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Scott J, White A, Walsh C, Aslett L, Rutherford MA, Ng J, Judge C, Sebastian K, O'Brien S, Kelleher J, Power J, Conlon N, Moran SM, Luqmani RA, Merkel PA, Tesar V, Hruskova Z, Little MA. Computable phenotype for real-world, data-driven retrospective identification of relapse in ANCA-associated vasculitis. RMD Open 2024; 10:e003962. [PMID: 38688690 PMCID: PMC11086371 DOI: 10.1136/rmdopen-2023-003962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 03/29/2024] [Indexed: 05/02/2024] Open
Abstract
OBJECTIVE ANCA-associated vasculitis (AAV) is a relapsing-remitting disease, resulting in incremental tissue injury. The gold-standard relapse definition (Birmingham Vasculitis Activity Score, BVAS>0) is often missing or inaccurate in registry settings, leading to errors in ascertainment of this key outcome. We sought to create a computable phenotype (CP) to automate retrospective identification of relapse using real-world data in the research setting. METHODS We studied 536 patients with AAV and >6 months follow-up recruited to the Rare Kidney Disease registry (a national longitudinal, multicentre cohort study). We followed five steps: (1) independent encounter adjudication using primary medical records to assign the ground truth, (2) selection of data elements (DEs), (3) CP development using multilevel regression modelling, (4) internal validation and (5) development of additional models to handle missingness. Cut-points were determined by maximising the F1-score. We developed a web application for CP implementation, which outputs an individualised probability of relapse. RESULTS Development and validation datasets comprised 1209 and 377 encounters, respectively. After classifying encounters with diagnostic histopathology as relapse, we identified five key DEs; DE1: change in ANCA level, DE2: suggestive blood/urine tests, DE3: suggestive imaging, DE4: immunosuppression status, DE5: immunosuppression change. F1-score, sensitivity and specificity were 0.85 (95% CI 0.77 to 0.92), 0.89 (95% CI 0.80 to 0.99) and 0.96 (95% CI 0.93 to 0.99), respectively. Where DE5 was missing, DE2 plus either DE1/DE3 were required to match the accuracy of BVAS. CONCLUSIONS This CP accurately quantifies the individualised probability of relapse in AAV retrospectively, using objective, readily accessible registry data. This framework could be leveraged for other outcomes and relapsing diseases.
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Affiliation(s)
- Jennifer Scott
- Trinity Kidney Centre, Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland
| | - Arthur White
- School of Computer Science and Statistics, Trinity College Dublin, Dublin, Ireland
- ADAPT SFI centre, Trinity College Dublin, Dublin, Ireland
| | - Cathal Walsh
- Department of Computer Science and Statistics, Trinity College Dublin, Dublin, Ireland
- National Centre for Pharmacoeconomics, St James's Hospital, Dublin, Ireland
| | - Louis Aslett
- Department of Mathematical Science, University of Durham, Durham, UK
| | | | - James Ng
- School of Computer Science and Statistics, Trinity College Dublin, Dublin, Ireland
| | - Conor Judge
- School of Medicine, College of Medicine, Nursing and Health Science, University of Galway, Galway, Ireland
| | - Kuruvilla Sebastian
- Trinity Kidney Centre, Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland
| | - Sorcha O'Brien
- Trinity Kidney Centre, Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland
| | - John Kelleher
- Department of Statistics, Dublin Institute of Technology, Dublin, Ireland
| | - Julie Power
- Vasculitis Ireland Awareness, Dublin, Ireland
| | - Niall Conlon
- Department of Immunology, St James's Hospital, Dublin, Ireland
| | - Sarah M Moran
- Trinity Kidney Centre, Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland
- Department of Nephrology, Cork University Hospital, Cork, Ireland
| | - Raashid Ahmed Luqmani
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science (NDORMs), University of Oxford, Oxford, UK
| | - Peter A Merkel
- Division of Rheumatology, Department of Medicine, Division of Epidemiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Vladimir Tesar
- Department of Nephrology, General University Hospital, Prague, Czech Republic
- 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Zdenka Hruskova
- 1st Faculty of Medicine, Charles University, Prague, Czech Republic
- General University Hospital, Prague, Czech Republic
| | - Mark A Little
- Trinity Kidney Centre, Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland
- ADAPT SFI centre, Trinity College Dublin, Dublin, Ireland
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McGlinn K, Rutherford MA, Gisslander K, Hederman L, Little MA, O'Sullivan D. FAIRVASC: A semantic web approach to rare disease registry integration. Comput Biol Med 2022; 145:105313. [DOI: 10.1016/j.compbiomed.2022.105313] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 02/03/2022] [Accepted: 02/08/2022] [Indexed: 11/26/2022]
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Stegeman R, Feldmann M, Claessens NHP, Jansen NJG, Breur JMPJ, de Vries LS, Logeswaran T, Reich B, Knirsch W, Kottke R, Hagmann C, Latal B, Simpson J, Pushparajah K, Bonthrone AF, Kelly CJ, Arulkumaran S, Rutherford MA, Counsell SJ, Benders MJNL. A Uniform Description of Perioperative Brain MRI Findings in Infants with Severe Congenital Heart Disease: Results of a European Collaboration. AJNR Am J Neuroradiol 2021; 42:2034-2039. [PMID: 34674999 PMCID: PMC8583253 DOI: 10.3174/ajnr.a7328] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 07/19/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND PURPOSE A uniform description of brain MR imaging findings in infants with severe congenital heart disease to assess risk factors, predict outcome, and compare centers is lacking. Our objective was to uniformly describe the spectrum of perioperative brain MR imaging findings in infants with congenital heart disease. MATERIALS AND METHODS Prospective observational studies were performed at 3 European centers between 2009 and 2019. Brain MR imaging was performed preoperatively and/or postoperatively in infants with transposition of the great arteries, single-ventricle physiology, or left ventricular outflow tract obstruction undergoing cardiac surgery within the first 6 weeks of life. Brain injury was assessed on T1, T2, DWI, SWI, and MRV. A subsample of images was assessed jointly to reach a consensus. RESULTS A total of 348 MR imaging scans (180 preoperatively, 168 postoperatively, 146 pre- and postoperatively) were obtained in 202 infants. Preoperative, new postoperative, and cumulative postoperative white matter injury was identified in 25%, 30%, and 36%; arterial ischemic stroke, in 6%, 10%, and 14%; hypoxic-ischemic watershed injury in 2%, 1%, and 1%; intraparenchymal cerebral hemorrhage, in 0%, 4%, and 5%; cerebellar hemorrhage, in 6%, 2%, and 6%; intraventricular hemorrhage, in 14%, 6%, and 13%; subdural hemorrhage, in 29%, 17%, and 29%; and cerebral sinovenous thrombosis, in 0%, 10%, and 10%, respectively. CONCLUSIONS A broad spectrum of perioperative brain MR imaging findings was found in infants with severe congenital heart disease. We propose an MR imaging protocol including T1-, T2-, diffusion-, and susceptibility-weighted imaging, and MRV to identify ischemic, hemorrhagic, and thrombotic lesions observed in this patient group.
