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Alkhulaifat D, Venkatakrishna SSB, Alves CAPF, Lerebo W, Tierradentro-Garcia LO, Elsingergy M, Worede F, Curic J, Andronikou S. Distinguishing multicystic from focal encephalomalacia on delayed MRI in children with term hypoxic ischemic injury. J Neuroimaging 2024; 34:386-392. [PMID: 38217068 DOI: 10.1111/jon.13190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 12/22/2023] [Accepted: 01/02/2024] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND AND PURPOSE To define cystic patterns resulting from term hypoxic ischemic injury (HII) on delayed Magnetic Resonance Imaging (MRI) and determine associated HII patterns and lesions that reflect the severity of injury, from a database of African children with cerebral palsy. METHODS Retrospective review of 1175 children with cerebral palsy due to term HII diagnosed on late MRI, identifying those with cystic changes. These were classified as multicystic or (multi-) focal-cystic, and were evaluated for associated injuries-thalami, basal ganglia, hippocampi, cerebellum, and presence of ulegyria. RESULTS Three hundred and eighty-eight of 1175 (33%) children had cystic encephalomalacia. Two hundred and seven of 388 (53.3%) had focal-cystic and 181/388 (46.6%) had multicystic injury. The focal-cystic group comprised 87.9% (182/207) with thalamic injury, 25.6% (53/207) with basal ganglia injury, and 15% (31/207) with cerebellar involvement. Basal-ganglia-thalamus (BGT) pattern was present in 43.9% (91/207) and ulegyria in 69.6% (144/207). In the multicystic group, 88.9% (161/181) had thalamic injury, 30.9% (56/181) had basal ganglia injury, and 21% (38/181) had cerebellar involvement. BGT pattern was observed in 29.8% (54/181) and ulegyria in 28.7%. (52/181). Significant associations (p<.05) were found between multicystic injury and caudate/globus pallidus involvement, and between focal-cystic pattern of injury and ulegyria. CONCLUSIONS Cystic encephalomalacia was seen in almost one-third of patients with term HII imaged with delayed MRI, with a similar prevalence of focal-cystic and multicystic injury. Multicystic injury was associated with caudate and globus pallidi involvement, typical of the BGT pattern of HII, whereas the focal-cystic pattern was associated with ulegyria, typical of watershed injury.
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Affiliation(s)
- Dana Alkhulaifat
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | | | - Wondwossen Lerebo
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | - Mohamed Elsingergy
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Fikadu Worede
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jelena Curic
- Graduate MBA Program, Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Cambridge, UK
| | - Savvas Andronikou
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Kim MJ, Hong E, Yum MS, Lee YJ, Kim J, Ko TS. Deep learning-based, fully automated, pediatric brain segmentation. Sci Rep 2024; 14:4344. [PMID: 38383725 PMCID: PMC10881508 DOI: 10.1038/s41598-024-54663-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 02/15/2024] [Indexed: 02/23/2024] Open
Abstract
The purpose of this study was to demonstrate the performance of a fully automated, deep learning-based brain segmentation (DLS) method in healthy controls and in patients with neurodevelopmental disorders, SCN1A mutation, under eleven. The whole, cortical, and subcortical volumes of previously enrolled 21 participants, under 11 years of age, with a SCN1A mutation, and 42 healthy controls, were obtained using a DLS method, and compared to volumes measured by Freesurfer with manual correction. Additionally, the volumes which were calculated with the DLS method between the patients and the control group. The volumes of total brain gray and white matter using DLS method were consistent with that volume which were measured by Freesurfer with manual correction in healthy controls. Among 68 cortical parcellated volume analysis, the volumes of only 7 areas measured by DLS methods were significantly different from that measured by Freesurfer with manual correction, and the differences decreased with increasing age in the subgroup analysis. The subcortical volume measured by the DLS method was relatively smaller than that of the Freesurfer volume analysis. Further, the DLS method could perfectly detect the reduced volume identified by the Freesurfer software and manual correction in patients with SCN1A mutations, compared with healthy controls. In a pediatric population, this new, fully automated DLS method is compatible with the classic, volumetric analysis with Freesurfer software and manual correction, and it can also well detect brain morphological changes in children with a neurodevelopmental disorder.
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Affiliation(s)
- Min-Jee Kim
- Department of Pediatrics, Asan Medical Center Children's Hospital, Ulsan University College of Medicine, 88, Olympic-ro 43-Gil, Songpa-Gu, Seoul, 05505, South Korea
| | | | - Mi-Sun Yum
- Department of Pediatrics, Asan Medical Center Children's Hospital, Ulsan University College of Medicine, 88, Olympic-ro 43-Gil, Songpa-Gu, Seoul, 05505, South Korea.
| | - Yun-Jeong Lee
- Department of Pediatrics, Kyungpook National University Hospital and School of Medicine, Kyungpook National University, Daegu, South Korea
| | | | - Tae-Sung Ko
- Department of Pediatrics, Asan Medical Center Children's Hospital, Ulsan University College of Medicine, 88, Olympic-ro 43-Gil, Songpa-Gu, Seoul, 05505, South Korea
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3
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Venkatakrishna SSB, Elsingergy M, Worede F, Curic J, Andronikou S. Unequal Cerebral Magnetic Resonance Imaging Changes in Perinatal Hypoxic Ischemic Injury of Term Neonates. J Comput Assist Tomogr 2023; 47:913-918. [PMID: 37948366 DOI: 10.1097/rct.0000000000001486] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
BACKGROUND Perinatal hypoxic ischemic injury (HII) has a higher prevalence in the developing world. One of the primary concepts for suggesting that an imaging pattern reflects a global insult to the brain is when the injury is noted to be bilateral and symmetric in distribution. In the context of HII in term neonates, this is either bilateral symmetric ( a ) peripheral/watershed (WS) injury or ( b ) bilateral symmetric basal-ganglia-thalamus (BGT) pattern, often with the peri-Rolandic and hippocampal injury. Unilateral, asymmetric, or unequal distribution of injury may therefore be misdiagnosed as perinatal arterial ischemic stroke. OBJECTIVES We aimed to determine the prevalence of unequal cerebral injury in HII, identify patterns, and determine their relationship with existing classification of HII. MATERIALS AND METHODS Review of brain magnetic resonance imaging from a database of children with HII. Reports with any unequal pattern of injury were included and further classified as a unilateral, bilateral asymmetric, or symmetric but unequal degree pattern of HII. RESULTS A total of 1213 MRI scans in patients with a diagnosis of HII revealed 156 (13%) with unequal involvement of the hemispheres: unilateral in 2 of 1213 (0.2%) (involvement only in the WS), asymmetric in 48 of 1213 (4%) (WS in 6 [0.5%], BGT in 4 [0.3%], and combined BGT and WS in 38 [3.1%]), and bilateral symmetric but unequal degree in 106 of 1213 (8.7%) (WS in 20 [1.6%], BGT in 17 [1.4%], and combined BGT and WS in 69 [5.7%]). CONCLUSIONS The majority of children with cerebral palsy due to HII demonstrate a characteristic bilateral symmetric pattern of injury. In our study, 13% demonstrated an unequal pattern. Differentiation from perinatal arterial ischemic stroke, which is mostly unilateral and distributed typically in the middle cerebral artery territory, should be possible and recognition of the typical BGT or WS magnetic resonance imaging patterns should add confidence to the diagnosis, in such scenarios.
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Affiliation(s)
| | - Mohamed Elsingergy
- From the Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Fikadu Worede
- From the Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Jelena Curic
- Graduate MBA Program, Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Cambridge, United Kingdom
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4
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Arulnathan E, Manchanda A, Dixit R, Kumar A. Temporal Evolution of Signal Alterations in the Deep Gray Nuclei in term Neonates With Hypoxic-Ischemic Brain Injury: A Comprehensive Review. J Child Neurol 2023; 38:550-556. [PMID: 37499176 DOI: 10.1177/08830738231188561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
The deep gray nuclei are paired interconnected gray nuclei comprising the basal ganglia and thalami. Injury to the deep gray nuclei secondary to hypoxic-ischemic injury is associated with poor short- and long-term clinical outcomes. The signal changes following hypoxic-ischemic injury are dynamic and evolve over a period of time from injury to resolution. Radiologically relevant events following hypoxic-ischemic injury include the onset of anaerobic metabolism immediately following hypoxic-ischemic injury, increase in cytotoxic edema followed by its resolution, and the onset and progression of neuronal necrosis and gliosis. Appearance of lactate peak on proton spectroscopy is the initial radiologic evidence of hypoxic-ischemic injury. Diffusion-weighted imaging has the highest prognostic value and pseudo-normalizes following 1 week of hypoxic-ischemic injury. Recommended timing for magnetic resonance imaging (MRI) is between 4 and 7 days. MR imaging performed between 1 and 6 months underestimates the extent of injury because radiologic changes are subtle. This review provides a detailed timeline of radiologic abnormalities in the deep gray nuclei following hypoxic-ischemic injury.
