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Seber T, Uylar Seber T, Özdemir A, Baştuğ O, Keskin Ş, Aktaş E. Volumetric apparent diffusion coefficient histogram analysis in term neonatal asphyxia treated with hypothermia. Br J Radiol 2024; 97:1302-1310. [PMID: 38775658 PMCID: PMC11186576 DOI: 10.1093/bjr/tqae105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 11/07/2023] [Accepted: 05/16/2024] [Indexed: 06/21/2024] Open
Abstract
OBJECTIVES Our aim is to estimate the long-term neurological sequelae and prognosis in term neonatal asphyxia treated with hypothermia via volumetric apparent diffusion coefficient (ADC) map histogram analysis (HA). METHODS Brain MRI studies of 83 term neonates with asphyxia who received whole-body hypothermia treatment and examined between postnatal (PN) fourth and sixth days were retrospectively re-evaluated by 2 radiologists. Volumetric HA was performed for the areas frequently affected in deep and superficial asphyxia (thalamus, lentiform nucleus, posterior limb of internal capsule, corpus callosum forceps major, and perirolandic cortex-subcortical white matter) on ADC map. The quantitative ADC values were obtained separately for each region. Qualitative-visual (conventional) MRI findings were also re-evaluated. Neonates were examined neurodevelopmentally according to the Revised Brunet-Lezine scale. The distinguishability of long-term neurodevelopmental outcomes was statistically investigated. RESULTS With HA, the adverse neurodevelopmental outcomes could only be distinguished from mild-moderated impairment and normal development at the thalamus with 10th percentile ADC (P = .02 and P = .03, respectively) and ADCmin (P = .03 and P = .04, respectively). Also with the conventional MRI findings, adverse outcome could be distinguished from mild-moderated impairment (P = .04) and normal development (P = .04) via cytotoxic oedema of the thalamus, corpus striatum, and diffuse cerebral cortical. CONCLUSION The long-term adverse neurodevelopmental outcomes in newborns with asphyxia who received whole-body hypothermia treatment can be estimated similarly with volumetric ADC-HA and the conventional assessment of the ADC map. ADVANCES IN KNOWLEDGE This study compares early MRI ADC-HA with neurological sequelae in term newborns with asphyxia who received whole-body hypothermia treatment. We could not find any significant difference in predicting adverse neurological sequelae between the visual-qualitative evaluation of the ADC map and HA.
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Affiliation(s)
- Turgut Seber
- Department of Radiology, Kayseri City Education and Research Hospital, Kayseri 38080, Turkey
| | - Tuğba Uylar Seber
- Department of Radiology, Kayseri City Education and Research Hospital, Kayseri 38080, Turkey
| | - Ahmet Özdemir
- Department of Neonatology, Kayseri City Education and Research Hospital, Kayseri 38080, Turkey
| | - Osman Baştuğ
- Department of Neonatology, Kayseri City Education and Research Hospital, Kayseri 38080, Turkey
| | - Şuayip Keskin
- Department of Child Health and Diseases, Kayseri City Education and Research Hospital, Kayseri 38080, Turkey
| | - Elif Aktaş
- Department of Radiology, Kayseri City Education and Research Hospital, Kayseri 38080, Turkey
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Pawale D, Fursule A, Tan J, Wagh D, Patole S, Rao S. Prevalence of hearing impairment in neonatal encephalopathy due to hypoxia-ischemia: a systematic review and meta-analysis. Pediatr Res 2024:10.1038/s41390-024-03261-w. [PMID: 38769399 DOI: 10.1038/s41390-024-03261-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 04/17/2024] [Accepted: 04/29/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND This systematic review was undertaken to estimate the overall prevalence of hearing impairment in survivors of neonatal HIE. METHODS PubMed, EMBASE, CINAHL, EMCARE and Cochrane databases, mednar (gray literature) were searched till January 2023. Randomized controlled trials and observational studies were included. The main outcome was estimation of overall prevalence of hearing impairment in survivors of HIE. RESULTS A total of 71studies (5821 infants assessed for hearing impairment) were included of which 56 were from high income countries (HIC) and 15 from low- or middle-income countries (LMIC). Overall prevalence rate of hearing impairment in cooled infants was 5% (95% CI: 3-6%, n = 4868) and 3% (95% CI: 1-6%, n = 953) in non-cooled HIE infants. The prevalence rate in cooled HIE infants in LMICs was 7% (95% CI: 2-15%) and in HICs was 4% (95% CI: 3-5%). The prevalence rate in non-cooled HIE infants in LMICs was 8% (95% CI: 2-17%) and HICs was 2% (95% CI: 0-4%). CONCLUSIONS These results would be useful for counseling parents, and in acting as benchmark when comparing institutional data, and while monitoring future RCTs testing new interventions in HIE. There is a need for more data from LMICs and standardization of reporting hearing impairment. IMPACT The overall prevalence rate of hearing impairment in cooled infants with HIE was 5% (95% CI: 3-6%) and 3% (95% CI: 1-6%) in the non-cooled infants. The prevalence rate in cooled HIE infants in LMICs was 7% (95% CI: 2-15%) and in HICs was 4% (95% CI: 3-5%). The prevalence rate in non-cooled HIE infants in LMICs was 8% (95% CI: 2-17%) and HICs was 2% (95% CI: 0-4%). These results would be useful for counseling parents, and in acting as benchmark when comparing institutional data, and while monitoring future RCTs testing new interventions in HIE.