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Affiliation(s)
- R Stegeman
- From the Departments of Neonatology (R.S., N.H.P.C., L.S.d.V., M.J.N.L.B.)
- Pediatric Intensive Care (R.S., N.H.P.C., N.J.G.J.)
- Pediatric Cardiology (R.S., N.H.P.C., J.M.P.J.B.), Wilhelmina Children's Hospital, UMC Utrecht, Utrecht, the Netherlands
- Utrecht Brain Center (R.S., L.S.d.V., M.J.N.L.B.), UMC Utrecht, Utrecht University, Utrecht, the Netherlands
| | | | - N H P Claessens
- From the Departments of Neonatology (R.S., N.H.P.C., L.S.d.V., M.J.N.L.B.)
- Pediatric Intensive Care (R.S., N.H.P.C., N.J.G.J.)
- Pediatric Cardiology (R.S., N.H.P.C., J.M.P.J.B.), Wilhelmina Children's Hospital, UMC Utrecht, Utrecht, the Netherlands
| | - N J G Jansen
- Pediatric Intensive Care (R.S., N.H.P.C., N.J.G.J.)
- Department of Pediatrics (N.J.G.J.), Beatrix Children's Hospital, UMC Groningen, Groningen, the Netherlands
| | - J M P J Breur
- Pediatric Cardiology (R.S., N.H.P.C., J.M.P.J.B.), Wilhelmina Children's Hospital, UMC Utrecht, Utrecht, the Netherlands
| | - L S de Vries
- From the Departments of Neonatology (R.S., N.H.P.C., L.S.d.V., M.J.N.L.B.)
- Utrecht Brain Center (R.S., L.S.d.V., M.J.N.L.B.), UMC Utrecht, Utrecht University, Utrecht, the Netherlands
| | - T Logeswaran
- Pediatric Heart Center (T.L., B.R.), University Hospital Giessen, Justus-Liebig-University Giessen, Giessen, Germany
| | - B Reich
- Pediatric Heart Center (T.L., B.R.), University Hospital Giessen, Justus-Liebig-University Giessen, Giessen, Germany
| | - W Knirsch
- Division of Pediatric Cardiology (W.K.), Pediatric Heart Center
| | - R Kottke
- Department of Diagnostic Imaging (R.K.)
| | - C Hagmann
- Department of Neonatology and Pediatric Intensive Care (C.H.), University Children's Hospital Zurich, Zurich, Switzerland
| | - B Latal
- Child Development Center (M.F., B.L.)
| | - J Simpson
- Department of Pediatric Cardiology (J.S., K.P.), Evelina Children's Hospital London, London, UK
| | - K Pushparajah
- Department of Pediatric Cardiology (J.S., K.P.), Evelina Children's Hospital London, London, UK
- Centre for the Developing Brain (K.P., A.F.B., C.J.K., S.A., M.A.R., S.J.C.), School of Biomedical Engineering and Imaging Sciences, King.s College London, London, UK
| | - A F Bonthrone
- Centre for the Developing Brain (K.P., A.F.B., C.J.K., S.A., M.A.R., S.J.C.), School of Biomedical Engineering and Imaging Sciences, King.s College London, London, UK
| | - C J Kelly
- Centre for the Developing Brain (K.P., A.F.B., C.J.K., S.A., M.A.R., S.J.C.), School of Biomedical Engineering and Imaging Sciences, King.s College London, London, UK
| | - S Arulkumaran
- Centre for the Developing Brain (K.P., A.F.B., C.J.K., S.A., M.A.R., S.J.C.), School of Biomedical Engineering and Imaging Sciences, King.s College London, London, UK
| | - M A Rutherford
- Centre for the Developing Brain (K.P., A.F.B., C.J.K., S.A., M.A.R., S.J.C.), School of Biomedical Engineering and Imaging Sciences, King.s College London, London, UK
| | - S J Counsell
- Centre for the Developing Brain (K.P., A.F.B., C.J.K., S.A., M.A.R., S.J.C.), School of Biomedical Engineering and Imaging Sciences, King.s College London, London, UK
| | - M J N L Benders
- From the Departments of Neonatology (R.S., N.H.P.C., L.S.d.V., M.J.N.L.B.)
