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Hayakawa K, Tanda K, Nishimoto M, Nishimura A, Kinoshita D, Sano Y. Apparent diffusion coefficient values can predict neuromotor outcome in term neonates with hypoxic-ischaemic encephalopathy. Acta Paediatr 2024; 113:191-198. [PMID: 37874257 DOI: 10.1111/apa.17011] [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] [Received: 07/08/2023] [Revised: 09/17/2023] [Accepted: 10/12/2023] [Indexed: 10/25/2023]
Abstract
AIM To determine the apparent diffusion coefficient (ADC) in brain structures during the first 2 weeks of life and its relation with neurological outcome for hypoxic-ischaemic encephalopathy (HIE) in term neonates. METHODS We retrospectively evaluated 56 term-born neonates. The ADC values were measured for 11 brain regions. The clinical outcomes at least 2 years of age were defined as normal outcome, mild disability and severe disability. The area under curves (AUCs) by ROC analysis were performed to predict the neurodevelopmental outcomes. The clinical outcomes were compared between favourable outcome and adverse outcome and also between normal outcome and unfavourable outcome. RESULTS Thirty-four patients were judged as normal outcome, 10 as mild disability and 12 as severe disability. When the clinical outcomes were compared between favourable outcome and adverse outcome, the AUC on the 1st week was highest value at the thalamus. When the clinical outcomes were compared between normal outcome and unfavourable outcome, the AUC on the 1st week was highest at the thalamus. CONCLUSION The ADC values in the thalamus in the 1st week can predict the neurological outcome. The ADC values in centrum semiovale on the 2nd week can be used to predict neurodevelopmental outcomes.
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Affiliation(s)
- Katsumi Hayakawa
- Department of Diagnostic Radiology, Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Koichi Tanda
- Department of Neonatology, Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
- Department of Pediatrics, Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Masakazu Nishimoto
- Department of Diagnostic Radiology, Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Akira Nishimura
- Department of Neonatology, Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Daisuke Kinoshita
- Department of Neonatology, Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Yuko Sano
- Department of Diagnostic Radiology, Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
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Wu CQ, Cowan FM, Jary S, Thoresen M, Chakkarapani E, Spencer APC. Cerebellar growth, volume and diffusivity in children cooled for neonatal encephalopathy without cerebral palsy. Sci Rep 2023; 13:14869. [PMID: 37684324 PMCID: PMC10491605 DOI: 10.1038/s41598-023-41838-3] [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: 06/01/2023] [Accepted: 08/31/2023] [Indexed: 09/10/2023] Open
Abstract
Children cooled for HIE and who did not develop cerebral palsy (CP) still underperform at early school age in motor and cognitive domains and have altered supra-tentorial brain volumes and white matter connectivity. We obtained T1-weighted and diffusion-weighted MRI, motor (MABC-2) and cognitive (WISC-IV) scores from children aged 6-8 years who were cooled for HIE secondary to perinatal asphyxia without CP (cases), and controls matched for age, sex, and socioeconomic status. In 35 case children, we measured cerebellar growth from infancy (age 4-15 days after birth) to childhood. In childhood, cerebellar volumes were measured in 26 cases and 23 controls. Diffusion properties (mean diffusivity, MD and fractional anisotropy, FA) were calculated in 24 cases and 19 controls, in 9 cerebellar regions. Cases with FSIQ ≤ 85 had reduced growth of cerebellar width compared to those with FSIQ > 85 (p = 0.0005). Regional cerebellar volumes were smaller in cases compared to controls (p < 0.05); these differences were not significant when normalised to total brain volume. There were no case-control differences in MD or FA. Interposed nucleus volume was more strongly associated with IQ in cases than in controls (p = 0.0196). Other associations with developmental outcome did not differ between cases and controls.