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Affiliation(s)
- Dinesh Pawale
- Department of Neonatology, Perth Children's Hospital, Perth, WA, Australia
| | - Anurag Fursule
- Department of Neonatology, Perth Children's Hospital, Perth, WA, Australia
| | - Jason Tan
- Department of Neonatology, Perth Children's Hospital, Perth, WA, Australia
- School of Medicine, University of Western Australia, Crawley, WA, Australia
| | - Deepika Wagh
- Department of Neonatology, Perth Children's Hospital, Perth, WA, Australia
- School of Medicine, University of Western Australia, Crawley, WA, Australia
| | - Sanjay Patole
- School of Medicine, University of Western Australia, Crawley, WA, Australia
- Department of Neonatology, King Edwards Memorial Hospital, Perth, WA, Australia
| | - Shripada Rao
- Department of Neonatology, Perth Children's Hospital, Perth, WA, Australia.
- School of Medicine, University of Western Australia, Crawley, WA, Australia.
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Mietzsch U, Flibotte JJ, Law JB, Puia-Dumitrescu M, Juul SE, Wood TR. Temperature dysregulation during therapeutic hypothermia predicts long-term outcome in neonates with HIE. J Cereb Blood Flow Metab 2023; 43:1180-1193. [PMID: 36883364 PMCID: PMC10291460 DOI: 10.1177/0271678x231162174] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 01/21/2023] [Accepted: 02/03/2023] [Indexed: 03/09/2023]
Abstract
Few reliable or easily obtainable biomarkers to predict long-term outcome in infants with hypoxic-ischemic encephalopathy (HIE) have been identified. We previously showed that mattress temperature (MT), as proxy for disturbed temperature regulation during therapeutic hypothermia (TH), predicts injury on early MRI and holds promise as physiologic biomarker. To determine whether MT in neonates treated with TH for moderate-severe HIE is associated with long-term outcome at 18-22 months, we performed a secondary analysis of the Optimizing Cooling trial using MT data from 167 infants treated at a core temperature of 33.5°C. Median MTs from four time-epochs (0-6 h, 6-24 h, 24-48 h, and 48-72 h of TH) were used to predict death or moderate-severe neurodevelopmental impairment (NDI), using epoch-specific derived and validated MT cutoffs. Median MT of infants who died or survived with NDI was consistently 1.5-3.0°C higher throughout TH. Infants requiring a median MT above the derived cut-offs had a significantly increased odds of death or NDI, most notably at 0-6 h (aOR 17.0, 95%CI 4.3-67.4). By contrast, infants who remained below cut-offs across all epochs had 100% NDI-free survival. MTs in neonates with moderate-severe HIE during TH are highly predictive of long-term outcome and can be used as physiologic biomarker.