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Affiliation(s)
- Ebinesh Arulnathan
- Department of Radiodiagnosis, Maulana Azad Medical College and associated Lok Nayak Hospital, New Delhi, India
| | - Alpana Manchanda
- Department of Radiodiagnosis, Maulana Azad Medical College and associated Lok Nayak Hospital, New Delhi, India
| | - Rashmi Dixit
- Department of Radiodiagnosis, Maulana Azad Medical College and associated Lok Nayak Hospital, New Delhi, India
| | - Ajay Kumar
- Department of Neonatology, Maulana Azad Medical College and associated Lok Nayak Hospital, New Delhi, India
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5
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Kanal HD, Levison SW. Neuroprotective Effects of Delayed TGF-β1 Receptor Antagonist Administration on Perinatal Hypoxic-Ischemic Brain Injury. Dev Neurosci 2023; 46:188-200. [PMID: 37348472 DOI: 10.1159/000531650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 06/19/2023] [Indexed: 06/24/2023] Open
Abstract
Hypoxic-ischemic (HI) brain injury in neonatal encephalopathy triggers a wave of neuroinflammatory events attributed to causing the progressive degeneration and functional deficits seen weeks after the primary damage. The cellular processes mediating this prolonged neurodegeneration in HI injury are not sufficiently understood. Consequently, current therapies are not fully protective. In a recent study, we found significant improvements in neurologic outcomes when a small molecule antagonist for activin-like kinase 5 (ALK5), a transforming growth factor beta (TGF-β) receptor was used as a therapeutic in a rat model of moderate term HI. Here, we have extended those studies to a mouse preterm pup model of HI. For these studies, postnatal day 7 CD1 mice of both sexes were exposed to 35-40 min of HI. Beginning 3 days later, SB505124, the ALK5 receptor antagonist, was administered systemically through intraperitoneal injections performed every 12 h for 5 days. When evaluated 23 days later, SB505124-treated mice had ∼2.5-fold more hippocampal area and ∼2-fold more thalamic tissue. Approximately 90% of the ipsilateral hemisphere (ILH) was preserved in the SB505124-treated HI mice compared to the vehicle-treated HI mice, where the ILH was ∼60% of its normal size. SB505124 also preserved the subcortical white matter. SB505124 treatment preserved levels of aquaporin-4 and n-cadherin, key proteins associated with blood-brain barrier function. Importantly, SB505124 administration improved sensorimotor function as assessed by a battery of behavioral tests. Altogether, these data lend additional support to the conclusion that SB505124 is a candidate neuroprotective molecule that could be an effective treatment for HI-related encephalopathy in moderately injured preterm infants.
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Affiliation(s)
- Hur Dolunay Kanal
- Department of Pharmacology, Physiology and Neuroscience, New Jersey Medical School, Rutgers University, Newark, New Jersey, USA
| | - Steven W Levison
- Department of Pharmacology, Physiology and Neuroscience, New Jersey Medical School, Rutgers University, Newark, New Jersey, USA
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Stern JA, Elsingergy M, Venkatakrishna SSB, Worede F, Curic J, Andronikou S. Frequency of ulegyria on delayed MRI scans in children with term hypoxic-ischemic injury. Pediatr Radiol 2023; 53:104-111. [PMID: 35882664 DOI: 10.1007/s00247-022-05445-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 05/31/2022] [Accepted: 06/30/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND Ulegyria is an under-recognized and underreported potential sequela of hypoxic-ischemic injury (HII) in full-term neonates. Ulegyria is a unique form of parenchymal scarring that leads to a mushroom-shape of the affected gyri resulting from volume loss at the deep portions of the sulci during HII in this specific period in infantile neurodevelopment. Identifying ulegyria is important for ascribing cause and timing of HII on delayed magnetic resonance imaging (MRI) scans and because of its close association with pharmaco-resistant epilepsy. OBJECTIVE The purpose of this study was to determine the frequency of ulegyria and characterize the anatomical distribution of watershed injury in a large database of patients who developed cerebral palsy with term HII pattern and underwent delayed MRI. MATERIALS AND METHODS Patients with term HII patterns on MRI were analyzed for ulegyria. The frequency of ulegyria overall and for each pattern of HII distribution was determined as was the anatomical distribution of watershed injury. RESULTS Of the 731 children with term HII and cortical injury, 484 (66%) had ulegyria. Ulegyria was most common in those cases with a combined watershed/basal ganglia-thalamic pattern (56%) and isolated watershed pattern (40%). Watershed injury in patients with ulegyria was most common at the posterior watershed (80.6%) and perisylvian watershed (76.7%). CONCLUSION Ulegyria was present in nearly two-thirds of patients with term HII and cortical injury and should be sought to support the diagnosis of previous perinatal HII, especially in posterior and perisylvian watershed regions. The implications of ulegyria can be significant for clinical decision-making and for ascribing timing of injury to the perinatal period.
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Affiliation(s)
- Joseph A Stern
- Department of Pediatric Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.
| | - Mohamed Elsingergy
- Department of Pediatric Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Shyam Sunder B Venkatakrishna
- Department of Pediatric Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Fikadu Worede
- Department of Pediatric Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Jelena Curic
- Graduate MBA Program, Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Cambridge, UK
| | - Savvas Andronikou
- Department of Pediatric Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.,Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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7
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Abstract
According to the World Health Organization (WHO), 15 million babies are born preterm each year. Preterm infants are those born at less than 37 weeks, while extremely and very preterm neonates include those born at 22 to less than 32 weeks gestational age. Infants that fail to make it to term are missing a key part in neurodevelopment, as weeks 24 to 40 are a critical period of brain development. Neonatal brain injury is a crucial predictor for mortality and morbidity in premature and low birth weight (<1500 g) infants. Although the complications associated with preterm birth continue to be the number one cause of death in children under 5, the survival rates are increasing (Volpe, 2019). Despite this, the incidence of comorbidities, such as learning disabilities and visual and hearing problems, is still high. The functional deficits seen in these infants can be contributed to the white matter abnormalities (WMA) that have been found in 50% to 80% of extremely and very preterm neonates. While numerous, the etiology of the neonatal brain injury is essential for determining the mortality and morbidities of the infant, as there is an increased risk for both intraventricular hemorrhage (IVH) and periventricular leukomalacia (PVL), which can be attributed to their lack of cerebrovascular autoregulation and hypoxic events. Neuroimaging plays a key role in detecting and assessing these neurologic injuries that preterm infants are at risk for. It is essential to diagnose these events early on to assess neurologic damage, minimize disease progression, and provide supportive care. Brain MRI and cranial ultrasound (CUS) are both extensively used neuroimaging techniques to assess WMA, and it has become ever more important to determine the best imaging techniques and modalities with the increasing survival rates and high incidence of comorbidities among these infants.
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Affiliation(s)
- Abigail Locke
- Radiology Research, Division of Neuroradiology, Penn State Health, Penn State College of Medicine, Mail Code H066 500 University Drive, Hershey, PA 17033, USA
| | - Sangam Kanekar
- Radiology Research, Division of Neuroradiology, Penn State Health, Penn State College of Medicine, Mail Code H066 500 University Drive, Hershey, PA 17033, USA.
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8
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Deep nuclei injury distribution in isolated “basal ganglia–thalamus” (BGT) versus combined “BGT and watershed” patterns of hypoxic–ischaemic injury (HII) in children with cerebral palsy. Clin Radiol 2022; 77:825-832. [DOI: 10.1016/j.crad.2022.04.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 04/27/2022] [Indexed: 11/22/2022]
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9
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Lai LM, Gropman AL, Whitehead MT. MR Neuroimaging in Pediatric Inborn Errors of Metabolism. Diagnostics (Basel) 2022; 12:diagnostics12040861. [PMID: 35453911 PMCID: PMC9027484 DOI: 10.3390/diagnostics12040861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 03/24/2022] [Accepted: 03/25/2022] [Indexed: 02/04/2023] Open
Abstract
Inborn errors of metabolism (IEM) are a group of disorders due to functional defects in one or more metabolic pathways that can cause considerable morbidity and death if not diagnosed early. While individually rare, the estimated global prevalence of IEMs comprises a substantial number of neonatal and infantile disorders affecting the central nervous system. Clinical manifestations of IEMs may be nonspecific. Newborn metabolic screens do not capture all IEMs, and likewise, genetic testing may not always detect pathogenic variants. Neuroimaging is a critical component of the work-up, given that imaging sometimes occurs before prenatal screen results are available, which may allow for recognition of imaging patterns that lead to early diagnosis and treatment of IEMs. This review will demonstrate the role of magnetic resonance imaging (MRI) and proton magnetic resonance spectroscopy (1H MRS) in the evaluation of IEMs. The focus will be on scenarios where MRI and 1H MRS are suggestive of or diagnostic for IEMs, or alternatively, refute the diagnosis.