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Affiliation(s)
- Chelsea Q Wu
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Frances M Cowan
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Department of Paediatrics, Imperial College London, London, UK
| | - Sally Jary
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Marianne Thoresen
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Faculty of Medicine, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Ela Chakkarapani
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
- Neonatal Intensive Care Unit, St Michael's Hospital, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, BS2 8EG, UK.
| | - Arthur P C Spencer
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Sarkar SS, Gupta S, Bapuraj JR, Dechert RE, Sarkar S. Brainstem hypoxic-ischemic lesions on MRI in infants treated with therapeutic cooling: effects on the length of stay and mortality. J Perinatol 2021; 41:512-518. [PMID: 33223525 DOI: 10.1038/s41372-020-00873-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 09/25/2020] [Accepted: 11/04/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To test the hypothesis that brainstem hypoxic-ischemic injury on magnetic resonance imaging (MRI) would be independently associated with short-term outcomes in cooled asphyxiated infants. METHODS A total of 90 consecutively cooled asphyxiated infants who survived to have brain MRI were reviewed. A neuroradiologist who was masked to outcomes evaluated MRI images for brainstem involvement. Outcomes were mortality and length of stay. RESULTS Brainstem lesions were present on post-cooling brain MRI in 20 of the 90 infants (22%). Overall, four infants died before discharge, and all four had brainstem involvement. The infants with brainstem involvement had longer hospital stay (29 days, IQR 20-47 versus 16 days, IQR 10-26; P = 0.0001), compared to infants without brainstem lesions (n = 70); and upon multivariate analysis, brainstem involvement remained independently associated with prolonged hospital stay (β = 12.4, P = 0.001). CONCLUSION This study demonstrates the importance of recognizing brainstem injury for the prediction of short-term outcomes in cooled asphyxiated infants.
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Affiliation(s)
| | - Suneeti Gupta
- Neonatal-Perinatal Medicine, University of Michigan Health System, Ann Arbor, MI, USA
| | | | - Ronald E Dechert
- Neonatal-Perinatal Medicine, University of Michigan Health System, Ann Arbor, MI, USA
| | - Subrata Sarkar
- Neonatal-Perinatal Medicine, University of Michigan Health System, Ann Arbor, MI, USA.
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Thomason ME. Development of Brain Networks In Utero: Relevance for Common Neural Disorders. Biol Psychiatry 2020; 88:40-50. [PMID: 32305217 PMCID: PMC7808399 DOI: 10.1016/j.biopsych.2020.02.007] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 01/05/2020] [Accepted: 02/05/2020] [Indexed: 01/27/2023]
Abstract
Magnetic resonance imaging, histological, and gene analysis approaches in living and nonliving human fetuses and in prematurely born neonates have provided insight into the staged processes of prenatal brain development. Increased understanding of micro- and macroscale brain network development before birth has spurred interest in understanding the relevance of prenatal brain development to common neurological diseases. Questions abound as to the sensitivity of the intrauterine brain to environmental programming, to windows of plasticity, and to the prenatal origin of disorders of childhood that involve disruptions in large-scale network connectivity. Much of the available literature on human prenatal neural development comes from cross-sectional or case studies that are not able to resolve the longitudinal consequences of individual variation in brain development before birth. This review will 1) detail specific methodologies for studying the human prenatal brain, 2) summarize large-scale human prenatal neural network development, integrating findings from across a variety of experimental approaches, 3) explore the plasticity of the early developing brain as well as potential sex differences in prenatal susceptibility, and 4) evaluate opportunities to link specific prenatal brain developmental processes to the forms of aberrant neural connectivity that underlie common neurological disorders of childhood.
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Affiliation(s)
- Moriah E Thomason
- Department of Child and Adolescent Psychiatry, Department of Population Health, and Neuroscience Institute, New York University Langone Health, New York, New York.