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Affiliation(s)
- Ulrike Mietzsch
- Division of Neonatology, Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - John J Flibotte
- Division of Neonatology, Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Janessa B Law
- Division of Neonatology, Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Mihai Puia-Dumitrescu
- Division of Neonatology, Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Sandra E Juul
- Division of Neonatology, Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Thomas R Wood
- Division of Neonatology, Department of Pediatrics, University of Washington, Seattle, Washington, USA
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Mietzsch U, Radhakrishnan R, Boyle FA, Juul S, Wood TR. Active cooling temperature required to achieve therapeutic hypothermia correlates with short-term outcome in neonatal hypoxic-ischaemic encephalopathy. J Physiol 2020; 598:415-424. [PMID: 31777079 DOI: 10.1113/jp278790] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Accepted: 11/26/2019] [Indexed: 11/08/2022] Open
Abstract
KEY POINTS Hypoxic-ischaemic encephalopathy (HIE) affects 2-4/1000 live term births. Treatment with therapeutic hypothermia (TH) improves the long-term neurodevelopmental outcome of neonates with moderate to severe HIE. However, early prediction of outcome still remains challenging, and no reliable and easily obtainable biomarker has been identified to date. Neonates with HIE display impaired thermoregulation, resulting in spontaneous hypothermia. The degree of cooling required to achieve TH may therefore act as a biomarker of injury severity. The present study demonstrates a correlation between servo-controlled mattress temperature during TH and short-term outcome. Neonates with an unfavourable outcome require less cooling to maintain a core temperature between 33 and 34°C during TH compared to neonates with a favourable outcome. The degree of impaired temperature regulation was strongly associated with a high magnetic resonance imaging injury score and death. Cooling device output temperature is a potential and easily obtainable early physiological biomarker of outcome in infants with HIE undergoing TH. ABSTRACT Neonatal hypoxic-ischaemic encephalopathy (HIE) is a leading cause of death and disability in children. Therapeutic hypothermia (TH) at 33.5°C for 72 h is the only therapy to date shown to improve outcome in moderate to severe HIE; however, assessment of severity and prediction of outcome remains challenging. Infants with HIE display significant physiological perturbations, including spontaneous hypothermia. We hypothesized that neonates with more severe brain injury on magnetic resonance imaging (MRI) would exhibit a greater degree of spontaneous hypothermia, and thus require less active cooling to attain TH. Twenty-eight neonates with moderate or severe HIE treated with TH were included in the present study. MRI images obtained on day of life 4-7 were scored according to standardized injury criteria. Unfavourable outcome was defined as death or significant grey matter injury on MRI according to a previously validated scoring system. A significantly higher cooling device output temperature was seen in infants with an unfavourable outcome. All neonates who required the mattress to provide a temperature ≥32°C to maintain their core body temperature at 33.5°C had a high likelihood of unfavourable outcome (likelihood ratio = 14.4). By contrast, infants who never required a device output temperature ≥32°C had a low likelihood of an unfavourable outcome (likelihood ratio = 0.07, P < 0.001). Infants with significant grey matter injury on MRI require less active cooling to maintain target temperature during TH. The cooling device output temperature has the potential to be an easily accessible physiological biomarker and predictor of injury and mortality in neonates with moderate or severe HIE.
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Affiliation(s)
- Ulrike Mietzsch
- Department of Pediatrics, Division of Neonatology, Indiana University School of Medicine, Indianapolis, IN, USA.,Department of Pediatrics, Division of Neonatology, University of Washington Medical School, Seattle, WA, USA
| | - Rupa Radhakrishnan
- Department of Radiology, Division of Neuroradiology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Frances A Boyle
- Department of Pediatrics, Division of Neonatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Sandra Juul
- Department of Pediatrics, Division of Neonatology, University of Washington Medical School, Seattle, WA, USA
| | - Thomas R Wood
- Department of Pediatrics, Division of Neonatology, University of Washington Medical School, Seattle, WA, USA
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Trivedi SB, Vesoulis ZA, Rao R, Liao SM, Shimony JS, McKinstry RC, Mathur AM. A validated clinical MRI injury scoring system in neonatal hypoxic-ischemic encephalopathy. Pediatr Radiol 2017; 47. [PMID: 28623417 PMCID: PMC6219383 DOI: 10.1007/s00247-017-3893-y] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Deep nuclear gray matter injury in neonatal hypoxic-ischemic encephalopathy (HIE) is associated with worse neurodevelopmental outcomes. We previously published a qualitative MRI injury scoring system utilizing serial T1-weighted, T2-weighted and diffusion-weighted imaging (DWI), weighted for deep nuclear gray matter injury. OBJECTIVES To establish the validity of the MRI scoring system with neurodevelopmental outcome at 18-24 months. MATERIALS AND METHODS MRI scans from neonates with moderate to severe HIE treated with therapeutic hypothermia were evaluated. Signal abnormality was scored on T1-weighted, T2-weighted and DWI sequences and assessed using an established system in five regions: (a) subcortical: caudate nucleus, globus pallidus and putamen, thalamus and the posterior limb of the internal capsule; (b) white matter; (c) cortex, (d) cerebellum and (e) brainstem. MRI injury was graded as none, mild, moderate or severe. Inter-rater reliability was tested on a subset of scans by two independent and blinded neuroradiologists. Surviving infants underwent the Bayley Scales of Infant and Toddler Development-III (Bayley-III) at 18-24 months. Data were analyzed using univariate and multivariate linear and logistic regression. RESULTS Fifty-seven eligible neonates underwent at least one MRI scan in the first 2 weeks of life. Mean postnatal age at scan 1 was 4±2 days in 50/57 (88%) neonates and 48/54 (89%) surviving infants underwent scan 2 at 10±2 days. In 54/57 (95%) survivors, higher MRI injury grades were significantly associated with worse outcomes in the cognitive, motor and language domains of the Bayley-III. CONCLUSION A qualitative MRI injury scoring system weighted for deep nuclear gray matter injury is a significant predictor of neurodevelopmental outcome at 18-24 months in neonates with HIE.