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Affiliation(s)
- Lillian M. Lai
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA;
- Department of Radiology, Children’s Hospital Los Angeles, Los Angeles, CA 90027, USA
| | - Andrea L. Gropman
- Department of Neurology, Children’s National, Washington, DC 20010, USA;
| | - Matthew T. Whitehead
- Department of Radiology, Children’s National, Washington, DC 20010, USA
- Correspondence: ; Tel.: +1-202-476-5000
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10
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Parmentier CEJ, de Vries LS, Groenendaal F. Magnetic Resonance Imaging in (Near-)Term Infants with Hypoxic-Ischemic Encephalopathy. Diagnostics (Basel) 2022; 12:diagnostics12030645. [PMID: 35328199 PMCID: PMC8947468 DOI: 10.3390/diagnostics12030645] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/03/2022] [Accepted: 03/04/2022] [Indexed: 01/14/2023] Open
Abstract
Hypoxic-ischemic encephalopathy (HIE) is a major cause of neurological sequelae in (near-)term newborns. Despite the use of therapeutic hypothermia, a significant number of newborns still experience impaired neurodevelopment. Neuroimaging is the standard of care in infants with HIE to determine the timing and nature of the injury, guide further treatment decisions, and predict neurodevelopmental outcomes. Cranial ultrasonography is a helpful noninvasive tool to assess the brain before initiation of hypothermia to look for abnormalities suggestive of HIE mimics or antenatal onset of injury. Magnetic resonance imaging (MRI) which includes diffusion-weighted imaging has, however, become the gold standard to assess brain injury in infants with HIE, and has an excellent prognostic utility. Magnetic resonance spectroscopy provides complementary metabolic information and has also been shown to be a reliable prognostic biomarker. Advanced imaging modalities, including diffusion tensor imaging and arterial spin labeling, are increasingly being used to gain further information about the etiology and prognosis of brain injury. Over the past decades, tremendous progress has been made in the field of neonatal neuroimaging. In this review, the main brain injury patterns of infants with HIE, the application of conventional and advanced MRI techniques in these newborns, and HIE mimics, will be described.
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Affiliation(s)
- Corline E. J. Parmentier
- Department of Neonatology, University Medical Center Utrecht, 3584 EA Utrecht, The Netherlands; (C.E.J.P.); (L.S.d.V.)
| | - Linda S. de Vries
- Department of Neonatology, University Medical Center Utrecht, 3584 EA Utrecht, The Netherlands; (C.E.J.P.); (L.S.d.V.)
- Department of Neonatology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Floris Groenendaal
- Department of Neonatology, University Medical Center Utrecht, 3584 EA Utrecht, The Netherlands; (C.E.J.P.); (L.S.d.V.)
- Correspondence:
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11
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Love SA, Haslin E, Bellardie M, Andersson F, Barantin L, Filipiak I, Adriaensen H, Fazekas CL, Leroy L, Zelena D, Morisse M, Elleboudt F, Moussu C, Lévy F, Nowak R, Chaillou E. Maternal deprivation and milk replacement affect the integrity of gray and white matter in the developing lamb brain. Dev Neurobiol 2022; 82:214-232. [DOI: 10.1002/dneu.22869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 01/17/2022] [Accepted: 01/27/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Scott A. Love
- CNRS, IFCE, INRAE Université de Tours PRC Nouzilly France
| | | | | | | | | | | | | | - Csilla L. Fazekas
- Institute of Experimental Medicine Budapest Hungary
- János Szentágothai Doctoral School of Neurosciences Semmelweis University Budapest Hungary
| | - Laurène Leroy
- CNRS, IFCE, INRAE Université de Tours PRC Nouzilly France
| | - Dóra Zelena
- Institute of Experimental Medicine Budapest Hungary
- Centre for Neuroscience, Szentágothai Research Centre Institute of Physiology Medical School University of Pécs Pécs Hungary
| | - Mélody Morisse
- CNRS, IFCE, INRAE Université de Tours PRC Nouzilly France
| | | | | | - Frédéric Lévy
- CNRS, IFCE, INRAE Université de Tours PRC Nouzilly France
| | - Raymond Nowak
- CNRS, IFCE, INRAE Université de Tours PRC Nouzilly France
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12
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Varghese B, Xavier R, Manoj VC, Aneesh MK, Priya PS, Kumar A, Sreenivasan VK. Magnetic resonance imaging spectrum of perinatal hypoxic-ischemic brain injury. Indian J Radiol Imaging 2021; 26:316-327. [PMID: 27857456 PMCID: PMC5036328 DOI: 10.4103/0971-3026.190421] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Perinatal hypoxic–ischemic brain injury results in neonatal hypoxic–ischemic encephalopathy and serious long-term neurodevelopmental sequelae. Magnetic resonance imaging (MRI) of the brain is an ideal and safe imaging modality for suspected hypoxic–ischemic injury. The pattern of injury depends on brain maturity at the time of insult, severity of hypotension, and duration of insult. Time of imaging after the insult influences the imaging findings. Mild to moderate hypoperfusion results in germinal matrix hemorrhages and periventricular leukomalacia in preterm neonates and parasagittal watershed territory infarcts in full-term neonates. Severe insult preferentially damages the deep gray matter in both term and preterm infants. However, associated frequent perirolandic injury is seen in term neonates. MRI is useful in establishing the clinical diagnosis, assessing the severity of injury, and thereby prognosticating the outcome. Familiarity with imaging spectrum and insight into factors affecting the injury will enlighten the radiologist to provide an appropriate diagnosis.
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Affiliation(s)
- Binoj Varghese
- Department of Radiology, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India
| | - Rose Xavier
- Department of Paediatrics, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India
| | - V C Manoj
- Department of Paediatrics, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India
| | - M K Aneesh
- Department of Radiology, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India
| | - P S Priya
- Department of Radiology, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India
| | - Ashok Kumar
- Department of Radiology, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India
| | - V K Sreenivasan
- Department of Paediatrics, Amala Institute of Medical Sciences, Thrissur, Kerala, India
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13
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Alheit B. Letter to the editor: Addressing radiological terminology of basal ganglia and thalamic injury in hypoxic ischaemic injury. SA J Radiol 2021; 25:2146. [PMID: 34192074 PMCID: PMC8182450 DOI: 10.4102/sajr.v25i1.2146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 04/18/2021] [Indexed: 11/25/2022] Open
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14
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Bisinotto HS, Jarry VM, Reis F. Clinical and radiological aspects of bilateral temporal abnormalities: pictorial essay. Radiol Bras 2021; 54:115-122. [PMID: 33854266 PMCID: PMC8029941 DOI: 10.1590/0100-3984.2019.0134] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
The temporal lobes are vulnerable to several diseases, including infectious, immune-mediated, degenerative, vascular, metabolic, and neoplastic processes. Therefore, lesions in the temporal lobes can pose a diagnostic challenge for the radiologist. The temporal lobes are connected by structures such as the anterior commissure, corpus callosum, and hippocampal commissure. That interconnectedness favors bilateral involvement in various clinical contexts. This pictorial essay is based on a retrospective analysis of case files from a tertiary university hospital and aims to illustrate some of the conditions that simultaneously affect the temporal lobes, as well as to define some neuroimaging elements that may be useful for the differential diagnosis of these diseases. Using computed tomography and magnetic resonance imaging scans, we illustrate the neuroradiological findings in confirmed cases of human herpesvirus 1, central nervous system tuberculosis, autoimmune encephalitis, Alzheimer's disease, frontotemporal dementia, mesial temporal sclerosis, stroke, kernicterus, megalencephalic leukoencephalopathy with subcortical cysts, low-grade glioma, and secondary lymphoma, the objective being to emphasize the importance of these imaging methods for making the differential diagnosis.
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Affiliation(s)
| | | | - Fabiano Reis
- Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brazil
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15
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Reliability of MRI in detection and differentiation of acute neonatal/pediatric encephalopathy causes among neonatal/pediatric intensive care unit patients. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-020-00173-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Causes of encephalopathy in neonates/pediatrics include hypoxic-ischemic injury (which is the most frequent cause and is defined as any impairment to the brain caused by insufficient blood flow and oxygenation), trauma, metabolic disorders, and congenital and infectious diseases. The aim of this study is to evaluate the value of MRI in detection and possible differentiation of different non-traumatic, non-infectious causes of acute neonatal/pediatric encephalopathy among NICU/PICU patients.