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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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Thomason ME, Hect J, Waller R, Manning JH, Stacks AM, Beeghly M, Boeve JL, Wong K, van den Heuvel MI, Hernandez-Andrade E, Hassan SS, Romero R. Prenatal neural origins of infant motor development: Associations between fetal brain and infant motor development. Dev Psychopathol 2018; 30:763-772. [PMID: 30068433 PMCID: PMC6261435 DOI: 10.1017/s095457941800072x] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Functional circuits of the human brain emerge and change dramatically over the second half of gestation. It is possible that variation in neural functional system connectivity in utero predicts individual differences in infant behavioral development, but this possibility has yet to be examined. The current study examines the association between fetal sensorimotor brain system functional connectivity and infant postnatal motor ability. Resting-state functional connectivity data was obtained in 96 healthy human fetuses during the second and third trimesters of pregnancy. Infant motor ability was measured 7 months after birth using the Bayley Scales of Infant Development. Increased connectivity between the emerging motor network and regions of the prefrontal cortex, temporal lobes, posterior cingulate, and supplementary motor regions was observed in infants that showed more mature motor functions. In addition, females demonstrated stronger fetal-brain to infant-behavior associations. These observations extend prior longitudinal research back into prenatal brain development and raise exciting new ideas about the advent of risk and the ontogeny of early sex differences.
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Mahdi ES, Bouyssi-Kobar M, Jacobs MB, Murnick J, Chang T, Limperopoulos C. Cerebral Perfusion Is Perturbed by Preterm Birth and Brain Injury. AJNR Am J Neuroradiol 2018; 39:1330-1335. [PMID: 29748205 DOI: 10.3174/ajnr.a5669] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 03/23/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Early disturbances in systemic and cerebral hemodynamics are thought to mediate prematurity-related brain injury. However, the extent to which CBF is perturbed by preterm birth is unknown. Our aim was to compare global and regional CBF in preterm infants with and without brain injury on conventional MR imaging using arterial spin-labeling during the third trimester of ex utero life and to examine the relationship between clinical risk factors and CBF. MATERIALS AND METHODS We prospectively enrolled preterm infants younger than 32 weeks' gestational age and <1500 g and performed arterial spin-labeling MR imaging studies. Global and regional CBF in the cerebral cortex, thalami, pons, and cerebellum was quantified. Preterm infants were stratified into those with and without structural brain injury. We further categorized preterm infants by brain injury severity: moderate-severe and mild. RESULTS We studied 78 preterm infants: 31 without brain injury and 47 with brain injury (29 with mild and 18 with moderate-severe injury). Global CBF showed a borderline significant increase with increasing gestational age at birth (P = .05) and trended lower in preterm infants with brain injury (P = .07). Similarly, regional CBF was significantly lower in the right thalamus and midpons (P < .05) and trended lower in the midtemporal, left thalamus, and anterior vermis regions (P < .1) in preterm infants with brain injury. Regional CBF in preterm infants with moderate-severe brain injury trended lower in the midpons, right cerebellar hemisphere, and dentate nuclei compared with mild brain injury (P < .1). In addition, a significant, lower regional CBF was associated with ventilation, sepsis, and cesarean delivery (P < .05). CONCLUSIONS We report early disturbances in global and regional CBF in preterm infants following brain injury. Regional cerebral perfusion alterations were evident in the thalamus and pons, suggesting regional vulnerability of the developing cerebro-cerebellar circuitry.
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Affiliation(s)
- E S Mahdi
- From the Developing Brain Research Program (E.S.M., M.B.-K., J.M., C.L.), Department of Diagnostic Imaging and Radiology
| | - M Bouyssi-Kobar
- From the Developing Brain Research Program (E.S.M., M.B.-K., J.M., C.L.), Department of Diagnostic Imaging and Radiology
- Department of Neurology (T.C.)
| | - M B Jacobs
- Department of Epidemiology and Biostatistics (M.B.J.), Children's Research Institute, Children's National Health System, Washington, DC
| | - J Murnick
- From the Developing Brain Research Program (E.S.M., M.B.-K., J.M., C.L.), Department of Diagnostic Imaging and Radiology
| | - T Chang
- Department of Neurology (T.C.)
