to date. Although arterial-spin-labeling (ASL) MRI is a powerful noninvasive tool to measure perfusion, its application in neonates has encountered obstacles related to low signal-to-noise ratio (SNR), large-vessel contaminations, and lack of technical development studies. PURPOSE To systematically develop and optimize ASL perfusion MRI in healthy neonates under 1 week of age. STUDY TYPE Prospective. SUBJECTS Thirty-two healthy term neonates (19 female; postnatal age 1.9 ± 0.7 days). FIELD STRENGTH/SEQUENCE 3.0 T; T2-weighted half-Fourier single-shot turbo-spin-echo (HASTE) imaging, single-delay and multi-delay 3D gradient-and-spin-echo (GRASE) large-vessel-suppression pseudo-continuous ASL (LVS-pCASL). ASSESSMENT Three studies were conducted. First, an LVS-pCASL MRI sequence was developed to suppress large-vessel spurious signals in neonatal pCASL. Second, multiple post-labeling delays (PLDs) LVS-pCASL were employed to simultaneously estimate normative cerebral blood flow (CBF) and arterial transit time (ATT) in neonates. Third, an enhanced background-suppression (BS) scheme was developed to increase the SNR of neonatal pCASL. STATISTICAL TESTS Repeated measure analysis-of-variance, paired t-test, spatial intraclass-correlation-coefficient (ICC), and voxel-wise coefficient-of-variation (CoV). P-value <0.05 was considered significant. RESULTS LVS-pCASL reduced spurious ASL signals, making the CBF images more homogenous and significantly reducing the temporal variation of CBF measurements by 58.0% when compared to the standard pCASL. Multi-PLD ASL yielded ATT and CBF maps showing a longer ATT and lower CBF in the white matter relative to the gray matter. The highest CBF was observed in basal ganglia and thalamus (10.4 ± 1.9 mL/100 g/min). Enhanced BS resulted in significantly higher test-retest reproducibility (ICC = 0.90 ± 0.04, CoV = 8.4 ± 1.2%) when compared to regular BS (ICC = 0.59 ± 0.12, CoV = 23.6 ± 3.8%). DATA CONCLUSION We devised an ASL method that can generate whole-brain CBF images in 4 minutes with a test-retest image ICC of 0.9. This technique holds potential for studying neonatal brain diseases involving perfusion abnormalities. PLAIN LANGUAGE SUMMARY MR imaging of cerebral blood flow in neonates remains a challenge due to low blood flow rates and confounding factors from large blood vessels. This study systematically developed an advanced MRI technique to enhance the reliability of perfusion measurements in neonates. The proposed method reduced signal artifacts from large blood vessels and improved the signal-to-noise ratio of brain perfusion images. With this approach, whole-brain neonatal perfusion can be measured in 4 minutes with excellent reproducibility. This technique may provide a useful tool for studying neonatal brain maturation and detecting perfusion abnormalities in diseases. EVIDENCE LEVEL 2 TECHNICAL EFFICACY: Stage 1.