Results
This retrospective study included 60 selected patients according to the study inclusion and exclusion criteria; all presented with positive MRI findings for non-traumatic, non-infectious acute brain injury. Females (32, 53.3%) were affected more than males (28, 46.7%) with a mean age of 1.1 ± 1.02 years; all presented with variable neurological symptoms and signs that necessitate neonatal intensive care unit/pediatric intensive care unit (NICU/PICU) admission. The final diagnosis of the study group patients were hypoxic ischemia injury (HII) in 39 patients (65%), metachromatic leukodystrophy in 6 patients (10%), biotin-thiamine-responsive basal ganglia disease (BTBGD) and Leigh disease each in 4 patients (6.7%), periventricular leukomalacia (PVL) in 3 patients (5%), and mitochondrial encephalopathy with lactic acidosis and stroke-like episodes syndrome (MELAS) and non-ketotic hyperglycinemia (NKH) each in 2 patients (3.3%).
Conclusion
Much attention should be paid to pediatric non-traumatic brain injuries. MRI is a safe modality and should be the first radiological investigation if neurological causes are suggested but should be aided by meticulous clinical evaluation and dedicated laboratory investigations for better characterization and differentiation of various causes of non-traumatic, non-infective brain encephalopathy among NICU/PICU patients. When interpreting MRI, it is essential to have thorough relevant clinical data, gestational age at birth which is prognostic of the pattern of hypoxic-ischemic injury, and the time lag between the onset of HII and the time of performing the MR study.
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Vitale V, Rossi E, Di Serafino M, Minelli R, Acampora C, Iacobellis F, D'Errico C, Esposito A, Esposito F, Vallone G, Zeccolini M. Pediatric encephalic ultrasonography: the essentials. J Ultrasound 2020; 23:127-137. [PMID: 30552663 PMCID: PMC7242593 DOI: 10.1007/s40477-018-0349-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 12/04/2018] [Indexed: 12/14/2022] Open
Abstract
Nowadays, cranial ultrasonography (US) of the newborn represents the first imaging method in brain damage study and its possible outcomes. This exam is performed using the natural fontanelles, especially the anterior one. It is fast, non-invasive and does not produce any side effect. Ultrasonographic examination is usually performed in cases of prematurity, especially in children with birth weight less than 1500 g, because important informations about the possible presence of pathologies such as cerebral hemorrhage and hypoxic-ischemic encephalopathy are given. This approach can be useful also in the study of pre- and post-natal infections, for example, type II Herpes Simplex virus or Cytomegalovirus infections, or pointing out vascular malformations such as vein of Galen aneurysm. Although less important than methods such as computed tomography (CT) and magnetic resonance imaging (MRI) in the evaluation of trauma and tumors, ultrasound can provide useful informations or be used in first instance in the suspicion of a brain mass.
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Affiliation(s)
- Valerio Vitale
- Department of Diagnostics-Neuroradiology Unit, Ospedale San Bortolo, AULSS 8 Berica, Vicenza, Italy.
| | - Eugenio Rossi
- Radiology Department, "Santobono-Pausilipon" Children Hospital, Naples, Italy
| | | | - Rocco Minelli
- Radiology Department, "Santobono-Pausilipon" Children Hospital, Naples, Italy
| | - Ciro Acampora
- Radiology Department, "Antonio Cardarelli" Hospital, Naples, Italy
| | | | - Chiara D'Errico
- Radiology Department, "Antonio Cardarelli" Hospital, Naples, Italy
| | - Aniello Esposito
- Radiology Department, Legnano Hospital, ASST Ovest Milanese, Legnano, Italy
| | - Francesco Esposito
- Radiology Department, "Santobono-Pausilipon" Children Hospital, Naples, Italy
| | - Gianfranco Vallone
- Paediatric Radiology Department, "Federico II" University Hospital, Naples, Italy
| | - Massimo Zeccolini
- Radiology Department, "Santobono-Pausilipon" Children Hospital, Naples, Italy
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Lin J, Niimi Y, Clausi MG, Kanal HD, Levison SW. Neuroregenerative and protective functions of Leukemia Inhibitory Factor in perinatal hypoxic-ischemic brain injury. Exp Neurol 2020; 330:113324. [PMID: 32320698 DOI: 10.1016/j.expneurol.2020.113324] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 04/13/2020] [Accepted: 04/17/2020] [Indexed: 12/14/2022]
Abstract
Neonatal hypoxic-ischemic encephalopathy remains the most important neurological problem of the newborn. Delays in diagnosing perinatal brain injuries are common, preventing access to acute therapies. Therefore, there is a critical need for therapeutic strategies that are beneficial when delivered beyond 24 h after birth. Here we show that Leukemia Inhibitory Factor (LIF) functions as an essential injury-induced neurotrophic cytokine in the CNS and that non-invasively administering LIF as late as 3 days after a hypoxic-ischemic insult improves neurological function. Using a mouse model of late preterm brain injury we show that astroglial and microglial/macrophage reactivity to hypoxia-ischemia was diminished at 3 days of recovery, but then exacerbated at 2 weeks of recovery in LIF haplodeficient mice. There also were significantly more CD68+/Iba-1+ cells in the ipsilateral striatum in LIF-Het mice compared to WT mice at 2 weeks of recovery. This desynchronized glial response was accompanied by increased neuronal cell death in the striatum and neocortex (Fluorojade C), hypomyelination (reduced MBP staining and thinner external capsule), increased extent of brain damage (Nissl) and diminished neurological function on sensorimotor tests. To our surprise, injured LIF-Het mice had ~7-fold higher IGF-1 levels than injured WT mice at 3 days after HI injury. Intranasally administered LIF activated the Jak-Stat-3 pathway both within the subventricular zone and the neocortex at 30 min after administration. When delivered with a delay of 3 days after the insult, intranasal LIF reduced the extent of brain injury by ~60%, attenuated astrogliosis and microgliosis in striatum, improved subcortical white matter thickness, increased numbers of Olig2+ cells in corpus callosum and improved performance on sensorimotor tests at 2 weeks of recovery. These studies provide key pre-clinical data recommending LIF administration as a neuroprotectant and regenerative cytokine and they highlight the feasibility of pursuing new therapeutics targeting the tertiary phase of neurodegeneration for hypoxic-ischemic encephalopathies.
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Affiliation(s)
- Jie Lin
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China; Department of Pharmacology, Physiology, and Neuroscience, Rutgers New Jersey Medical School, Newark, New Jersey 07103, USA
| | - Yusuke Niimi
- Department of Pharmacology, Physiology, and Neuroscience, Rutgers New Jersey Medical School, Newark, New Jersey 07103, USA
| | - Mariano Guardia Clausi
- Department of Pharmacology, Physiology, and Neuroscience, Rutgers New Jersey Medical School, Newark, New Jersey 07103, USA
| | - Hur Dolunay Kanal
- Department of Pharmacology, Physiology, and Neuroscience, Rutgers New Jersey Medical School, Newark, New Jersey 07103, USA
| | - Steven W Levison
- Department of Pharmacology, Physiology, and Neuroscience, Rutgers New Jersey Medical School, Newark, New Jersey 07103, USA.
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Chacko A, Andronikou S, Mian A, Gonçalves FG, Vedajallam S, Thai NJ. Cortical ischaemic patterns in term partial-prolonged hypoxic-ischaemic injury-the inter-arterial watershed demonstrated through atrophy, ulegyria and signal change on delayed MRI scans in children with cerebral palsy. Insights Imaging 2020; 11:53. [PMID: 32232679 PMCID: PMC7105592 DOI: 10.1186/s13244-020-00857-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 03/05/2020] [Indexed: 12/24/2022] Open
Abstract
The inter-arterial watershed zone in neonates is a geographic area without discernible anatomic boundaries and difficult to demarcate and usually not featured in atlases. Schematics currently used to depict the areas are not based on any prior anatomic mapping, compared to adults.Magnetic resonance imaging (MRI) of neonates in the acute to subacute phase with suspected hypoxic-ischaemic injury (HII) can demonstrate signal abnormality and restricted diffusion in the cortical and subcortical parenchyma of the watershed regions.In the chronic stage of partial-prolonged hypoxic-ischaemic injury, atrophy and ulegyria can make the watershed zone more conspicuous as a region. Our aim is to use images extracted from a sizable medicolegal database (approximately 2000 cases), of delayed MRI scans in children with cerebral palsy, to demonstrate the watershed region.To achieve this, we have selected cases diagnosed on imaging as having sustained a term pattern of partial-prolonged HII affecting the hemispheric cortex, based on the presence of bilateral, symmetric atrophy with ulegyria. From these, we have identified those patients demonstrating injury along the whole watershed continuum as well as those demonstrating selective anterior or posterior watershed predominant injury for demonstration.Recognition of this zone is essential for diagnosing partial-prolonged hypoxic-ischaemic injury sustained in term neonates. The images presented in this pictorial review provide a template for identifying the cortical watershed distribution when there is milder regional (anterior, parasagittal, peri-Sylvian and posterior) watershed injury and for more severe injury where multiple regions are injured in combination or as a continuum.