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Affiliation(s)
- Shamik B. Trivedi
- Division of Newborn Medicine,Edward Mallinckrodt Department of Pediatrics, Washington University School of Medicine, One Children’s Place, Campus Box 8116,St. Louis, MO 63110, USA
| | - Zachary A. Vesoulis
- Division of Newborn Medicine,Edward Mallinckrodt Department of Pediatrics, Washington University School of Medicine, One Children’s Place, Campus Box 8116,St. Louis, MO 63110, USA
| | - Rakesh Rao
- Division of Newborn Medicine,Edward Mallinckrodt Department of Pediatrics, Washington University School of Medicine, One Children’s Place, Campus Box 8116,St. Louis, MO 63110, USA
| | - Steve M. Liao
- Division of Newborn Medicine,Edward Mallinckrodt Department of Pediatrics, Washington University School of Medicine, One Children’s Place, Campus Box 8116,St. Louis, MO 63110, USA
| | - Joshua S. Shimony
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Robert C. McKinstry
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Amit M. Mathur
- Division of Newborn Medicine,Edward Mallinckrodt Department of Pediatrics, Washington University School of Medicine, One Children’s Place, Campus Box 8116,St. Louis, MO 63110, USA
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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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Tian K, Wang L, Ma J, Wang K, Li D, Du J, Jia G, Wu Z, Zhang J. MR Imaging Grading System for Skull Base Chordoma. AJNR Am J Neuroradiol 2017; 38:1206-1211. [PMID: 28428207 DOI: 10.3174/ajnr.a5152] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 01/22/2017] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND PURPOSE Skull base chordoma has been widely studied in recent years, however, imaging characteristics of this tumor have not been well elaborated. The purpose of this study was to establish an MR imaging grading system for skull base chordoma. MATERIALS AND METHODS In this study, 156 patients with skull base chordomas were retrospectively assessed. Tumor-to-pons signal intensity ratios were calculated from pretreatment MR images RT1 (ratio of tumor to pons signal intensity in T1 FLAIR sequence), RT2 (ratio of tumor to pons signal intensity in T2 sequence) and REN (ratio of tumor to pons signal intensity in enhanced T1 FLAIR sequence), and significant ratios for overall survival and progression-free survival were selected to establish a grading system. Clinical variables among different MR imaging grades were then analyzed to evaluate the usefulness of the grading system. RESULTS RT2 (P < .001) and REN (P = .04) were identified as significant variables affecting progression-free survival. After analysis, the classification criteria were set as follows: MR grade I, RT2 > 2.49 and REN ≤ 0.77; MR grade II, RT2 > 2.49 and REN > 0.77, or RT2 ≤ 2.49 and REN ≤ 0.77; and MR grade III, RT2 ≤ 2.49 and REN > 0.77. MR grade III tumors had a more abundant tumor blood supply than MR grade I tumors (P < .001), and the intraoperative blood loss of MR grade III tumors was higher than that of MR grade I tumors (P = .002). Additionally, skull base chordoma progression risk increased by 2.071 times for every single MR grade increase (P < .001). CONCLUSIONS A higher RT2 value was a negative indicator of tumor progression, whereas a higher REN value was a positive risk factor of tumor progression. MR grade III tumors showed a more abundant blood supply than MR grade I tumors, and the risk of skull base chordoma progression increased with every single MR grade increase.