- Utrecht Brain Center (R.S., L.S.d.V., M.J.N.L.B.), UMC Utrecht, Utrecht University, Utrecht, the Netherlands
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Rutherford MA, Scott J, Karabayas M, Antonelou M, Gopaluni S, Gray D, Barrett J, Brix SR, Dhaun N, McAdoo SP, Smith RM, Geddes C, Jayne D, Luqmani R, Salama AD, Little MA, Basu N. Risk Factors for Severe Outcomes in Patients With Systemic Vasculitis and COVID-19: A Binational, Registry-Based Cohort Study. Arthritis Rheumatol 2021; 73:1713-1719. [PMID: 33750043 PMCID: PMC8251299 DOI: 10.1002/art.41728] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 03/04/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVE COVID-19 is a novel infectious disease with a broad spectrum of clinical severity. Patients with systemic vasculitis have an increased risk of serious infections and may be at risk of severe outcomes following COVID-19. We undertook this study to establish the risk factors for severe COVID-19 outcomes in these patients, including the impact of immunosuppressive therapies. METHODS A multicenter cohort was developed through the participation of centers affiliated with national UK and Ireland vasculitis registries. Clinical characteristics and outcomes are described. Logistic regression was used to evaluate associations between potential risk factors and a severe COVID-19 outcome, defined as a requirement for advanced oxygen therapy, a requirement for invasive ventilation, or death. RESULTS The cohort included 65 patients with systemic vasculitis who developed COVID-19 (median age 70 years, 49% women), of whom 25 patients (38%) experienced a severe outcome. Most patients (55 of 65 [85%]) had antineutrophil cytoplasmic antibody-associated vasculitis (AAV). Almost all patients required hospitalization (59 of 65 [91%]), 7 patients (11%) were admitted to intensive care, and 18 patients (28%) died. Background glucocorticoid therapy was associated with severe outcomes (adjusted odds ratio [OR] 3.7 [95% confidence interval 1.1-14.9]; P = 0.047), as was comorbid respiratory disease (adjusted OR 7.5 [95% confidence interval 1.9-38.2]; P = 0.006). Vasculitis disease activity and nonglucocorticoid immunosuppressive therapy were not associated with severe outcomes. CONCLUSION In patients with systemic vasculitis, glucocorticoid use at presentation and comorbid respiratory disease were associated with severe outcomes in COVID-19. These data can inform clinical decision-making relating to the risk of severe COVID-19 in this vulnerable patient group.
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Affiliation(s)
| | | | | | | | | | | | | | - Silke R. Brix
- Manchester University NHS Foundation Trust and University of ManchesterManchesterUK
| | | | | | | | | | | | | | - Alan D. Salama
- University College London and Royal Free HospitalLondonUK
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Arulkumaran S, Tusor N, Chew A, Falconer S, Kennea N, Nongena P, Hajnal JV, Counsell SJ, Rutherford MA, Edwards AD. MRI Findings at Term-Corrected Age and Neurodevelopmental Outcomes in a Large Cohort of Very Preterm Infants. AJNR Am J Neuroradiol 2020; 41:1509-1516. [PMID: 32796100 DOI: 10.3174/ajnr.a6666] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 05/19/2020] [Indexed: 01/29/2023]
Abstract
BACKGROUND AND PURPOSE Brain MR imaging at term-equivalent age is a useful tool to define brain injury in preterm infants. We report pragmatic clinical radiological assessment of images from a large unselected cohort of preterm infants imaged at term and document the spectrum and frequency of acquired brain lesions and their relation to outcomes at 20 months. MATERIALS AND METHODS Infants born at <33 weeks' gestation were recruited from South and North West London neonatal units and imaged in a single center at 3T at term-equivalent age. At 20 months' corrected age, they were invited for neurodevelopmental assessment. The frequency of acquired brain lesions and the sensitivity, specificity, and negative and positive predictive values for motor, cognitive, and language outcomes were calculated, and corpus callosal thinning and ventricular dilation were qualitatively assessed. RESULTS Five hundred four infants underwent 3T MR imaging at term-equivalent age; 477 attended for assessment. Seventy-six percent of infants had acquired lesions, which included periventricular leukomalacia, hemorrhagic parenchymal infarction, germinal matrix-intraventricular hemorrhage, punctate white matter lesions, cerebellar hemorrhage, and subependymal cysts. All infants with periventricular leukomalacia, and 60% of those with hemorrhagic parenchymal infarction had abnormal motor outcomes. Routine 3T MR imaging of the brain at term-equivalent age in an unselected preterm population that demonstrates no focal lesion is 45% sensitive and 61% specific for normal neurodevelopment at 20 months and 17% sensitive and 94% specific for a normal motor outcome. CONCLUSIONS Acquired brain lesions are common in preterm infants routinely imaged at term-equivalent age, but not all predict an adverse neurodevelopmental outcome.
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Affiliation(s)
- S Arulkumaran
- From the Centre for the Developing Brain (S.A., N.T., A.C., S.F., J.V.H., S.J.C., M.A.R., A.D.E.), School of Biomedical engineering and Imaging Sciences, King's College London and Evelina London Children's Hospital, London, UK
| | - N Tusor
- From the Centre for the Developing Brain (S.A., N.T., A.C., S.F., J.V.H., S.J.C., M.A.R., A.D.E.), School of Biomedical engineering and Imaging Sciences, King's College London and Evelina London Children's Hospital, London, UK
| | - A Chew
- From the Centre for the Developing Brain (S.A., N.T., A.C., S.F., J.V.H., S.J.C., M.A.R., A.D.E.), School of Biomedical engineering and Imaging Sciences, King's College London and Evelina London Children's Hospital, London, UK
| | - S Falconer
- From the Centre for the Developing Brain (S.A., N.T., A.C., S.F., J.V.H., S.J.C., M.A.R., A.D.E.), School of Biomedical engineering and Imaging Sciences, King's College London and Evelina London Children's Hospital, London, UK
| | - N Kennea
- Neonatal Unit (N.K.), St. George's Hospital, London, UK
| | - P Nongena
- Division of Clinical Sciences (P.N.), Imperial College London, London, UK
| | - J V Hajnal
- From the Centre for the Developing Brain (S.A., N.T., A.C., S.F., J.V.H., S.J.C., M.A.R., A.D.E.), School of Biomedical engineering and Imaging Sciences, King's College London and Evelina London Children's Hospital, London, UK
| | - S J Counsell
- From the Centre for the Developing Brain (S.A., N.T., A.C., S.F., J.V.H., S.J.C., M.A.R., A.D.E.), School of Biomedical engineering and Imaging Sciences, King's College London and Evelina London Children's Hospital, London, UK
| | - M A Rutherford
- From the Centre for the Developing Brain (S.A., N.T., A.C., S.F., J.V.H., S.J.C., M.A.R., A.D.E.), School of Biomedical engineering and Imaging Sciences, King's College London and Evelina London Children's Hospital, London, UK
| | - A D Edwards
- From the Centre for the Developing Brain (S.A., N.T., A.C., S.F., J.V.H., S.J.C., M.A.R., A.D.E.), School of Biomedical engineering and Imaging Sciences, King's College London and Evelina London Children's Hospital, London, UK
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Jackson LH, Price AN, Hutter J, Ho A, Roberts TA, Slator PJ, Clough JR, Deprez M, McCabe L, Malik SJ, Chappell L, Rutherford MA, Hajnal JV. Respiration resolved imaging with continuous stable state 2D acquisition using linear frequency SWEEP. Magn Reson Med 2019; 82:1631-1645. [PMID: 31183892 PMCID: PMC6682494 DOI: 10.1002/mrm.27834] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 04/04/2019] [Accepted: 05/09/2019] [Indexed: 01/31/2023]
Abstract
Purpose To investigate the potential of continuous radiofrequency (RF) shifting (SWEEP) as a technique for creating densely sampled data while maintaining a stable signal state for dynamic imaging. Methods We present a method where a continuous stable state of magnetization is swept smoothly across the anatomy of interest, creating an efficient approach to dense multiple 2D slice imaging. This is achieved by introducing a linear frequency offset to successive RF pulses shifting the excited slice by a fraction of the slice thickness with each successive repeat times (TR). Simulations and in vivo imaging were performed to assess how this affects the measured signal. Free breathing, respiration resolved 4D volumes in fetal/placental imaging is explored as potential application of this method. Results The SWEEP method maintained a stable signal state over a full acquisition reducing artifacts from unstable magnetization. Simulations demonstrated that the effects of SWEEP on slice profiles was of the same order as that produced by physiological motion observed with conventional methods. Respiration resolved 4D data acquired with this method shows reduced respiration artifacts and resilience to non‐rigid and non‐cyclic motion. Conclusions The SWEEP method is presented as a technique for improved acquisition efficiency of densely sampled short‐TR 2D sequences. Using conventional slice excitation the number of RF pulses required to enter a true steady state is excessively high when using short‐TR 2D acquisitions, SWEEP circumvents this limitation by creating a stable signal state that is preserved between slices.