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Affiliation(s)
- Anith Chacko
- Clinical Research & Imaging Centre, Bristol Medical School, Faculty of Health Sciences, University of Bristol, Bristol, UK.
| | - Savvas Andronikou
- Clinical Research & Imaging Centre, Bristol Medical School, Faculty of Health Sciences, University of Bristol, Bristol, UK
- Department of Radiology, Division of Neuroradiology, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Ali Mian
- Department of Radiology, Division of Neuroradiology, Children's Hospital of Philadelphia, Philadelphia, USA
| | | | - Schadie Vedajallam
- Clinical Research & Imaging Centre, Bristol Medical School, Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - Ngoc Jade Thai
- Clinical Research & Imaging Centre, Bristol Medical School, Faculty of Health Sciences, University of Bristol, Bristol, UK
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Ding Y, Acosta R, Enguix V, Suffren S, Ortmann J, Luck D, Dolz J, Lodygensky GA. Using Deep Convolutional Neural Networks for Neonatal Brain Image Segmentation. Front Neurosci 2020; 14:207. [PMID: 32273836 PMCID: PMC7114297 DOI: 10.3389/fnins.2020.00207] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 02/25/2020] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Deep learning neural networks are especially potent at dealing with structured data, such as images and volumes. Both modified LiviaNET and HyperDense-Net performed well at a prior competition segmenting 6-month-old infant magnetic resonance images, but neonatal cerebral tissue type identification is challenging given its uniquely inverted tissue contrasts. The current study aims to evaluate the two architectures to segment neonatal brain tissue types at term equivalent age. METHODS Both networks were retrained over 24 pairs of neonatal T1 and T2 data from the Developing Human Connectome Project public data set and validated on another eight pairs against ground truth. We then reported the best-performing model from training and its performance by computing the Dice similarity coefficient (DSC) for each tissue type against eight test subjects. RESULTS During the testing phase, among the segmentation approaches tested, the dual-modality HyperDense-Net achieved the best statistically significantly test mean DSC values, obtaining 0.94/0.95/0.92 for the tissue types and took 80 h to train and 10 min to segment, including preprocessing. The single-modality LiviaNET was better at processing T2-weighted images than processing T1-weighted images across all tissue types, achieving mean DSC values of 0.90/0.90/0.88 for gray matter, white matter, and cerebrospinal fluid, respectively, while requiring 30 h to train and 8 min to segment each brain, including preprocessing. DISCUSSION Our evaluation demonstrates that both neural networks can segment neonatal brains, achieving previously reported performance. Both networks will be continuously retrained over an increasingly larger repertoire of neonatal brain data and be made available through the Canadian Neonatal Brain Platform to better serve the neonatal brain imaging research community.
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Affiliation(s)
- Yang Ding
- The Canadian Neonatal Brain Platform (CNBP), Montreal, QC, Canada
| | - Rolando Acosta
- The Canadian Neonatal Brain Platform (CNBP), Montreal, QC, Canada
| | - Vicente Enguix
- The Canadian Neonatal Brain Platform (CNBP), Montreal, QC, Canada
| | - Sabrina Suffren
- The Canadian Neonatal Brain Platform (CNBP), Montreal, QC, Canada
| | - Janosch Ortmann
- Department of Management and Technology, Université du Québec à Montréal, Montreal, QC, Canada
| | - David Luck
- The Canadian Neonatal Brain Platform (CNBP), Montreal, QC, Canada
| | - Jose Dolz
- Laboratory for Imagery, Vision and Artificial Intelligence (LIVIA), École de Technologie Supérieure, Montreal, QC, Canada
| | - Gregory A. Lodygensky
- Laboratory for Imagery, Vision and Artificial Intelligence (LIVIA), École de Technologie Supérieure, Montreal, QC, Canada
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20
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Lakatos A, Kolossváry M, Szabó M, Jermendy Á, Barta H, Gyebnár G, Rudas G, Kozák LR. Neurodevelopmental effect of intracranial hemorrhage observed in hypoxic ischemic brain injury in hypothermia-treated asphyxiated neonates - an MRI study. BMC Pediatr 2019; 19:430. [PMID: 31718607 PMCID: PMC6849254 DOI: 10.1186/s12887-019-1777-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 10/09/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Identification of early signs of hypoxic ischemic encephalopathy (HIE) with magnetic resonance imaging (MRI) has proven of prognostic significance. Yet, the importance of intracranial hemorrhage (ICH), being present concomitantly had not been investigated yet, despite the known influence of hypothermia on hemostasis. We aimed to determine whether presence of ICH on MRI alongside the signs of HIE have an impact on prognosis in neonates with the clinical diagnosis of HIE. METHODS A retrospective study of consecutively sampled 108 asphyxiated term infants admitted to a tertiary neonatal intensive care unit (between 2007 and 2016), treated with whole body hypothermia and having brain MRI within 1 week of life was conducted. Presence or absence of HIE signs on MRI (basal ganglia-thalamus, watershed pattern and total brain injury) and on MR spectroscopy (lactate peak with decreased normal metabolites measured by Lac/NAA ratio) and/or of the five major types of ICH were recorded. Neurodevelopmental outcome was measured with Bayley Scales of Infant Development-II (BSID-II) test. Death or abnormal neurodevelopment (BSID-II score < 85) was defined as poor outcome in Chi-square test. Multivariate logistic regression analysis was performed on survivors. RESULTS MRI and MR-spectroscopy (MRS) signs of HIE were present in 72% (n = 78). 36% (n = 39) of neonates had ICH, being mainly small in size. Chi-square test showed a relationship between neurodevelopmental outcome and initial MRI. Unadjusted logistic regression showed that neonates presenting MRI and MRS signs of HIE have 6.23 times higher odds for delayed mental development (OR = 6.2292; CI95% = [1.2642; 30.6934], p = 0.0246), than infants without imaging alterations; with no ICH effect on outcome. Adjustment for clinical and imaging parameters did not change the pattern of results, i.e. HIE remained an independent risk factor for delayed neurodevelopment (OR = 6.2496; CI95% = [1.2018; 32.4983], p = 0.0294), while ICH remained to have no significant effect. CONCLUSION HIE related MRI abnormalities proved to be important prognostic factors of poor outcome in cooled asphyxiated infants when present, suggesting that early MRI with MRS is beneficial for prognostication. Interestingly, ICHs present in about one third of all cases had no significant effect on neurodevelopmental outcome, despite the known hemostasis altering effects of hypothermia.
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Affiliation(s)
- Andrea Lakatos
- Department of Neuroradiology, Medical Imaging Centre, Semmelweis University, Balassa u. 6, Budapest, 1083, Hungary
| | - Márton Kolossváry
- MTA-SE "Lendület" Cardiovascular Imaging Research Group, Semmelweis University, Városmajor u. 68, Budapest, 1122, Hungary
| | - Miklós Szabó
- First Department of Paediatrics, Semmelweis University, Bókay u. 53-54, Budapest, 1083, Hungary
| | - Ágnes Jermendy
- First Department of Paediatrics, Semmelweis University, Bókay u. 53-54, Budapest, 1083, Hungary
| | - Hajnalka Barta
- First Department of Paediatrics, Semmelweis University, Bókay u. 53-54, Budapest, 1083, Hungary
| | - Gyula Gyebnár
- Department of Neuroradiology, Medical Imaging Centre, Semmelweis University, Balassa u. 6, Budapest, 1083, Hungary
| | - Gábor Rudas
- Department of Neuroradiology, Medical Imaging Centre, Semmelweis University, Balassa u. 6, Budapest, 1083, Hungary
| | - Lajos R Kozák
- Department of Neuroradiology, Medical Imaging Centre, Semmelweis University, Balassa u. 6, Budapest, 1083, Hungary.
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21
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Abstract
Hyperbilirubinemia is a common occurrence in neonates; it may be physiological or pathological. Conjugated hyperbilirubinemia may result from medical or surgical causes, and can result in irreversible liver damage if untreated. The aim of imaging is the timely diagnosis of surgical conditions like biliary atresia and choledochal cysts. Abdominal ultrasound is the first line imaging modality, and Magnetic resonance cholangiopancreatography (MRCP) also has a role, especially in pre-operative assessment of choledochal cysts (CDCs). For biliary atresia, the triangular cord sign and gallbladder abnormalities are the two most useful ultrasound features, with a combined sensitivity of 95%. Liver biopsy has an important role in pre-operative evaluation; however, the gold standard for diagnosis of biliary atresia remains an intra-operative cholangiogram. Choledochal cysts are classified into types according to the number, location, extent and morphology of the areas of cystic dilatation. They are often associated with an abnormal pancreaticobiliary junction, which is best assessed on MRCP. Caroli's disease or type 5 CDC comprises of multiple intrahepatic cysts. CDCs, though benign, require surgery as they may be associated with complications like cholelithiasis, cholangitis and development of malignancy. Severe unconjugated hyperbilirubinemia puts neonates at high risk of developing bilirubin induced brain injury, which may be acute or chronic. Magnetic resonance imaging of the brain is the preferred modality for evaluation, and shows characteristic involvement of the globus pallidi, subthalamic nuclei and cerebellum - in acute cases, these areas show T1 hyperintensity, while chronic cases typically show hyperintensity on T2 weighted images.