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Affiliation(s)
- K Tian
- From the Department of Neurosurgery (K.T., L.W., J.M., K.W., D.L., G.J., Z.W., J.Z.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases (K.T., L.W., J.M., K.W., D.L., G.J., Z.W., J.Z.), Beijing, China.,Center of Brain Tumor (K.T., L.W., J.M., K.W., D.L., G.J., Z.W., J.Z.), Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Brian Tumor (K.T., L.W., J.M., K.W., D.L., G.J., Z.W., J.Z.), Beijing, China
| | - L Wang
- From the Department of Neurosurgery (K.T., L.W., J.M., K.W., D.L., G.J., Z.W., J.Z.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China .,China National Clinical Research Center for Neurological Diseases (K.T., L.W., J.M., K.W., D.L., G.J., Z.W., J.Z.), Beijing, China.,Center of Brain Tumor (K.T., L.W., J.M., K.W., D.L., G.J., Z.W., J.Z.), Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Brian Tumor (K.T., L.W., J.M., K.W., D.L., G.J., Z.W., J.Z.), Beijing, China
| | - J Ma
- From the Department of Neurosurgery (K.T., L.W., J.M., K.W., D.L., G.J., Z.W., J.Z.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases (K.T., L.W., J.M., K.W., D.L., G.J., Z.W., J.Z.), Beijing, China.,Center of Brain Tumor (K.T., L.W., J.M., K.W., D.L., G.J., Z.W., J.Z.), Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Brian Tumor (K.T., L.W., J.M., K.W., D.L., G.J., Z.W., J.Z.), Beijing, China
| | - K Wang
- From the Department of Neurosurgery (K.T., L.W., J.M., K.W., D.L., G.J., Z.W., J.Z.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases (K.T., L.W., J.M., K.W., D.L., G.J., Z.W., J.Z.), Beijing, China.,Center of Brain Tumor (K.T., L.W., J.M., K.W., D.L., G.J., Z.W., J.Z.), Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Brian Tumor (K.T., L.W., J.M., K.W., D.L., G.J., Z.W., J.Z.), Beijing, China
| | - D Li
- From the Department of Neurosurgery (K.T., L.W., J.M., K.W., D.L., G.J., Z.W., J.Z.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases (K.T., L.W., J.M., K.W., D.L., G.J., Z.W., J.Z.), Beijing, China.,Center of Brain Tumor (K.T., L.W., J.M., K.W., D.L., G.J., Z.W., J.Z.), Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Brian Tumor (K.T., L.W., J.M., K.W., D.L., G.J., Z.W., J.Z.), Beijing, China
| | - J Du
- Department of Neuropathology (J.D), Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases (J.D.), Center of Brain Tumor, Beijing, China.,Institute for Brain Disorders (J.D.), Beijing Key Laboratory of Brain Tumor, Beijing, China
| | - G Jia
- From the Department of Neurosurgery (K.T., L.W., J.M., K.W., D.L., G.J., Z.W., J.Z.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases (K.T., L.W., J.M., K.W., D.L., G.J., Z.W., J.Z.), Beijing, China.,Center of Brain Tumor (K.T., L.W., J.M., K.W., D.L., G.J., Z.W., J.Z.), Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Brian Tumor (K.T., L.W., J.M., K.W., D.L., G.J., Z.W., J.Z.), Beijing, China
| | - Z Wu
- From the Department of Neurosurgery (K.T., L.W., J.M., K.W., D.L., G.J., Z.W., J.Z.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases (K.T., L.W., J.M., K.W., D.L., G.J., Z.W., J.Z.), Beijing, China.,Center of Brain Tumor (K.T., L.W., J.M., K.W., D.L., G.J., Z.W., J.Z.), Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Brian Tumor (K.T., L.W., J.M., K.W., D.L., G.J., Z.W., J.Z.), Beijing, China
| | - J Zhang
- From the Department of Neurosurgery (K.T., L.W., J.M., K.W., D.L., G.J., Z.W., J.Z.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China .,China National Clinical Research Center for Neurological Diseases (K.T., L.W., J.M., K.W., D.L., G.J., Z.W., J.Z.), Beijing, China.,Center of Brain Tumor (K.T., L.W., J.M., K.W., D.L., G.J., Z.W., J.Z.), Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Brian Tumor (K.T., L.W., J.M., K.W., D.L., G.J., Z.W., J.Z.), Beijing, China
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Ma JP, Tian KB, Wang L, Wang K, Li D, Yang Y, Du J, Ru XJ, Zhang LW, Wu Z, Zhang JT. Proposal and Validation of a Basic Progression Scoring System for Patients with Skull Base Chordoma. World Neurosurg 2016; 91:409-18. [DOI: 10.1016/j.wneu.2016.04.073] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 04/19/2016] [Accepted: 04/20/2016] [Indexed: 10/21/2022]
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10