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Affiliation(s)
- Zhiyi Hu
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Dengrong Jiang
- The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jennifer Shepard
- Eudowood Neonatal Pulmonary Division, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Yuto Uchida
- The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kenichi Oishi
- The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Wen Shi
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Peiying Liu
- Department of Diagnostic Radiology & Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Doris Lin
- The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Vivek Yedavalli
- The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Aylin Tekes
- The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - William Christopher Golden
- Eudowood Neonatal Pulmonary Division, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Hanzhang Lu
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Research Institute, Baltimore, Maryland, USA
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Arti L, Gnirs K, Papageorgiou S, Ruel Y, Agoulon A, Boddaert N, Gaillot H. Exploring brain perfusion in dogs with meningoencephalitis of unknown origin: A promising role for arterial spin labeling imaging. J Vet Intern Med 2025; 39:e17259. [PMID: 39655753 PMCID: PMC11629257 DOI: 10.1111/jvim.17259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2024] [Accepted: 11/11/2024] [Indexed: 12/13/2024] Open
Abstract
BACKGROUND Arterial spin labeling (ASL) is a noninvasive brain perfusion magnetic resonance imaging (MRI) technique that has not been assessed in dogs with meningoencephalitis of unknown origin (MUO). HYPOTHESIS/OBJECTIVES Assess brain perfusion changes characteristics before and after medical treatment, and investigate the role of ASL perfusion in the diagnosis and prognosis of MUO in dogs. ANIMALS Thirty-one dogs with presumed MUO. METHODS Prospective study. Each animal had brain MRI including standard and ASL perfusion sequences at presentation and after treatment of 3 months or longer. Brain perfusion characteristics were assessed visually and by cerebral blood flow (CBF) measurements. Perfusion characteristics were compared pre- and post-treatment. RESULTS Dogs with MUO had preferential localization of lesions in optic nerves (ONs) and brainstem. At presentation, one third of the dogs with MUO had focal brain perfusion alterations and two-thirds had global brain hypoperfusion. Both focal and global brain perfusion changes resolved after treatment in all surviving dogs. Arterial spin labeling failed to predict prognosis. CONCLUSIONS AND CLINICAL IMPORTANCE Brain ASL perfusion in dogs with MUO demonstrated the value of ASL in the diagnosis and follow-up of the condition, suggesting the value of adding ASL to the clinical evaluation in dogs with suspected MUO. Preferential lesion localization in ON and brainstem resembled findings in the central nervous system of human patients with inflammatory demyelinating diseases. Future studies with histopathological confirmation are needed to better characterize the benefits of ASL in the different subtypes of non-infectious encephalomyelitis in dogs.
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Affiliation(s)
- Léa Arti
- Unit of NeurologyCentre Hospitalier Vétérinaire ADVETIAVélizy‐VillacoublayFrance
| | - Kirsten Gnirs
- Unit of NeurologyCentre Hospitalier Vétérinaire ADVETIAVélizy‐VillacoublayFrance
| | - Stella Papageorgiou
- Unit of NeurologyCentre Hospitalier Vétérinaire ADVETIAVélizy‐VillacoublayFrance
| | - Yannick Ruel
- Unit of Diagnostic ImagingCentre Hospitalier Vétérinaire ADVETIAVélizy‐VillacoublayFrance
| | | | - Nathalie Boddaert
- Paediatric Radiology DepartmentAP‐HP, Hôpital Necker Enfants Malades, Université de ParisParis F‐75105France
- Institut Imagine INSERM U1163, Universié de ParisParis F‐75015France
| | - Hugues Gaillot
- Unit of Diagnostic ImagingCentre Hospitalier Vétérinaire ADVETIAVélizy‐VillacoublayFrance
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Andelius TCK, Hansen ESS, Bøgh N, Pedersen MV, Kyng KJ, Henriksen TB, Laustsen C. Hyperpolarized 13C magnetic resonance imaging in neonatal hypoxic-ischemic encephalopathy: First investigations in a large animal model. NMR IN BIOMEDICINE 2024; 37:e5110. [PMID: 38317333 DOI: 10.1002/nbm.5110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 12/03/2023] [Accepted: 01/07/2024] [Indexed: 02/07/2024]
Abstract
Early biomarkers of cerebral damage are essential for accurate prognosis, timely intervention, and evaluation of new treatment modalities in newborn infants with hypoxia and ischemia at birth. Hyperpolarized 13C magnetic resonance imaging (MRI) is a novel method with which to quantify metabolism in vivo with unprecedented sensitivity. We aimed to investigate the applicability of hyperpolarized 13C MRI in a newborn piglet model and whether this method may identify early changes in cerebral metabolism after a standardized hypoxic-ischemic (HI) insult. Six piglets were anesthetized and subjected to a standardized HI insult. Imaging was performed prior to and 2 h after the insult on a 3-T MR scanner. For 13C studies, [1-13C]pyruvate was hyperpolarized in a commercial polarizer. Following intravenous injection, images were acquired using metabolic-specific imaging. HI resulted in a metabolic shift with a decrease in pyruvate to bicarbonate metabolism and an increase in pyruvate to lactate metabolism (lactate/bicarbonate ratio, mean [SD]; 2.28 [0.36] vs. 3.96 [0.91]). This is the first study to show that hyperpolarized 13C MRI can be used in newborn piglets and applied to evaluate early changes in cerebral metabolism after an HI insult.