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22
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Kozana A, Boursianis T, Kalaitzakis G, Raissaki M, Maris TG. Neonatal brain: Fabrication of a tissue-mimicking phantom and optimization of clinical Τ1w and T2w MRI sequences at 1.5 T. Phys Med 2018; 55:88-97. [PMID: 30471825 DOI: 10.1016/j.ejmp.2018.10.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 10/06/2018] [Accepted: 10/25/2018] [Indexed: 01/12/2023] Open
Abstract
PURPOSE Tο fabricate a tissue-mimicking phantom simulating the MR relaxation times of neonatal gray and white matter at 1.5 T, for the optimization of clinical Τ1 weighted (T1w) and T2 weighted (T2w) sequences. METHODS Numerous agarose gel solutions, doped with paramagnetic Gadopentetic acid (Gd-DTPA) ions, underwent quantitative relaxometry with a Turbo-Inversion-Recovery Spin-Echo (TIRSE) sequence and a Car-Purcell-Meiboom-Gill (CPMG) sequence for T1 and T2 measurements, respectively. Twenty samples which simulated the spectrum of relaxation times of neonatal brain parenchyma were selected. Reproducibility was tested by refabrication and relaxometry of the relevant samples while stability was tested by six sets of quantitative relaxometry scans during a 12-month period. RESULTS "Neonatal gray matter equivalent"(0.6%w/v agarose-0.10 mM Gd-DTPA), accurately mimicked relaxation times of neonatal gray matter: T1 = (1134 ± 7)ms, T2 = (200 ± 7)ms. "Neonatal white matter equivalent"(0.3%w/v agarose-0.03 mM Gd-DTPA), accurately mimicked relaxation times of neonatal white matter: T1 = (1654 ± 9)ms, T2 = (376 ± 4)ms. Coefficient of variation of T1 and T2 relaxation times measurements remained less than 5% during 12 months. Sequences were modified according to maximum relative contrast (RC) between neonatal gray and white matter equivalents. Optimized T2wTSE and T1wTSE parameters were TR/TE = 9500 ms/280 ms and TR/TE = 1200 ms/10 ms, respectively for a MAGNETOM Vision/Sonata Hybrid 1.5 T system. Quantitative relaxometry at different 1.5 T MR systems resulted in inter-system T1, T2 measurement deviations of 12% and 3%, respectively. CONCLUSION A precise, stable and reproducible phantom for the neonatal brain was fabricated. Subsequent optimization of clinical T1w and T2w sequences based on maximum RC between neonatal gray and white matter equivalents was scientifically supported with robust relaxometry. The procedure was applicable in different 1.5 T systems. HIGHLIGHT TR & TE optimization of neonatal brain at 1.5 T was based on relaxometry of a stable, reproducible phantom.
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Affiliation(s)
- Androniki Kozana
- Radiology Department, University Hospital of Heraklion, GR71110, Voutes, Heraklion, Crete, Greece; Department of Medical Physics, Medical School, University of Crete, GR 71201, Voutes, Heraklion, Crete, Greece
| | - Themis Boursianis
- Department of Medical Physics, Medical School, University of Crete, GR 71201, Voutes, Heraklion, Crete, Greece
| | - George Kalaitzakis
- Department of Medical Physics, Medical School, University of Crete, GR 71201, Voutes, Heraklion, Crete, Greece
| | - Maria Raissaki
- Radiology Department, University Hospital of Heraklion, GR71110, Voutes, Heraklion, Crete, Greece
| | - Thomas G Maris
- Radiology Department, University Hospital of Heraklion, GR71110, Voutes, Heraklion, Crete, Greece; Department of Medical Physics, Medical School, University of Crete, GR 71201, Voutes, Heraklion, Crete, Greece.
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Jisa KA, Clarey DD, Peeples ES. Magnetic Resonance Imaging Findings of Term and Preterm Hypoxic-Ischemic Encephalopathy: A Review of Relevant Animal Models and Correlation to Human Imaging. Open Neuroimag J 2018; 12:55-65. [PMID: 30450146 PMCID: PMC6198416 DOI: 10.2174/1874440001812010055] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 08/07/2018] [Accepted: 09/16/2018] [Indexed: 11/22/2022] Open
Abstract
Background: Neonatal hypoxic-ischemic encephalopathy is brain injury caused by decreased perfusion and oxygen delivery that most commonly occurs in the context of delivery complications such as umbilical cord compression or placental abruption. Imaging is a key component for guiding treatment and prediction of prognosis, and the most sensitive clinical imaging modality for the brain injury patterns seen in hypoxic-ischemic encephalopathy is magnetic resonance imaging. Objective: The goal of this review is to compare magnetic resonance imaging findings demonstrated in the available animal models of hypoxic-ischemic encephalopathy to those found in preterm (≤ 36 weeks) and term (>36 weeks) human neonates with hypoxic-ischemic encephalopathy, with special attention to the strengths and weaknesses of each model. Methods: A structured literature search was performed independently by two authors and the results of the searches were compiled. Animal model, human brain age equivalency, mechanism of injury, and area of brain injury were recorded for comparison to imaging findings in preterm and term human neonates with hypoxic-ischemic encephalopathy. Conclusion: Numerous animal models have been developed to better elicit the expected findings that occur after HIE by allowing investigators to control many of the clinical variables that result in injury. Although modeling the same disease process, magnetic resonance imaging findings in the animal models vary with the species and methods used to induce hypoxia and ischemia. The further development of animal models of HIE should include a focus on comparing imaging findings, and not just pathologic findings, to human studies.
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Affiliation(s)
- Kyle A Jisa
- Department of Pediatrics, University of Nebraska Medical Center, Omaha, NE, United States
| | - Dillon D Clarey
- Department of Pediatrics, University of Nebraska Medical Center, Omaha, NE, United States
| | - Eric S Peeples
- Department of Pediatrics, University of Nebraska Medical Center, Omaha, NE, United States
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Mankad K, Talenti G, Tan AP, Gonçalves FG, Robles C, Kan EYL, Siddiqui A. Neurometabolic Disorders of the Newborn. Top Magn Reson Imaging 2018; 27:179-196. [PMID: 30086107 DOI: 10.1097/rmr.0000000000000176] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
There is an extensive and diverse set of medical conditions affecting the neonatal brain within the spectrum of neurometabolic disorders. As such, their clinical presentations can be rather nonspecific, and can often mimic acquired entities such as hypoxic-ischemic encephalopathy and sepsis. Similarly, the radiological findings in these entities can also be frequently nonspecific, but a more detailed analysis of imaging findings (especially magnetic resonance imaging) alongside the relevant clinical details can be a rewarding experience, thus enabling a timely and targeted diagnosis. Early diagnosis of an underlying neurometabolic disorder is vital, as some of these entities are potentially treatable, and laboratory and genetic testing can be precisely targeted. Further, their detection helps with counselling families for future pregnancies. We present a review of neurometabolic disorders specific to the newborns with a focus on how neuroimaging findings match their clinical presentation patterns.
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Affiliation(s)
- Kshitij Mankad
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | | | - Ai Peng Tan
- Department of Diagnostic Imaging, National University Health System, Singapore, Singapore
| | | | - Carlos Robles
- Department of Radiology, Hospital Clinico Universidad de Chile, Región Metropolitana, Chile
| | - Elaine Y L Kan
- Department of Radiology, Hong Kong Children's Hospital, Kai Tak, Hong Kong
| | - Ata Siddiqui
- Department of Neuroradiology, King's College Hospital, London, UK
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25
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Sorokan ST, Jefferies AL, Miller SP. L’imagerie du cerveau du nouveau-né à terme. Paediatr Child Health 2018. [DOI: 10.1093/pch/pxy002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- S Todd Sorokan
- Société canadienne de pédiatrie, comité d’étude du fœtus et du nouveau-né, Ottawa (Ontario)
| | - Ann L Jefferies
- Société canadienne de pédiatrie, comité d’étude du fœtus et du nouveau-né, Ottawa (Ontario)
| | - Steven P Miller
- Société canadienne de pédiatrie, comité d’étude du fœtus et du nouveau-né, Ottawa (Ontario)
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26
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Abstract
Brain imaging is important for the diagnosis and management of sick term neonates. Although ultrasound and computed tomography may provide some information, magnetic resonance imaging is now the brain imaging modality of choice because it is the most sensitive technique for detecting and quantifying brain abnormalities and does not expose infants to radiation. This statement describes the principles, roles and limitations of these three imaging modalities and makes recommendations for appropriate use in term neonates. The primary focus is the brain of term infants with neonatal encephalopathy, many of whom are diagnosed with hypoxic-ischemic encephalopathy.