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Gaillot K, Maurin L, Bertrand P, Fakhri N, Saliba E, Sirinelli D. Prédiction du devenir neurologique à moyen terme par IRM cérébrale précoce, après encéphalopathie hypoxique-ischémique néonatale traitée par hypothermie contrôlée : apports de la séquence de diffusion et du calcul du coefficient apparent de diffusion (ADC), comparativement aux séquences morphologiques en pondération T1 et T2. MEDECINE INTENSIVE REANIMATION 2015. [DOI: 10.1007/s13546-015-1081-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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11
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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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Magalhães M, Rodrigues FPM, Chopard MRT, Melo VCDA, Melhado A, Oliveira I, Gallacci CB, Pachi PR, Lima TB. Neuroprotective body hypothermia among newborns with hypoxic ischemic encephalopathy: three-year experience in a tertiary university hospital. A retrospective observational study. SAO PAULO MED J 2015; 133:314-9. [PMID: 25351640 PMCID: PMC10876352 DOI: 10.1590/1516-3180.2013.7740026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 09/26/2013] [Accepted: 06/24/2014] [Indexed: 11/21/2022] Open
Abstract
CONTEXT AND OBJECTIVE Neonatal hypoxic-ischemic encephalopathy is associated with high morbidity and mortality. Studies have shown that therapeutic hypothermia decreases neurological sequelae and death. Our aim was therefore to report on a three-year experience of therapeutic hypothermia among asphyxiated newborns. DESIGN AND SETTING Retrospective study, conducted in a university hospital. METHODS Thirty-five patients with perinatal asphyxia undergoing body cooling between May 2009 and November 2012 were evaluated. RESULTS Thirty-nine infants fulfilled the hypothermia protocol criteria. Four newborns were removed from study due to refractory septic shock, non-maintenance of temperature and severe coagulopathy. The median Apgar scores at 1 and 5 minutes were 2 and 5. The main complication was infection, diagnosed in seven mothers (20%) and 14 newborns (40%). Convulsions occurred in 15 infants (43%). Thirty-one patients (88.6%) required mechanical ventilation and 14 of them (45%) were extubated within 24 hours. The duration of mechanical ventilation among the others was 7.7 days. The cooling protocol was started 1.8 hours after birth. All patients showed elevated levels of creatine phosphokinase, creatine phosphokinase- MB and lactate dehydrogenase. There was no severe arrhythmia; one newborn (2.9%) presented controlled coagulopathy. Four patients (11.4%) presented controlled hypotension. Twenty-nine patients (82.9%) underwent cerebral ultrasonography and 10 of them (34.5%) presented white matter hyper-echogenicity. Brain magnetic resonance imaging was performed on 33 infants (94.3%) and 11 of them (33.3%) presented hypoxic-ischemic changes. The hospital stay was 23 days. All newborns were discharged. Two patients (5.8%) needed gastrostomy. CONCLUSION Hypothermia as therapy for asphyxiated newborns was shown to be safe.
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Affiliation(s)
- Mauricio Magalhães
- MD, MSc. Head, Division of Neonatology, Department of Pediatrics, Santa Casa de São Paulo, São Paulo, Brazil.
| | | | - Maria Renata Tollio Chopard
- MD, MSc. Instructor Professor, Division of Neonatology, Department of Pediatrics, Santa Casa de São Paulo, São Paulo, Brazil.
| | | | - Amanda Melhado
- MD. Instructor Professor, Division of Neonatology, Department of Pediatrics, Santa Casa de São Paulo, São Paulo, Brazil.
| | - Inez Oliveira
- MD. Resident, Division of Neonatology, Department of Pediatrics, Santa Casa de São Paulo, São Paulo, Brazil.
| | - Clery Bernardi Gallacci
- MD, PhD. Assistant Professor, Division of Neonatology, Department of Pediatrics, Santa Casa de São Paulo, São Paulo, Brazil.
| | - Paulo Roberto Pachi
- MD, PhD. Assistant Professor, Division of Neonatology, Department of Pediatrics, Santa Casa de São Paulo, São Paulo, Brazil.
| | - Tabajara Barbosa Lima
- MD. Instructor Professor, Division of Neonatology, Department of Pediatrics, Santa Casa de São Paulo, São Paulo, Brazil.