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Affiliation(s)
- Ted C K Andelius
- Department of Paediatrics, Aarhus University Hospital, Aarhus, Denmark
| | | | - Nikolaj Bøgh
- The MR Research Centre, Aarhus University, Aarhus, Denmark
| | - Mette V Pedersen
- Department of Paediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Kasper J Kyng
- Department of Paediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Tine B Henriksen
- Department of Paediatrics, Aarhus University Hospital, Aarhus, Denmark
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Tierradentro-García LO, Saade-Lemus S, Freeman C, Kirschen M, Huang H, Vossough A, Hwang M. Cerebral Blood Flow of the Neonatal Brain after Hypoxic-Ischemic Injury. Am J Perinatol 2023; 40:475-488. [PMID: 34225373 PMCID: PMC8974293 DOI: 10.1055/s-0041-1731278] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Hypoxic-ischemic encephalopathy (HIE) in infants can have long-term adverse neurodevelopmental effects and markedly reduce quality of life. Both the initial hypoperfusion and the subsequent rapid reperfusion can cause deleterious effects in brain tissue. Cerebral blood flow (CBF) assessment in newborns with HIE can help detect abnormalities in brain perfusion to guide therapy and prognosticate patient outcomes. STUDY DESIGN The review will provide an overview of the pathophysiological implications of CBF derangements in neonatal HIE, current and emerging techniques for CBF quantification, and the potential to utilize CBF as a physiologic target in managing neonates with acute HIE. CONCLUSION The alterations of CBF in infants during hypoxia-ischemia have been studied by using different neuroimaging techniques, including nitrous oxide and xenon clearance, transcranial Doppler ultrasonography, contrast-enhanced ultrasound, arterial spin labeling MRI, 18F-FDG positron emission tomography, near-infrared spectroscopy (NIRS), functional NIRS, and diffuse correlation spectroscopy. Consensus is lacking regarding the clinical significance of CBF estimations detected by these different modalities. Heterogeneity in the imaging modality used, regional versus global estimations of CBF, time for the scan, and variables impacting brain perfusion and cohort clinical characteristics should be considered when translating the findings described in the literature to routine practice and implementation of therapeutic interventions. KEY POINTS · Hypoxic-ischemic injury in infants can result in adverse long-term neurologic sequelae.. · Cerebral blood flow is a useful biomarker in neonatal hypoxic-ischemic injury.. · Imaging modality, variables affecting cerebral blood flow, and patient characteristics affect cerebral blood flow assessment..
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Affiliation(s)
| | - Sandra Saade-Lemus
- Department of Radiology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Neurology, Brigham and Women’s Hospital & Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Colbey Freeman
- Department of Radiology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Matthew Kirschen
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Hao Huang
- Department of Radiology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Arastoo Vossough
- Department of Radiology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Misun Hwang
- Department of Radiology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
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Tang S, Liu X, Nie L, Qian F, Chen W, He L. Three-dimensional pseudocontinuous arterial spin labeling perfusion imaging shows cerebral blood flow perfusion decline in attention-deficit/hyperactivity disorder children. Front Psychiatry 2023; 14:1064647. [PMID: 36741108 PMCID: PMC9889924 DOI: 10.3389/fpsyt.2023.1064647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 01/04/2023] [Indexed: 01/19/2023] Open
Abstract
PURPOSE To investigate the feasibility of three-dimensional pseudocontinuous arterial spin labeling (3D-pcASL) perfusion imaging in the brain of children with Attention-deficit/hyperactivity disorder (ADHD). METHODS A total of 78 ADHD children aged 5-13 years were prospectively selected as the study group, and 89 healthy children matched in age and sex were selected as the control group. All children underwent MRI conventional sequence, 3D-pcASL, and 3D-T1 sequence scans. The brain gray and white matter volume and cerebral blood flow (CBF) perfusion values were obtained by software post-processing, and were compared and analyzed in the two groups to find out their characteristics in the brain of ADHD children. RESULTS The total brain volume and total CBF values were lower in ADHD children than in healthy children (P < 0.05); the gray and white matter volumes in the frontal lobe, temporal lobe, hippocampus, caudate nucleus, putamen, globus pallidus and other brain regions were lower in ADHD children than in healthy children (P < 0.05); the gray matter CBF values in the frontal lobe, temporal lobe, hippocampus, caudate nucleus, putamen, globus pallidus and other brain regions were lower in ADHD children than in healthy children (P < 0.05); the differences between the white matter CBF values of white matter in the said brain regions of ADHD children and healthy children were not statistically significant (P > 0.05); and the CBF values in frontal lobe and caudate nuclei could distinguish ADHD children (AUC > 0.05, P < 0.05). CONCLUSION The 3D-pcASL technique showed reduced cerebral perfusion in some brain regions of ADHD children.