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Affiliation(s)
- L H Jackson
- Biomedical Engineering, School of Imaging Sciences and Biomedical Engineering, Kings College London, London, United Kingdom
| | - A N Price
- Biomedical Engineering, School of Imaging Sciences and Biomedical Engineering, Kings College London, London, United Kingdom
| | - J Hutter
- Biomedical Engineering, School of Imaging Sciences and Biomedical Engineering, Kings College London, London, United Kingdom
| | - A Ho
- Biomedical Engineering, School of Imaging Sciences and Biomedical Engineering, Kings College London, London, United Kingdom.,Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, United Kingdom
| | - T A Roberts
- Biomedical Engineering, School of Imaging Sciences and Biomedical Engineering, Kings College London, London, United Kingdom
| | - P J Slator
- Centre for Medical Image Computing, University College London, London, United Kingdom
| | - J R Clough
- Biomedical Engineering, School of Imaging Sciences and Biomedical Engineering, Kings College London, London, United Kingdom
| | - M Deprez
- Biomedical Engineering, School of Imaging Sciences and Biomedical Engineering, Kings College London, London, United Kingdom
| | - L McCabe
- Biomedical Engineering, School of Imaging Sciences and Biomedical Engineering, Kings College London, London, United Kingdom
| | - S J Malik
- Biomedical Engineering, School of Imaging Sciences and Biomedical Engineering, Kings College London, London, United Kingdom
| | - L Chappell
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, United Kingdom
| | - M A Rutherford
- Biomedical Engineering, School of Imaging Sciences and Biomedical Engineering, Kings College London, London, United Kingdom
| | - J V Hajnal
- Biomedical Engineering, School of Imaging Sciences and Biomedical Engineering, Kings College London, London, United Kingdom
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Pasupathy D, Denbow ML, Rutherford MA. The Combined Use of Ultrasound and Fetal Magnetic Resonance Imaging for a Comprehensive Fetal Neurological Assessment in Fetal Congenital Cardiac Defects: Scientific Impact Paper No. 60. BJOG 2019; 126:e142-e151. [PMID: 30916430 DOI: 10.1111/1471-0528.15620] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Heart problems are common in newborn babies, affecting approximately 5-10 in 1000 babies. Some are more serious than others, but most babies born with heart problems do not have other health issues. Of those babies who have a serious heart problem, almost 1 in 4 will have heart surgery in their first year. In the UK, pregnant women are offered a scan at around 20 weeks to try and spot any heart problems. In most cases there is not a clear reason for the problem, but sometimes other issues, such as genetic conditions, are discovered. In recent years the care given to these babies after they are born has improved their chances of surviving. However, it is recognised that babies born with heart problems have a risk of delays in their learning and development. This may be due to their medical condition, or as a result of surgery and complications after birth. In babies with heart problems, there is a need for more research on ultrasound and magnetic resonance imaging (MRI) to understand how the brain develops and why these babies are more likely to have delays in learning and development. This paper discusses the way ultrasound and MRI are used in assessing the baby's brain. Ultrasound is often used to spot any problems, looking at how the baby's brain develops in pregnancy. Advances in ultrasound technologies have made this easier. MRI is well-established and safe in pregnancy, and if problems in the brain have been seen on ultrasound, MRI may be used to look at these problems in more detail. While it is not always clear what unusual MRI findings can mean for the baby in the long term, increased understanding may mean parents can be given more information about possible outcomes for the baby and may help to improve the counselling they are offered before their baby's birth.