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Abstract
MRI performed in the neonatal period has become a tool widely used by clinicians and researchers to evaluate the developing brain. MRI can provide detailed anatomical resolution, enabling identification of brain injuries due to various perinatal insults. This review will focus on the link between neonatal MRI findings and later neurodevelopmental outcomes in high-risk term infants. In particular, the role of conventional and advanced MR imaging in prognosticating outcomes in neonates with hypoxic-ischemic encephalopathy, ischemic perinatal stroke, need for extracorporeal membrane oxygenation life support, congenital heart disease, and other neonatal neurological conditions will be discussed.
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Affiliation(s)
- An N Massaro
- Department of Pediatrics, The George Washington University School of Medicine, 111 Michigan Ave, NW Washington, DC 20010.
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Massaro AN, Bouyssi-Kobar M, Chang T, Vezina LG, du Plessis AJ, Limperopoulos C. Brain perfusion in encephalopathic newborns after therapeutic hypothermia. AJNR Am J Neuroradiol 2013; 34:1649-55. [PMID: 23493898 DOI: 10.3174/ajnr.a3422] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Cerebral perfusion patterns in neonates with HIE after therapeutic hypothermia have not been well described. The objectives of this study were to compare global and regional perfusion between infants with HIE and neonate controls and to relate measures of cerebral perfusion to brain injury on conventional MR imaging in neonates with HIE. MATERIALS AND METHODS Term encephalopathic neonates meeting criteria for hypothermia between June 2011 and January 2012 were enrolled in this prospective observational study. MR imaging-ASL was performed in the second week of life. Comparisons were made with data from neonate controls who underwent the same imaging protocol. NIRS measures of cerebral oxygenation during and immediately after hypothermia were also evaluated in a subset of patients. Secondary analyses were performed to assess cerebral perfusion and oxygenation differences by pattern of injury on qualitative MR imaging interpretation. RESULTS We enrolled 18 infants with HIE and 18 control infants. Mean global CBF and regional CBF in the basal ganglia, thalamus, and anterior white matter were higher in cases compared with controls. Infants with HIE with injury on MR imaging, however, had lower CBF (significant in the thalamus) compared with those with normal MR imaging. Decreased FTOE by NIRS further differentiated patients with HIE with injury on MR imaging. CONCLUSIONS Disturbed cerebral perfusion is observed in the second week of life in some babies with HIE despite treatment with hypothermia. Infants with HIE with injury on MR imaging have lower regional CBF in the thalamus compared with those without injury, possibly representing pseudonormalization of CBF and low metabolic demand after progression to irreversible brain injury.
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Affiliation(s)
- A N Massaro
- Department of Neonatology, Children's National Medical Center, Washington, DC 20010, USA.
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15
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Findings and patterns on MRI and MR spectroscopy in neonates after therapeutic hypothermia for hypoxic ischemic encephalopathy treatment. South Med J 2013; 106:350-5. [PMID: 23736175 DOI: 10.1097/smj.0b013e3182967d38] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The purpose of this study is to describe the findings and patterns of injury on magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS) after whole-body hypothermia treatment for neonatal hypoxic ischemic encephalopathy. METHODS A retrospective review of consecutive term neonates treated with whole-body hypothermia was performed. Data recorded included demographics and MRI and MRS findings, and day of life (DOL) studies were performed. Injury patterns were classified on MRI as deep, cortical, mixed, or diffuse. The relative apparent diffusion coefficient (rADC) was plotted against DOL scanned and the presence of lactate was recorded. RESULTS MRI was performed in 44 infants, 34 of whom also underwent MRS. MRI was abnormal in 32% of neonates, 29.5% of whom were imaged at DOL 4 to 8. rADC values were lowest in neonates scanned on DOL 4 and 5 and remained low up to DOL 8. The deep brain nuclei were involved in hypoxic ischemic encephalopathy in 93% of neonates with abnormal MRIs and lactate was identified on MRS in 18% of neonates between DOL 4 and 8. CONCLUSIONS MRI performed after therapeutic cooling was abnormal in 29.5% of neonates scanned on DOL 4 to 8. Deep nuclear injury was identified in 93% of neonates. Lactate was present on MRS in 18% of neonates, and rADC values were most reduced on MRI between DOL 4 and 8.