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Affiliation(s)
- Shilong Tang
- Department of Radiology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Xianfan Liu
- Department of Radiology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Lisha Nie
- GE Healthcare, MR Research China, Beijing, China
| | - Fangfang Qian
- Department of Radiology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Wushang Chen
- Department of Radiology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Ling He
- Department of Radiology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
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Rocha NP, Charron O, Colpo GD, Latham LB, Patino JE, Stimming EF, Freeman L, Teixeira AL. Cerebral blood flow is associated with markers of neurodegeneration in Huntington’s disease. Parkinsonism Relat Disord 2022; 102:79-85. [DOI: 10.1016/j.parkreldis.2022.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 07/21/2022] [Accepted: 07/30/2022] [Indexed: 10/16/2022]
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Cerebral perfusion changes of the basal ganglia and thalami in full-term neonates with hypoxic-ischaemic encephalopathy: a three-dimensional pseudo continuous arterial spin labelling perfusion magnetic resonance imaging study. Pediatr Radiol 2022; 52:1559-1567. [PMID: 35357515 DOI: 10.1007/s00247-022-05344-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 02/09/2022] [Accepted: 02/25/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Neonatal hypoxic-ischemic encephalopathy (HIE) is one of the common causes of neurological injury in full-term neonates following perinatal asphyxia. The conventional magnetic resonance technique has low sensitivity in detecting variations in cerebral blood flow in patients with HIE. OBJECTIVE This article evaluates the clinical diagnostic value of three-dimensional pseudo-continuous arterial spin labelling (3-D pcASL) perfusion magnetic resonance imaging (MRI) for early prediction of neurobehavioral outcomes in full-term neonates with HIE. MATERIALS AND METHODS All neonates diagnosed with HIE underwent MRI (conventional and 3-D pcASL perfusion MRI). Cerebral blood flow values were measured in the basal ganglia (caudate nuclei, lenticular nuclei), thalami and white matter regions (frontal lobes, corona radiata). After 1-month follow-up, the Neonatal Behavioral Neurological Assessment scores were used to divide patients into favourable outcome group versus adverse outcome group. RESULTS Twenty-three patients were enrolled in this study. There were no statistical differences between the symmetrical cerebral blood flow values of bilateral basal ganglia, thalami and white matter regions. However, the cerebral blood flow values of grey matter nuclei were higher than the white matter regions. The average value of cerebral blood flow in the basal ganglia and thalami in the adverse outcome group was 37.28±6.42 ml/100 g/min, which is greater than the favourable outcome group (22.55 ± 3.21 ml/100 g/min) (P<0.01). The area under the curve (AUC) of 3-D pcASL perfusion MRI was 0.992 with a cutoff value of 28.75 ml/100 g/min, with a Youden's index of 0.9231. The sensitivity and specificity were 92.3% and 100%, respectively. CONCLUSION The 3-D pcASL demonstrated higher perfusion alteration in the basal ganglia and thalami of neonatal HIE with adverse outcomes. The 3-D pcASL perfusion MRI has the potential to predict neurobehavioral outcomes of neonates with HIE.