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Lee C, Guinan JJ, Rutherford MA, Kaf WA, Kennedy KM, Buchman CA, Salt AN, Lichtenhan JT. Cochlear compound action potentials from high-level tone bursts originate from wide cochlear regions that are offset toward the most sensitive cochlear region. J Neurophysiol 2019; 121:1018-1033. [PMID: 30673362 DOI: 10.1152/jn.00677.2018] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Little is known about the spatial origins of auditory nerve (AN) compound action potentials (CAPs) evoked by moderate to intense sounds. We studied the spatial origins of AN CAPs evoked by 2- to 16-kHz tone bursts at several sound levels by slowly injecting kainic acid solution into the cochlear apex of anesthetized guinea pigs. As the solution flowed from apex to base, it sequentially reduced CAP responses from low- to high-frequency cochlear regions. The times at which CAPs were reduced, combined with the cochlear location traversed by the solution at that time, showed the cochlear origin of the removed CAP component. For low-level tone bursts, the CAP origin along the cochlea was centered at the characteristic frequency (CF). As sound level increased, the CAP center shifted basally for low-frequency tone bursts but apically for high-frequency tone bursts. The apical shift was surprising because it is opposite the shift expected from AN tuning curve and basilar membrane motion asymmetries. For almost all high-level tone bursts, CAP spatial origins extended over 2 octaves along the cochlea. Surprisingly, CAPs evoked by high-level low-frequency (including 2 kHz) tone bursts showed little CAP contribution from CF regions ≤ 2 kHz. Our results can be mostly explained by spectral splatter from the tone-burst rise times, excitation in AN tuning-curve "tails," and asynchronous AN responses to high-level energy ≤ 2 kHz. This is the first time CAP origins have been identified by a spatially specific technique. Our results show the need for revising the interpretation of the cochlear origins of high-level CAPs-ABR wave 1. NEW & NOTEWORTHY Cochlear compound action potentials (CAPs) and auditory brain stem responses (ABRs) are routinely used in laboratories and clinics. They are typically interpreted as arising from the cochlear region tuned to the stimulus frequency. However, as sound level is increased, the cochlear origins of CAPs from tone bursts of all frequencies become very wide and their centers shift toward the most sensitive cochlear region. The standard interpretation of CAPs and ABRs from moderate to intense stimuli needs revision.
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Affiliation(s)
- C Lee
- Department of Otolaryngology, Washington University School of Medicine in St. Louis , St. Louis, Missouri
| | - J J Guinan
- Eaton-Peabody Laboratories, Massachusetts Eye and Ear, and Department of Otolaryngology, Harvard Medical School , Boston, Massachusetts
| | - M A Rutherford
- Department of Otolaryngology, Washington University School of Medicine in St. Louis , St. Louis, Missouri
| | - W A Kaf
- Communication Sciences and Disorders Department, Missouri State University , Springfield, Missouri
| | - K M Kennedy
- Department of Otolaryngology, Washington University School of Medicine in St. Louis , St. Louis, Missouri.,Communication Sciences and Disorders Department, Missouri State University , Springfield, Missouri
| | - C A Buchman
- Department of Otolaryngology, Washington University School of Medicine in St. Louis , St. Louis, Missouri
| | - A N Salt
- Department of Otolaryngology, Washington University School of Medicine in St. Louis , St. Louis, Missouri
| | - J T Lichtenhan
- Department of Otolaryngology, Washington University School of Medicine in St. Louis , St. Louis, Missouri
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Hayat TTA, Martinez-Biarge M, Kyriakopoulou V, Hajnal JV, Rutherford MA. Neurodevelopmental Correlates of Fetal Motor Behavior Assessed Using Cine MR Imaging. AJNR Am J Neuroradiol 2018; 39:1519-1522. [PMID: 29880478 DOI: 10.3174/ajnr.a5694] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 04/11/2018] [Indexed: 01/16/2023]
Abstract
BACKGROUND AND PURPOSE Fetal motor behavior is widely used as a clinical indicator for healthy development; however, our understanding of its potential as a marker for neurologic integrity is underdeveloped. MR imaging allows complete views of the whole fetus, which, combined with brain imaging, may improve the characterization of this relationship. This study aimed to combine an analysis of fetal motor behavior, brain MR imaging, and postnatal outcome, to provide insight into neurodevelopmental correlates of motor behavior. MATERIALS AND METHODS Cine MR imaging was used to acquire sequences of fetal motor behavior in subjects with normal and abnormal findings on conventional brain MR imaging between 18 weeks' gestation and term. General movement sequences were analyzed using established criteria. Brain MR imaging was reported by an expert fetal neuroradiologist. Subjects were followed for up to 4 years postnatally with standard postnatal assessments. RESULTS Nineteen of 21 fetuses with normal brain MR imaging findings showed normal general movements, compared with 14 of 22 of the fetuses with abnormal brain MR imaging findings, which, when classified by severity of the malformation, showed a significant relationship with postnatal outcome (P = .021). There was a significant relationship among neurodevelopmental outcome, general movement quality, and MR imaging of the brain (P = .020). CONCLUSIONS The findings from this study demonstrate that a combined structural and functional imaging approach to the fetus will improve the characterization of early neurologic integrity, with the potential to inform postnatal outcome. This also lays the groundwork for further in vivo research as advanced imaging techniques are developed to study fetal neurologic development.
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Affiliation(s)
- T T A Hayat
- From the Centre for the Developing Brain (T.T.A.H., V.K., J.V.H., M.A.R.), Perinatal Imaging and Health, Imaging Sciences & Biomedical Engineering Division, King's College London, London, UK
| | - M Martinez-Biarge
- Department of Paediatrics (M.M.-B.), Hammersmith Hospital, Imperial College London, London, UK
| | - V Kyriakopoulou
- From the Centre for the Developing Brain (T.T.A.H., V.K., J.V.H., M.A.R.), Perinatal Imaging and Health, Imaging Sciences & Biomedical Engineering Division, King's College London, London, UK
| | - J V Hajnal
- From the Centre for the Developing Brain (T.T.A.H., V.K., J.V.H., M.A.R.), Perinatal Imaging and Health, Imaging Sciences & Biomedical Engineering Division, King's College London, London, UK
| | - M A Rutherford
- From the Centre for the Developing Brain (T.T.A.H., V.K., J.V.H., M.A.R.), Perinatal Imaging and Health, Imaging Sciences & Biomedical Engineering Division, King's College London, London, UK
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Lockwood Estrin G, Kyriakopoulou V, Makropoulos A, Ball G, Kuhendran L, Chew A, Hagberg B, Martinez-Biarge M, Allsop J, Fox M, Counsell SJ, Rutherford MA. Altered white matter and cortical structure in neonates with antenatally diagnosed isolated ventriculomegaly. Neuroimage Clin 2016; 11:139-148. [PMID: 26937382 PMCID: PMC4753810 DOI: 10.1016/j.nicl.2016.01.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 01/05/2016] [Accepted: 01/12/2016] [Indexed: 12/31/2022]
Abstract
Ventriculomegaly (VM) is the most common central nervous system abnormality diagnosed antenatally, and is associated with developmental delay in childhood. We tested the hypothesis that antenatally diagnosed isolated VM represents a biological marker for altered white matter (WM) and cortical grey matter (GM) development in neonates. 25 controls and 21 neonates with antenatally diagnosed isolated VM had magnetic resonance imaging at 41.97(± 2.94) and 45.34(± 2.14) weeks respectively. T2-weighted scans were segmented for volumetric analyses of the lateral ventricles, WM and cortical GM. Diffusion tensor imaging (DTI) measures were assessed using voxel-wise methods in WM and cortical GM; comparisons were made between cohorts. Ventricular and cortical GM volumes were increased, and WM relative volume was reduced in the VM group. Regional decreases in fractional anisotropy (FA) and increases in mean diffusivity (MD) were demonstrated in WM of the VM group compared to controls. No differences in cortical DTI metrics were observed. At 2 years, neurodevelopmental delays, especially in language, were observed in 6/12 cases in the VM cohort. WM alterations in isolated VM cases may be consistent with abnormal development of WM tracts involved in language and cognition. Alterations in WM FA and MD may represent neural correlates for later neurodevelopmental deficits. This study compared brain development in neonates with isolated VM to controls. Neonates with isolated VM have enlarged cortical volumes compared to controls. FA was reduced and MD was increased in the WM of the VM cohort. Children with antenatal isolated VM are at increased risk for language delay.