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Bonifacio SL, Saporta A, Glass HC, Lee P, Glidden DV, Ferriero DM, Barkovich AJ, Xu D. Therapeutic hypothermia for neonatal encephalopathy results in improved microstructure and metabolism in the deep gray nuclei. AJNR Am J Neuroradiol 2012; 33:2050-5. [PMID: 22595900 DOI: 10.3174/ajnr.a3117] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Therapeutic hypothermia has reduced morbidity and mortality and is associated with a lower burden of lesions on conventional imaging in NE. However, its effects on brain microstructure and metabolism have not been fully characterized. We hypothesized that therapeutic hypothermia improves measures of brain microstructure and metabolism. MATERIALS AND METHODS Forty-one neonates with moderate/severe NE (29 treated with hypothermia, 12 nontreated) and 12 healthy neonates underwent MR imaging, DTI, and (1)H-MR spectroscopy. MR imaging scans were scored by the predominant pattern of brain injury: normal, watershed, and BG/thalamus. ADC, FA, Lac:NAA, and NAA:Cho values from bilateral BG and thalamus ROIs were averaged. T test and linear regression analysis were used to determine the association between hypothermia and MR imaging quantitative measures. RESULTS Conventional MR imaging findings were normal in 41% of treated neonates; all nontreated neonates had brain injury. Values of MR imaging metrics were closer to normal in treated neonates compared with nontreated neonates: ADC was 63% higher in the BG and 116% higher in the thalamus (both P < .05), and Lac:NAA was 76% lower (P = .04) in the BG. Treated neonates with normal MR imaging findings had normal (1)H-MR spectroscopy metabolites, and ADC was higher by 35% in the thalamus (P = .03) compared with healthy neonates. CONCLUSIONS Therapeutic hypothermia may reduce disturbances of brain metabolism and preserve its microstructure in the setting of NE, possibly by minimizing cytotoxic edema and cell death. Long-term follow-up studies are required to determine whether early post-treatment DTI and (1)H-MR spectroscopy will be useful biomarkers of treatment response.
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Affiliation(s)
- S L Bonifacio
- Department of Pediatrics, Division of Neonatology, UCSF School of Medicine, 533 Parnassus Ave, Room U-585, Box 0748, San Francisco, CA 94143-0748, USA.
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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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Corbo ET, Bartnik-Olson BL, Machado S, Merritt TA, Peverini R, Wycliffe N, Ashwal S. The effect of whole-body cooling on brain metabolism following perinatal hypoxic-ischemic injury. Pediatr Res 2012; 71:85-92. [PMID: 22289855 DOI: 10.1038/pr.2011.8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Magnetic resonance imaging (MRI) and spectroscopy (MRS) have proven valuable in evaluating neonatal hypoxic-ischemic injury (HII). RESULTS MRI scores in the basal ganglia of HII/HT(+) neonates were significantly lower than HII/HT(-) neonates, indicating less severe injury and were associated with lower discharge encephalopathy severity scores in the HII/HT(+) group (P = 0.01). Lactate (Lac) was detected in the occipital gray matter (OGM) and thalamus (TH) of significantly more HII/HT(-) neonates (31.6 and 35.3%) as compared to the HII/HT(+) group (10.5 and 15.8%). In contrast, the -N-acetylaspartate (NAA)-based ratios in the OGM and TH did not differ between the HII groups. DISCUSSION Our data show that the HT was associated with a decrease in the number of HII neonates with detectable cortical and subcortical Lac as well as a decrease in the number of MRI-detectable subcortical lesions. METHODS We retrospectively compared the medical and neuroimaging data of 19 HII neonates who received 72 h of whole-body cooling (HII/HT(+)) with those of 19 noncooled HII neonates (HII/HT(-)) to determine whether hypothermia was associated with improved recovery from the injury as measured by MRI and MRS within the first 14 days of life. MRI scores and metabolite ratios of HII/HT(+) and HII/HT(-) neonates were also compared with nine healthy, nonasphyxiated "control" neonates.
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Affiliation(s)
- Elizabeth T Corbo
- Department of Pediatric Neurology, Loma Linda University Medical Center, Loma Linda, California, USA
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