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Tang S, Nie L, Liu X, Chen Z, Zhou Y, Pan Z, He L. Application of Quantitative Magnetic Resonance Imaging in the Diagnosis of Autism in Children. Front Med (Lausanne) 2022; 9:818404. [PMID: 35646984 PMCID: PMC9133426 DOI: 10.3389/fmed.2022.818404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 04/26/2022] [Indexed: 11/13/2022] Open
Abstract
Objective To explore the application of quantitative magnetic resonance imaging in the diagnosis of autism in children. Methods Sixty autistic children aged 2–3 years and 60 age- and sex-matched healthy children participated in the study. All the children were scanned using head MRI conventional sequences, 3D-T1, diffusion kurtosis imaging (DKI), enhanced T2*- weighted magnetic resonance angiography (ESWAN) and 3D-pseudo continuous Arterial Spin-Labeled (3D-pcASL) sequences. The quantitative susceptibility mapping (QSM), cerebral blood flow (CBF), and brain microstructure of each brain area were compared between the groups, and correlations were analyzed. Results The iron content and cerebral blood flow in the frontal lobe, temporal lobe, hippocampus, caudate nucleus, substantia nigra, and red nucleus of the study group were lower than those in the corresponding brain areas of the control group (P < 0.05). The mean kurtosis (MK), radial kurtosis (RK), and axial kurtosis (AK) values of the frontal lobe, temporal lobe, putamen, hippocampus, caudate nucleus, substantia nigra, and red nucleus in the study group were lower than those of the corresponding brain areas in the control group (P < 0.05). The mean diffusivity (MD) and fractional anisotropy of kurtosis (FAK) values of the frontal lobe, temporal lobe and hippocampus in the control group were lower than those in the corresponding brain areas in the study group (P < 0.05). The values of CBF, QSM, and DKI in frontal lobe, temporal lobe and hippocampus could distinguish ASD children (AUC > 0.5, P < 0.05), among which multimodal technology (QSM, CBF, DKI) had the highest AUC (0.917) and DKI had the lowest AUC (0.642). Conclusion Quantitative magnetic resonance imaging (including QSM, 3D-pcASL, and DKI) can detect abnormalities in the iron content, cerebral blood flow and brain microstructure in young autistic children, multimodal technology (QSM, CBF, DKI) could be considered as the first choice of imaging diagnostic technology. Clinical Trial Registration [http://www.chictr.org.cn/searchprojen.aspx], identifier [ChiCTR2000029699].
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Affiliation(s)
- Shilong Tang
- Department of Radiology, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Lisha Nie
- GE Healthcare, MR Research China, Beijing, China
| | - Xianfan Liu
- Department of Radiology, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Zhuo Chen
- Department of Radiology, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Yu Zhou
- Department of Radiology, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Zhengxia Pan
- Department of Radiology, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
- *Correspondence: Zhengxia Pan,
| | - Ling He
- Department of Radiology, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
- Ling He,
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Tang S, Liu X, Ran Q, Nie L, Wu L, Pan Z, He L. Application of Three-Dimensional Pseudocontinuous Arterial Spin Labeling Perfusion Imaging in the Brains of Children With Autism. Front Neurol 2022; 13:851430. [PMID: 35280268 PMCID: PMC8905523 DOI: 10.3389/fneur.2022.851430] [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: 01/09/2022] [Accepted: 01/24/2022] [Indexed: 11/15/2022] Open
Abstract
Objective To explore the application of three-dimensional pseudocontinuous arterial spin labeling (3D-PCASL) perfusion imaging in the brains of children with autism and to understand the characteristics of cerebral blood perfusion in children with autism. Methods A total of 320 children with autism (160 men and 160 women) aged between 2 and 18 years and 320 age- and sex-matched healthy children participated in the study. All children were scanned by 3.0 T magnetic resonance axial T1 fluid-attenuated inversion recovery (FLAIR), T2 FLAIR, 3D-T1, and 3D-PCASL sequences. After postprocessing, cerebral blood flow (CBF) values in each brain region of children with autism and healthy children at the same age were compared and analyzed. Furthermore, CBF characteristics in each brain region of autistic children at various ages were determined. Results The CBF values of the frontal lobe, hippocampus, temporal lobe, and caudate nucleus of children with autism are lower than those of healthy children (P < 0.05). Additionally, as the ages of children with autism increase, the number of brain regions with decreased CBF values gradually increases. A receiver operating characteristic (ROC) analysis results show that the CBF values of the frontal lobe, hippocampus, temporal lobe, and caudate nucleus can distinguish children with autism [area under the ROC curve (AUC) > 0.05, P < 0.05]. Conclusion The 3D-PCASL shows lower brain CBF values in children with autism. Clinical Trial Registration www.ClinicalTrials.gov, identifier: ChiCTR2000034356.