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Affiliation(s)
- G Lockwood Estrin
- Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, King's College London, King's Health Partners, St. Thomas' Hospital, London SE1 7EH, United Kingdom; Robert Steiner Unit, Imaging Sciences Department, MRC Clinical Sciences Centre, Hammersmith Hospital, Imperial College London, London W12 0HS, United Kingdom
| | - V Kyriakopoulou
- Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, King's College London, King's Health Partners, St. Thomas' Hospital, London SE1 7EH, United Kingdom
| | - A Makropoulos
- Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, King's College London, King's Health Partners, St. Thomas' Hospital, London SE1 7EH, United Kingdom
| | - G Ball
- Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, King's College London, King's Health Partners, St. Thomas' Hospital, London SE1 7EH, United Kingdom
| | - L Kuhendran
- Robert Steiner Unit, Imaging Sciences Department, MRC Clinical Sciences Centre, Hammersmith Hospital, Imperial College London, London W12 0HS, United Kingdom
| | - A Chew
- Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, King's College London, King's Health Partners, St. Thomas' Hospital, London SE1 7EH, United Kingdom; Robert Steiner Unit, Imaging Sciences Department, MRC Clinical Sciences Centre, Hammersmith Hospital, Imperial College London, London W12 0HS, United Kingdom
| | - B Hagberg
- Robert Steiner Unit, Imaging Sciences Department, MRC Clinical Sciences Centre, Hammersmith Hospital, Imperial College London, London W12 0HS, United Kingdom; Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Kungsgatan 12, 411 18 Gothenburg, Sweden
| | - M Martinez-Biarge
- Robert Steiner Unit, Imaging Sciences Department, MRC Clinical Sciences Centre, Hammersmith Hospital, Imperial College London, London W12 0HS, United Kingdom
| | - J Allsop
- Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, King's College London, King's Health Partners, St. Thomas' Hospital, London SE1 7EH, United Kingdom
| | - M Fox
- Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, King's College London, King's Health Partners, St. Thomas' Hospital, London SE1 7EH, United Kingdom
| | - S J Counsell
- Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, King's College London, King's Health Partners, St. Thomas' Hospital, London SE1 7EH, United Kingdom
| | - M A Rutherford
- Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, King's College London, King's Health Partners, St. Thomas' Hospital, London SE1 7EH, United Kingdom
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11
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Wright R, Makropoulos A, Kyriakopoulou V, Patkee PA, Koch LM, Rutherford MA, Hajnal JV, Rueckert D, Aljabar P. Construction of a fetal spatio-temporal cortical surface atlas from in utero MRI: Application of spectral surface matching. Neuroimage 2015; 120:467-80. [PMID: 26070259 DOI: 10.1016/j.neuroimage.2015.05.087] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 05/15/2015] [Accepted: 05/18/2015] [Indexed: 02/01/2023] Open
Abstract
In this study, we construct a spatio-temporal surface atlas of the developing cerebral cortex, which is an important tool for analysing and understanding normal and abnormal cortical development. In utero Magnetic Resonance Imaging (MRI) of 80 healthy fetuses was performed, with a gestational age range of 21.7 to 38.9 weeks. Topologically correct cortical surface models were extracted from reconstructed 3D MRI volumes. Accurate correspondences were obtained by applying a joint spectral analysis to cortices for sets of subjects close to a specific age. Sulcal alignment was found to be accurate in comparison to spherical demons, a state of the art registration technique for aligning 2D cortical representations (average Fréchet distance≈0.4 mm at 30 weeks). We construct consistent, unbiased average cortical surface templates, for each week of gestation, from age-matched groups of surfaces by applying kernel regression in the spectral domain. These were found to accurately capture the average cortical shape of individuals within the cohort, suggesting a good alignment of cortical geometry. Each spectral embedding and its corresponding cortical surface template provide a dual reference space where cortical geometry is aligned and a vertex-wise morphometric analysis can be undertaken.
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Affiliation(s)
- R Wright
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London SW7 2AZ, UK.