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Affiliation(s)
- S Todd Sorokan
- Canadian Paediatric Society, Fetus and Newborn Committee, Ottawa, Ontario
| | - Ann L Jefferies
- Canadian Paediatric Society, Fetus and Newborn Committee, Ottawa, Ontario
| | - Steven P Miller
- Canadian Paediatric Society, Fetus and Newborn Committee, Ottawa, Ontario
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27
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Mohammad SA, Abdelkhalek HS. Nonketotic hyperglycinemia: spectrum of imaging findings with emphasis on diffusion-weighted imaging. Neuroradiology 2017; 59:1155-1163. [PMID: 28864914 DOI: 10.1007/s00234-017-1913-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 08/22/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to explore brain abnormalities in nonketotic hyperglycinemia (NKH) using diffusion-weighted imaging (DWI) and when feasible, diffusion tensor imaging (DTI) and tractography. METHODS Seven patients with confirmed diagnosis of NKH (8 days-2 years) underwent brain MRI. Conventional T1 and T2WI were acquired in all patients, DWI in six and DTI and tractography in two (4 months and 2 years). Measurements of fractional anisotropy (FA), radial diffusivity (RD), axial diffusivity (AD) and Trace from eight white matter regions were compared between the two patients and age-matched controls. Tractography of corpus callosum, superior longitudinal fasciculus and corticospinal tracts was performed with extraction of their FA and diffusivity indices. RESULTS MRI showed nonspecific brain atrophy in three children. Corpus callosum atrophy was found as a part of these atrophic changes. Cerebellar vermian hypoplasia and supratentorial hydrocephalus were seen in one patient. The topographic distribution of diffusion restriction was different among patients. The affected white matter regions were not predominantly following the expected areas of myelination according to patients' age. Deep grey matter nuclei were affected in one patient. DTI revealed lower FA with higher RD in most of the measured white matter regions and tracts. These changes were more appreciated in the 2-year-old patient. However, Trace was higher in the 2-year-old patient and lower in the 4-month-old one. The extracted tracts were decreased in volume. CONCLUSION DWI, DTI and tractography with FA and diffusivity measurements can give insights into white matter microstructural alterations that can occur in NKH.
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Affiliation(s)
- Shaimaa Abdelsattar Mohammad
- Radiodiagnosis Department, Faculty of Medicine, Ain-Shams University, 9 Lotfi Elsayed St. Ain-Shams University Staff Buildings, Cairo, 11657, Egypt.
| | - Heba Salah Abdelkhalek
- Medical Genetics Unit, Pediatric Department, Faculty of Medicine, Ain-Shams University, Cairo, Egypt
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A Controversial Medicolegal Issue: Timing the Onset of Perinatal Hypoxic-Ischemic Brain Injury. Mediators Inflamm 2017; 2017:6024959. [PMID: 28883688 PMCID: PMC5572618 DOI: 10.1155/2017/6024959] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 07/18/2017] [Indexed: 12/11/2022] Open
Abstract
Perinatal hypoxic-ischemic brain injury, as a result of chronic, subacute, and acute insults, represents the pathological consequence of fetal distress and birth or perinatal asphyxia, that is, “nonreassuring fetal status.” Hypoxic-ischemic injury (HII) is typically characterized by an early phase of damage, followed by a delayed inflammatory local response, in an apoptosis-necrosis continuum. In the early phase, the cytotoxic edema and eventual acute lysis take place; with reperfusion, additional damage should be assigned to excitotoxicity and oxidative stress. Finally, a later phase involves all the inflammatory activity and long-term neural tissue repairing and remodeling. In this model mechanism, loss of mitochondrial function is supposed to be the hallmark of secondary injury progression, and autophagy which is lysosome-mediated play a role in enhancing brain injury. Early-induced molecules driven by hypoxia, as chaperonins HSPs and ORP150, besides common markers for inflammatory responses, have predictive value in timing the onset of neonatal HII; on the other hand, clinical biomarkers for HII diagnosis, as CK-BB, LDH, S-100beta, and NSE, could be useful to predict outcomes.
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The New Findings in the Genetics and Pathology of Structural Brain Diseases. CURRENT PEDIATRICS REPORTS 2016. [DOI: 10.1007/s40124-016-0112-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Abstract
Magnetic resonance (MR) imaging is emerging as one of the most important tools in identifying the etiology of neonatal encephalopathy as well as in predicting long-term outcomes. This makes it imperative to have a broader understanding of normal myelination of the neonatal brain on MR imaging and to be familiar with the spectrum of imaging features in ischemic and non-ischemic neonatal encephalopathy. Hypoxic ischemic injury (HIE) is one of the most common causes of neonatal encephalopathy and imaging appearances are influenced by factors such as the stage of maturation of the neonatal brain and severity as well as duration of ischemic insult. Other common causes of neonatal encephalopathy include infectious diseases, congenital disorders and inborn errors of metabolism.
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Ho ML, Patton AC, DeLone DR, Kim H, Gilbertson JR, Felmlee J, Watson RE. Brain Injury in the Preterm and Term Neonate. CURRENT RADIOLOGY REPORTS 2016. [DOI: 10.1007/s40134-016-0161-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
BACKGROUND We review clinical, neuroimaging, and genetic information on six individuals with isolated sulfite oxidase deficiency (ISOD). METHODS All patients were examined, and clinical records, biochemistry, neuroimaging, and sulfite oxidase gene (SUOX) sequencing were reviewed. RESULTS Data was available on six individuals from four nuclear families affected by ISOD. Each individual began to seize within the first week of life. neurologic development was arrested at brainstem reflexes, and severe microcephaly developed rapidly. neuroimaging within days of birth revealed hypoplasia of the cerebellum and corpus callosum and damage to the supratentorial brain looking like severe hypoxic-ischemic injury that evolved into cystic hemispheric white matter changes. Affected individuals all had elevated urinary S-sulfocysteine and normal urinary xanthine and hypoxanthine levels diagnostic of ISOD. Genetic studies confirmed SUOX mutations in four patients. CONCLUSIONS ISOD impairs systemic sulfite metabolism, and yet this genetic disease affects only the brain with damage that is commonly confused with the clinical and radiologic features of severe hypoxic-ischemic encephalopathy. Lésions neurologiques dans le déficit isolé en sulfite oxydase.
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Wong DM, Jeffery N, Hepworth-Warren KL, Wiechert SA, Miles K. Magnetic resonance imaging of presumptive neonatal encephalopathy in a foal. EQUINE VET EDUC 2016. [DOI: 10.1111/eve.12590] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- D. M. Wong
- Department of Veterinary Clinical Sciences; College of Veterinary Medicine; Iowa State University; Ames USA
| | - N. Jeffery
- Department of Veterinary Clinical Sciences; College of Veterinary Medicine; Iowa State University; Ames USA
| | - K. L. Hepworth-Warren
- Department of Veterinary Clinical Sciences; College of Veterinary Medicine; Iowa State University; Ames USA
| | - S. A. Wiechert
- Department of Veterinary Clinical Sciences; College of Veterinary Medicine; Iowa State University; Ames USA
| | - K. Miles
- Department of Veterinary Clinical Sciences; College of Veterinary Medicine; Iowa State University; Ames USA
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Abstract
Investigators from Children's National Medical Center and George Washington University School of Medicine, Washington, DC, studied the correlation between white matter tract changes and developmental outcomes in a series of infants with hypoxic ischemic encephalopathy (HIE) treated with whole body cooling.
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Affiliation(s)
- Maura E Ryan
- Division of Neuroradiology, Department of Medical Imaging, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL
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You SK, Choi YH, Park SJ, Cheon JE, Kim IO, Kim WS, Lee SM, Cho HH. Quantitative Sonographic Texture Analysis in Preterm Neonates With White Matter Injury: Correlation of Texture Features With White Matter Injury Severity. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2015; 34:1931-1940. [PMID: 26384612 DOI: 10.7863/ultra.15.01031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 05/11/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES To analyze the texture features on cranial sonography in preterm neonates with white matter injury quantitatively and to correlate these features with magnetic resonance imaging (MRI). METHODS The study included 33 preterm neonates treated in our neonatal intensive care unit who underwent serial cranial sonography and brain MRI near term. Patients were subdivided into 3 groups according to the presence and severity of white matter injury as revealed by MRI: normal (group 1; n = 20), mild (group 2; n = 5), and severe (group 3; n = 8). The periventricular echogenicity on sonography was evaluated quantitatively with second-order gray-level statistics (gray-level co-occurrence matrix [GLCM] method). Four GLCM texture features representing homogeneity were extracted in 12 directions: (1) angular second moment (ASM), (2) inverse differential moment (IDM), (3) contrast, and (4) entropy. RESULTS Thirty of 48 features showed a statistically significant difference between groups 1 and 3 (ASM in 9 directions, IDM in 6 directions, contrast in 3 directions, and entropy in all 12 directions). There were no significant differences observed between groups 1 and 2 or groups 2 and 3. The mean contrast and entropy values were generally lower in group 1 than group 3, whereas the mean ASM and IDM values were higher in group 1. CONCLUSIONS Severe white matter injury could be identified by using GLCM texture analysis, whereas mild white matter injury observed on MRI could not be evaluated by GLCM analysis. Quantitative texture analysis using the GLCM may serve as a complementary tool for quantitative assessment of periventricular echogenicity.