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Affiliation(s)
- Shilong Tang
- Department of Radiology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Xianfan Liu
- Department of Radiology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Qiying Ran
- Department of Radiology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Lisha Nie
- GE Healthcare, MR Research China, Beijing, China
| | - Lan Wu
- Department of Radiology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Zhengxia Pan
- Department of Cardiovascular and Thoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Ling He
- Department of Radiology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
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Tang S, Liu X, Nie L, Chen Z, Ran Q, He L. Diagnosis of children with attention-deficit/hyperactivity disorder (ADHD) comorbid autistic traits (ATs) by applying quantitative magnetic resonance imaging techniques. Front Psychiatry 2022; 13:1038471. [PMID: 36465303 PMCID: PMC9712964 DOI: 10.3389/fpsyt.2022.1038471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 11/03/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To explore the feasibility of applying quantitative magnetic resonance imaging techniques for the diagnosis of children with attention-deficit/hyperactivity disorder (ADHD) comorbid autistic traits (ATs). METHODS A prospective study was performed by selecting 56 children aged 4-5 years with ADHD-ATs as the study group and 53 sex- and age-matched children with ADHD without ATs as the control group. All children underwent magnetic resonance scans with enhanced T2*- weighted magnetic resonance angiography (ESWAN), 3D-PCASL, and 3D-T1 sequences. Iron content and cerebral blood flow parameters were obtained via subsequent software processing, and the parameter values in particular brain regions in both groups were compared and analyzed to determine the characteristics of these parameters in children with ADHD-ATs. RESULTS Iron content and cerebral blood flow in the frontal lobe, temporal lobe, hippocampus, and caudate nucleus of children with ADHD-ATs were lower than those of children with ADHD without ATs (p < 0.05). Iron content and CBF values in the frontal lobe, temporal lobe and caudate nucleus could distinguish children with ADHD-ATs from those without ATs (AUC > 0.5, p < 0.05). CONCLUSIONS Quantitative magnetic resonance techniques could distinguish children with ADHD-ATs. TRIAL REGISTRATION This study protocol was registered at the Chinese clinical trial registry (ChiCTR2100046616).
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Affiliation(s)
- Shilong Tang
- Department of Radiology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Xianfan Liu
- Department of Radiology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Lisha Nie
- GE Healthcare, MR Research China, Beijing, China
| | - Zhuo Chen
- Department of Radiology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Qiying Ran
- Department of Radiology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Ling He
- Department of Radiology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
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Wang DJJ, Le Bihan D, Krishnamurthy R, Smith M, Ho ML. Noncontrast Pediatric Brain Perfusion: Arterial Spin Labeling and Intravoxel Incoherent Motion. Magn Reson Imaging Clin N Am 2021; 29:493-513. [PMID: 34717841 DOI: 10.1016/j.mric.2021.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Noncontrast magnetic resonance imaging techniques for measuring brain perfusion include arterial spin labeling (ASL) and intravoxel incoherent motion (IVIM). These techniques provide noninvasive and repeatable assessment of cerebral blood flow or cerebral blood volume without the need for intravenous contrast. This article discusses the technical aspects of ASL and IVIM with a focus on normal physiologic variations, technical parameters, and artifacts. Multiple pediatric clinical applications are presented, including tumors, stroke, vasculopathy, vascular malformations, epilepsy, migraine, trauma, and inflammation.