| | - A Makropoulos
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London SW7 2AZ, UK
| | - V Kyriakopoulou
- Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, King's College London, King's Health Partners, St. Thomas' Hospital, London SE1 7EH, UK
| | - P A Patkee
- Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, King's College London, King's Health Partners, St. Thomas' Hospital, London SE1 7EH, UK
| | - L M Koch
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London SW7 2AZ, UK
| | - M A Rutherford
- Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, King's College London, King's Health Partners, St. Thomas' Hospital, London SE1 7EH, UK
| | - J V Hajnal
- Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, King's College London, King's Health Partners, St. Thomas' Hospital, London SE1 7EH, UK
| | - D Rueckert
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London SW7 2AZ, UK
| | - P Aljabar
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London SW7 2AZ, UK; Department of Biomedical Engineering, Division of Imaging Sciences and Biomedical Engineering, King's College London, King's Health Partners, St. Thomas' Hospital, London SE1 7EH, UK
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12
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Rutherford MA, Rankin AJ, Yates TM, Mark PB, Perry CG, Reed NS, Freel EM. Management of metastatic phaeochromocytoma and paraganglioma: use of iodine-131-meta-iodobenzylguanidine therapy in a tertiary referral centre. QJM 2015; 108:361-8. [PMID: 25267727 DOI: 10.1093/qjmed/hcu208] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Phaeochromocytoma (phaeo) and paraganglioma (PGL) are rare conditions, which are malignant in up to 30%. Optimal treatment is controversial, but in patients with metastatic iodine-131-meta-iodobenzylguanidine ((123)I-MIBG) avid tumours, we offer (131)I-MIBG therapy. We summarize response rates, survival and safety in a cohort of such patients treated with (131)I-MIBG in our centre from 1986 to 2012. DESIGN/METHODS Retrospective analysis of the case notes of patients with metastatic phaeo/PGL who received (131)I-MIBG was undertaken; patients underwent clinical, biochemical and radiological evaluation within 6 months of each course of (131)I-MIBG therapy. RESULTS Twenty-two patients (9 males) were identified, 12 with metastatic PGL and 10 with phaeo. Overall median follow-up time after first dose of (131)I-MIBG was 53 months. In total, 68 doses of (131)I-MIBG were administered; average dose was 9967 MBq (269.4 mCi). After the first dose, >50% of patients demonstrated disease stability or partial response; progressive disease was seen in 9%. A subset of patients underwent repeated treatment with the majority demonstrating partial response or stable disease. No life-threatening adverse events were reported, but three patients developed hypothyroidism and two developed ovarian failure after repeated dosing. Five-year survival after original diagnosis was 68% and median (+inter quartile range) survival from date of diagnosis was 17 years (7.6-26.4) with no difference in survival according to diagnosis (P < 0.1). CONCLUSIONS (131)I-MIBG is well tolerated and associates with disease stabilization or improvement in the majority of patients with metastatic phaeo/PGL. However, stronger conclusions on treatment effectiveness are limited by lack of a directly comparable 'control group' as well as an alternative 'gold standard' treatment.
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Affiliation(s)
- M A Rutherford
- From the Department of Endocrinology, Western Infirmary, Dumbarton Road, Glasgow G11 6NT, UK, Institute of Cardiovascular & Medical Sciences, University of Glasgow, 126 University Place, Glasgow G12 8TA, UK and Beatson West of Scotland Oncology Centre, Gartnavel General Hospital, 1053 Great Western Road, Glasgow G12 0YN, UK
| | - A J Rankin
- From the Department of Endocrinology, Western Infirmary, Dumbarton Road, Glasgow G11 6NT, UK, Institute of Cardiovascular & Medical Sciences, University of Glasgow, 126 University Place, Glasgow G12 8TA, UK and Beatson West of Scotland Oncology Centre, Gartnavel General Hospital, 1053 Great Western Road, Glasgow G12 0YN, UK
| | - T M Yates
- From the Department of Endocrinology, Western Infirmary, Dumbarton Road, Glasgow G11 6NT, UK, Institute of Cardiovascular & Medical Sciences, University of Glasgow, 126 University Place, Glasgow G12 8TA, UK and Beatson West of Scotland Oncology Centre, Gartnavel General Hospital, 1053 Great Western Road, Glasgow G12 0YN, UK
| | - P B Mark
- From the Department of Endocrinology, Western Infirmary, Dumbarton Road, Glasgow G11 6NT, UK, Institute of Cardiovascular & Medical Sciences, University of Glasgow, 126 University Place, Glasgow G12 8TA, UK and Beatson West of Scotland Oncology Centre, Gartnavel General Hospital, 1053 Great Western Road, Glasgow G12 0YN, UK
| | - C G Perry
- From the Department of Endocrinology, Western Infirmary, Dumbarton Road, Glasgow G11 6NT, UK, Institute of Cardiovascular & Medical Sciences, University of Glasgow, 126 University Place, Glasgow G12 8TA, UK and Beatson West of Scotland Oncology Centre, Gartnavel General Hospital, 1053 Great Western Road, Glasgow G12 0YN, UK
| | - N S Reed
- From the Department of Endocrinology, Western Infirmary, Dumbarton Road, Glasgow G11 6NT, UK, Institute of Cardiovascular & Medical Sciences, University of Glasgow, 126 University Place, Glasgow G12 8TA, UK and Beatson West of Scotland Oncology Centre, Gartnavel General Hospital, 1053 Great Western Road, Glasgow G12 0YN, UK
| | - E M Freel
- From the Department of Endocrinology, Western Infirmary, Dumbarton Road, Glasgow G11 6NT, UK, Institute of Cardiovascular & Medical Sciences, University of Glasgow, 126 University Place, Glasgow G12 8TA, UK and Beatson West of Scotland Oncology Centre, Gartnavel General Hospital, 1053 Great Western Road, Glasgow G12 0YN, UK From the Department of Endocrinology, Western Infirmary, Dumbarton Road, Glasgow G11 6NT, UK, Institute of Cardiovascular & Medical Sciences, University of Glasgow, 126 University Place, Glasgow G12 8TA, UK and Beatson West of Scotland Oncology Centre, Gartnavel General Hospital, 1053 Great Western Road, Glasgow G12 0YN, UK
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13
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Abstract
Neonatal stroke encompasses a range of focal and multifocal ischaemic and haemorrhagic tissue injuries. This review will concentrate on focal brain injury that occurs as a consequence of arterial infarction, most frequently the left middle cerebral artery, or more rarely as a consequence of cerebral sinus venous thrombosis (CSVT). Both conditions are multifactorial in origin. The incidence of both acquired and genetic thrombophilic disorders in both mothers and infants is high although rarely causal in isolation. Neurodevelopmental morbidity occurs in over 50% of children. Specific therapy in the form of anticoagulation is currently only recommended in CSVT and needs to be carefully monitored in the presence of haemorrhage.
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Affiliation(s)
- M A Rutherford
- Imaging Sciences Department, Imperial College and MRC Clinical Sciences Centre, Hammersmith Hospital, London, UK.