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Affiliation(s)
- Sun Kyoung You
- Department of Radiology, Seoul National University Children's Hospital, Seoul, Korea (S.K.Y., Y.H.C., J-E.C., I.-O.K., W.-S.K., S.M.L., H.-H.C.); Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea (J-E.C., I.-O.K., W.-S.K.); and Biomedical Research Institute, Department of Radiology, Seoul National University Hospital, Seoul, Korea (S.J.P.)
| | - Young Hun Choi
- Department of Radiology, Seoul National University Children's Hospital, Seoul, Korea (S.K.Y., Y.H.C., J-E.C., I.-O.K., W.-S.K., S.M.L., H.-H.C.); Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea (J-E.C., I.-O.K., W.-S.K.); and Biomedical Research Institute, Department of Radiology, Seoul National University Hospital, Seoul, Korea (S.J.P.).
| | - Sang Joon Park
- Department of Radiology, Seoul National University Children's Hospital, Seoul, Korea (S.K.Y., Y.H.C., J-E.C., I.-O.K., W.-S.K., S.M.L., H.-H.C.); Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea (J-E.C., I.-O.K., W.-S.K.); and Biomedical Research Institute, Department of Radiology, Seoul National University Hospital, Seoul, Korea (S.J.P.)
| | - Jung-Eun Cheon
- Department of Radiology, Seoul National University Children's Hospital, Seoul, Korea (S.K.Y., Y.H.C., J-E.C., I.-O.K., W.-S.K., S.M.L., H.-H.C.); Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea (J-E.C., I.-O.K., W.-S.K.); and Biomedical Research Institute, Department of Radiology, Seoul National University Hospital, Seoul, Korea (S.J.P.)
| | - In-One Kim
- Department of Radiology, Seoul National University Children's Hospital, Seoul, Korea (S.K.Y., Y.H.C., J-E.C., I.-O.K., W.-S.K., S.M.L., H.-H.C.); Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea (J-E.C., I.-O.K., W.-S.K.); and Biomedical Research Institute, Department of Radiology, Seoul National University Hospital, Seoul, Korea (S.J.P.)
| | - Woo-Sun Kim
- Department of Radiology, Seoul National University Children's Hospital, Seoul, Korea (S.K.Y., Y.H.C., J-E.C., I.-O.K., W.-S.K., S.M.L., H.-H.C.); Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea (J-E.C., I.-O.K., W.-S.K.); and Biomedical Research Institute, Department of Radiology, Seoul National University Hospital, Seoul, Korea (S.J.P.)
| | - So Mi Lee
- Department of Radiology, Seoul National University Children's Hospital, Seoul, Korea (S.K.Y., Y.H.C., J-E.C., I.-O.K., W.-S.K., S.M.L., H.-H.C.); Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea (J-E.C., I.-O.K., W.-S.K.); and Biomedical Research Institute, Department of Radiology, Seoul National University Hospital, Seoul, Korea (S.J.P.)
| | - Hyun-Hae Cho
- Department of Radiology, Seoul National University Children's Hospital, Seoul, Korea (S.K.Y., Y.H.C., J-E.C., I.-O.K., W.-S.K., S.M.L., H.-H.C.); Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea (J-E.C., I.-O.K., W.-S.K.); and Biomedical Research Institute, Department of Radiology, Seoul National University Hospital, Seoul, Korea (S.J.P.)
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Babiker MS, Omer AM, Al Oufi AR. Evaluation of Neonatal Hypoxic-Ischemic Encephalopathy by MRI and Ultrasound. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2013. [DOI: 10.1177/8756479313484549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Hypoxic-ischemic encephalopathy (HIE) is a major cause of brain damage and neurodevelopmental abnormalities in full-term newborn infants. We are reporting the results of a study comparing cranial magnetic resonance imaging (MRI) and cranial sonography (US) in 150 neonates with suspected HIE. Magnetic resonance imaging findings were normal in 44 patients (29%); 18% of patients showed only basal ganglia (BG) brightness, 10.6% showed brightness of the BG with intracerebral hemorrhage, and 63% of patients showed additional diagnostic details. Cranial US was normal in 75 patients (50%) and showed increased periventricular echogenicity in 32%, intraventricular hemorrhage in 9%, and additional diagnostic details in 13%. There was a positive correlation between MRI studies and US ( P = .013). These data suggest that US is a worthwhile modality for the diagnosis of HIE but that early MRI findings will provide additional information in many cases in the detection of cerebral intraventricular hemorrhage.
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Leviton A. Why the term neonatal encephalopathy should be preferred over neonatal hypoxic-ischemic encephalopathy. Am J Obstet Gynecol 2013; 208:176-80. [PMID: 22901708 DOI: 10.1016/j.ajog.2012.07.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Revised: 07/13/2012] [Accepted: 07/19/2012] [Indexed: 02/05/2023]
Abstract
The unresponsiveness of the full-term newborn is sometimes attributed to asphyxia, even when no severe physiologic disturbance occurred during labor and delivery. The controversy about whether to use the name "hypoxic-ischemic encephalopathy" or "newborn encephalopathy" has recently flared in publications directed toward pediatricians and neurologists. In this clinic opinion piece, I discuss the importance to obstetricians of this decision and explain why "newborn encephalopathy" should be the default term.
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Neonatal ischemic brain injury: what every radiologist needs to know. Pediatr Radiol 2012; 42:606-19. [PMID: 22249600 DOI: 10.1007/s00247-011-2332-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2011] [Revised: 11/28/2011] [Accepted: 12/07/2011] [Indexed: 01/21/2023]
Abstract
We present a pictorial review of neonatal ischemic brain injury and look at its pathophysiology, imaging features and differential diagnoses from a radiologist's perspective. The concept of perinatal stroke is defined and its distinction from hypoxic-ischemic injury is emphasized. A brief review of recent imaging advances is included and a diagnostic approach to neonatal ischemic brain injury is suggested.
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Intracranial hemorrhage associated with vitamin K-deficiency bleeding in patients with biliary atresia: focus on long-term outcomes. J Pediatr Gastroenterol Nutr 2012; 54:552-7. [PMID: 22124309 DOI: 10.1097/mpg.0b013e3182421878] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND AIM The prophylactic oral administration of vitamin K to newborns has markedly reduced the incidence of vitamin K deficiency (VKD); however, intracranial hemorrhage (ICH) is still one of the complications found in biliary atresia (BA) patients and is associated with VKD bleeding. Therefore, we aimed to investigate the incidence and long-term outcome of ICH in patients with BA who previously received prophylactic vitamin K during the neonatal period. METHODS Eighty-eight consecutive infants with BA were treated and followed up at Kyushu University Hospital from 1979 to 2009. The clinical records and imaging study results were retrospectively reviewed in the infants with BA who presented with ICH. RESULTS ICH occurred in 7.95% of patients with BA. The onset of ICH occurred at 47 to 76 days after birth, before the patients underwent surgery for BA (9-37 days after the onset of ICH). Coagulopathy was found upon admission in all of the cases with available data and improved after intravenous administration of vitamin K. A craniotomy was required in 2 cases before the surgery for BA. During the 22 to 278 months of follow-up, some neurologic sequelae persisted in 5 of 7 cases. Follow-up head computed tomography scans showed a low-density area in the left hemisphere in 5 cases. CONCLUSIONS Although vitamin K prophylaxis had been given during the neonatal period, ICH-associated VKD bleeding was still found in 7.95% of patients with BA. Persistent neurologic sequelae were found in 5 of 7 cases, with low-density area in the left hemisphere.
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Abstract
Diffusion-weighted imaging (DWI) has become an important tool in pediatric neuroradiology, helping in the evaluation of the encephalopathic and seizing neonate, and adding conspicuity, specificity, and prognostic value to the conventional magnetic resonance (MR) imaging data. DWI also facilitates understanding the pathophysiology and natural time course of ischemic and nonischemic disorders. When interpreted concurrently with the conventional MR imaging and other advanced MR imaging techniques, such as spectroscopy and arterial spin labeling, DWI can give clues leading to an accurate diagnosis and provide important information about pathophysiology and prognosis of the diseases, as well as guide adequate therapeutic modalities.
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Affiliation(s)
- Katyucia Rodrigues
- Multi-Imagem/CDPI Clinics, R. Alm. Saddock de Sá, 266-Ipanema, Rio de Janeiro 22411-040, Brazil.
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