| | - C Limperopoulos
- From the Developing Brain Research Program (E.S.M., M.B.-K., J.M., C.L.), Department of Diagnostic Imaging and Radiology
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Carrasco M, Perin J, Jennings JM, Parkinson C, Gilmore MM, Chavez-Valdez R, Massaro AN, Koehler RC, Northington FJ, Tekes A, Lee JK. Cerebral Autoregulation and Conventional and Diffusion Tensor Imaging Magnetic Resonance Imaging in Neonatal Hypoxic-Ischemic Encephalopathy. Pediatr Neurol 2018; 82:36-43. [PMID: 29622488 PMCID: PMC5960435 DOI: 10.1016/j.pediatrneurol.2018.02.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 02/16/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Deviation of mean arterial blood pressure (MAP) from the range that optimizes cerebral autoregulatory vasoreactivity (optimal MAP) could increase neurological injury from hypoxic-ischemic encephalopathy (HIE). We tested whether a global magnetic resonance imaging (MRI) brain injury score and regional diffusion tensor imaging (DTI) are associated with optimal MAP in neonates with HIE. METHODS Twenty-five neonates cooled for HIE were monitored with the hemoglobin volume index. In this observational study, we identified optimal MAP and measured brain injury by qualitative and quantitative MRIs with the Neonatal Research Network (NRN) score and DTI mean diffusivity scalars. Optimal MAP and blood pressure were compared with brain injury. RESULTS Neonates with blood pressure measurements within optimal MAP during rewarming had less brain injury by NRN score (P = 0.040). Longer duration of MAP within optimal MAP during hypothermia correlated with higher mean diffusivity in the anterior centrum semiovale (P = 0.008) and pons (P = 0.002). Blood pressure deviation below optimal MAP was associated with lower mean diffusivity in cerebellar white matter (P = 0.033). Higher optimal MAP values related to lower mean diffusivity in the basal ganglia (P = 0.021), the thalamus (P = 0.006), the posterior limb of the internal capsule (P = 0.018), the posterior centrum semiovale (P = 0.035), and the cerebellar white matter (P = 0.008). Optimal MAP values were not associated with the NRN score. CONCLUSIONS The NRN score and the regional mean diffusivity scalars detected injury with mean arterial blood pressure deviations from the optimal MAP. Higher optimal MAP and lower mean diffusivity may be related because of cytotoxic edema and limited vasodilatory reserve at low MAP in injured brain. DTI detected injury with elevated optimal MAP better than the NRN score.
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Affiliation(s)
- Melisa Carrasco
- Department of Neurology, Division of Pediatric Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Jamie Perin
- Center for Child and Community Health Research (CCHR), Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Jacky M. Jennings
- Center for Child and Community Health Research (CCHR), Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Charlamaine Parkinson
- Neurosciences Intensive Care Nursery, Johns Hopkins School of Medicine, Baltimore, Maryland,Division of Neonatology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Maureen M. Gilmore
- Neurosciences Intensive Care Nursery, Johns Hopkins School of Medicine, Baltimore, Maryland,Division of Neonatology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Raul Chavez-Valdez
- Neurosciences Intensive Care Nursery, Johns Hopkins School of Medicine, Baltimore, Maryland,Division of Neonatology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - An N. Massaro
- Department of Pediatrics, Children’s National Medical Center, George Washington University School of Medicine, Washington, District of Columbia
| | - Raymond C. Koehler
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Frances J. Northington
- Neurosciences Intensive Care Nursery, Johns Hopkins School of Medicine, Baltimore, Maryland,Division of Neonatology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Aylin Tekes
- Neurosciences Intensive Care Nursery, Johns Hopkins School of Medicine, Baltimore, Maryland,Department of Radiology, Division of Pediatric Radiology and Pediatric Neuroradiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jennifer K. Lee
- Neurosciences Intensive Care Nursery, Johns Hopkins School of Medicine, Baltimore, Maryland,Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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