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Affiliation(s)
- Danny J J Wang
- USC Institute for Neuroimaging and Informatics, SHN, 2025 Zonal Avenue, Health Sciences Campus, Los Angeles, CA 90033, USA
| | - Denis Le Bihan
- NeuroSpin, Centre d'études de Saclay, Bâtiment 145, Gif-sur-Yvette 91191, France
| | - Ram Krishnamurthy
- Department of Radiology, Nationwide Children's Hospital, 700 Children's Drive - ED4, Columbus, OH 43205, USA
| | - Mark Smith
- Department of Radiology, Nationwide Children's Hospital, 700 Children's Drive - ED4, Columbus, OH 43205, USA
| | - Mai-Lan Ho
- Department of Radiology, Nationwide Children's Hospital, 700 Children's Drive - ED4, Columbus, OH 43205, USA.
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Hoffmann AC, Ruel Y, Gnirs K, Papageorgiou S, Zilberstein L, Nahmani S, Boddaert N, Gaillot H. Brain perfusion magnetic resonance imaging using pseudocontinuous arterial spin labeling in 314 dogs and cats. J Vet Intern Med 2021; 35:2327-2341. [PMID: 34291497 PMCID: PMC8478041 DOI: 10.1111/jvim.16215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 06/17/2021] [Accepted: 06/22/2021] [Indexed: 11/30/2022] Open
Abstract
Background Arterial spin labeling (ASL) is a noninvasive brain perfusion magnetic resonance imaging (MRI) technique that has not been assessed in clinical veterinary medicine. Hypothesis/Objectives To test the feasibility of ASL using a 1.5 Tesla scanner and provide recommendations for optimal quantification of cerebral blood flow (CBF) in dogs and cats. Animals Three hundred fourteen prospectively selected client‐owned dogs and cats. Methods Each animal underwent brain MRI including morphological sequences and ≥1 ASL sequences using different sites of blood labeling and postlabeling delays (PLD). Calculated ASL success rates were compared. The CBF was quantified in animals that had morphologically normal brain MRI results and parameters of ASL optimization were investigated. Results Arterial spin labeling was easily implemented with an overall success rate of 95% in animals with normal brain MRI. Technical recommendations included (a) positioning of the imaging slab at the foramen magnum and (b) selected PLD of 1025 ms in cats and dogs <7 kg, 1525 ms in dogs 7 to 38 kg, and 2025 ms in dogs >38 kg. In 37 dogs, median optimal CBF in the cortex and thalamic nuclei were 114 and 95 mL/100 g/min, respectively. In 28 cats, median CBF in the cortex and thalamic nuclei were 113 and 114 mL/100 g/min, respectively. Conclusions and Clinical Importance Our survey of brain perfusion ASL‐MRI demonstrated the feasibility of ASL at 1.5 Tesla, suggested technical recommendations and provided CBF values that should be helpful in the characterization of various brain diseases in dogs and cats.
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Affiliation(s)
- Anne-Cécile Hoffmann
- Unit of Diagnostic Imaging, ADVETIA Veterinary Referral Hospital, Vélizy-Villacoublay, France
| | - Yannick Ruel
- Unit of Diagnostic Imaging, ADVETIA Veterinary Referral Hospital, Vélizy-Villacoublay, France
| | - Kirsten Gnirs
- Unit of Neurology, ADVETIA Veterinary Referral Hospital, Vélizy-Villacoublay, France
| | - Stella Papageorgiou
- Unit of Neurology, ADVETIA Veterinary Referral Hospital, Vélizy-Villacoublay, France
| | - Luca Zilberstein
- Unit of Anesthesiology-Analgesia, ADVETIA Veterinary Referral Hospital, Vélizy-Villacoublay, France
| | - Sarah Nahmani
- Paediatric Radiology Department, AP-HP, Hôpital Necker Enfants Malades, Université de Paris, Paris, France
| | - Nathalie Boddaert
- Paediatric Radiology Department, AP-HP, Hôpital Necker Enfants Malades, Université de Paris, Paris, France.,Universié de Paris, Institut Imagine INSERM U1163, Paris, France
| | - Hugues Gaillot
- Unit of Diagnostic Imaging, ADVETIA Veterinary Referral Hospital, Vélizy-Villacoublay, France
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