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14
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Malamateniou C, Malik SJ, Counsell SJ, Allsop JM, McGuinness AK, Hayat T, Broadhouse K, Nunes RG, Ederies AM, Hajnal JV, Rutherford MA. Motion-compensation techniques in neonatal and fetal MR imaging. AJNR Am J Neuroradiol 2012; 34:1124-36. [PMID: 22576885 DOI: 10.3174/ajnr.a3128] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
SUMMARY Fetal and neonatal MR imaging is increasingly used as a complementary diagnostic tool to sonography. MR imaging is an ideal technique for imaging fetuses and neonates because of the absence of ionizing radiation, the superior contrast of soft tissues compared with sonography, the availability of different contrast options, and the increased FOV. Motion in the normally mobile fetus and the unsettled, sleeping, or sedated neonate during a long acquisition will decrease image quality in the form of motion artifacts, hamper image interpretation, and often necessitate a repeat MR imaging to establish a diagnosis. This article reviews current techniques of motion compensation in fetal and neonatal MR imaging, including the following: 1) motion-prevention strategies (such as adequate patient preparation, patient coaching, and sedation, when required), 2) motion-artifacts minimization methods (such as fast imaging protocols, data undersampling, and motion-resistant sequences), and 3) motion-detection/correction schemes (such as navigators and self-navigated sequences, external motion-tracking devices, and postprocessing approaches) and their application in fetal and neonatal brain MR imaging. Additionally some background on the repertoire of motion of the fetal and neonatal patient and the resulting artifacts will be presented, as well as insights into future developments and emerging techniques of motion compensation.
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Affiliation(s)
- C Malamateniou
- Robert Steiner MRI Unit, Imaging Sciences Department, Hammersmith Hospital Campus, Imperial College London, London, United Kingdom.
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15
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Aljabar P, Wolz R, Srinivasan L, Counsell SJ, Rutherford MA, Edwards AD, Hajnal JV, Rueckert D. A combined manifold learning analysis of shape and appearance to characterize neonatal brain development. IEEE Trans Med Imaging 2011; 30:2072-2086. [PMID: 21788184 DOI: 10.1109/tmi.2011.2162529] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Large medical image datasets form a rich source of anatomical descriptions for research into pathology and clinical biomarkers. Many features may be extracted from data such as MR images to provide, through manifold learning methods, new representations of the population's anatomy. However, the ability of any individual feature to fully capture all aspects morphology is limited. We propose a framework for deriving a representation from multiple features or measures which can be chosen to suit the application and are processed using separate manifold-learning steps. The results are then combined to give a single set of embedding coordinates for the data. We illustrate the framework in a population study of neonatal brain MR images and show how consistent representations, correlating well with clinical data, are given by measures of shape and of appearance. These particular measures were chosen as the developing neonatal brain undergoes rapid changes in shape and MR appearance and were derived from extracted cortical surfaces, nonrigid deformations, and image similarities. Combined single embeddings show improved correlations demonstrating their benefit for further studies such as identifying patterns in the trajectories of brain development. The results also suggest a lasting effect of age at birth on brain morphology, coinciding with previous clinical studies.
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Affiliation(s)
- P Aljabar
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, SW7 2AZ London, U.K.
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16
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Martinez-Biarge M, Diez-Sebastian J, Kapellou O, Gindner D, Allsop JM, Rutherford MA, Cowan FM. Predicting motor outcome and death in term hypoxic-ischemic encephalopathy. Neurology 2011; 76:2055-61. [PMID: 21670434 DOI: 10.1212/wnl.0b013e31821f442d] [Citation(s) in RCA: 175] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Central gray matter damage, the hallmark of term acute perinatal hypoxia-ischemia, frequently leads to severe cerebral palsy and sometimes death. The precision with which these outcomes can be determined from neonatal imaging has not been fully explored. We evaluated the accuracy of early brain MRI for predicting death, the presence and severity of motor impairment, and ability to walk at 2 years in term infants with hypoxic-ischemic encephalopathy (HIE) and basal ganglia-thalamic (BGT) lesions. METHODS From 1993 to 2007, 175 term infants with evidence of perinatal asphyxia, HIE, and BGT injury seen on early MRI scans were studied. BGT, white matter, posterior limb of the internal capsule (PLIC), and cortex and brainstem abnormality were classified by severity. Motor impairment was staged using the Gross Motor Function Classification System. RESULTS The severity of BGT lesions was strongly associated with the severity of motor impairment (Spearman rank correlation 0.77; p < 0.001). The association between white matter, cortical, and brainstem injury and motor impairment was less strong and only BGT injury correlated significantly in a logistic regression model. The predictive accuracy of severe BGT lesions for severe motor impairment was 0.89 (95% confidence interval 0.83-0.96). Abnormal PLIC signal intensity predicted the inability to walk independently by 2 years (sensitivity 0.92, specificity 0.77, positive predictive value 0.88, negative predictive value 0.85). Brainstem injury was the only factor with an independent association with death. CONCLUSION We have shown that in term newborns with HIE and BGT injury, early MRI can be used to predict death and specific motor outcomes.
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Hayat TTA, Nihat A, Martinez-Biarge M, McGuinness A, Allsop JM, Hajnal JV, Rutherford MA. Optimization and initial experience of a multisection balanced steady-state free precession cine sequence for the assessment of fetal behavior in utero. AJNR Am J Neuroradiol 2011; 32:331-8. [PMID: 21087938 PMCID: PMC7965695 DOI: 10.3174/ajnr.a2295] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2010] [Accepted: 07/15/2010] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The assessment of motor function is an essential component of neurologic examinations, which imaging studies have extended to the fetus. US assessment is hampered by a limited FOV, whereas MR imaging has the potential to be an alternative. Our objectives were to optimize a cine MR imaging sequence for capturing fetal movements and to perform a pilot analysis of the relationship between the frequency of movements and uterine spatial constrictions in healthy fetuses. MATERIALS AND METHODS Initially, a bSSFP cine sequence was selected for optimization, and various compromises were explored in all acquisition parameters to achieve an effective balance between anatomic coverage of the fetus and the temporal resolution of cine data, with the aim of maximizing both. Subsequently, cross-sectional qualitative and quantitative analyses of fetal movements were performed prospectively by using a cohort of 37 healthy fetuses (median GA, 29 weeks; range, 20-37 weeks) with the optimized cine protocol. Two smaller subgroups were selected for representative sampling of overall behavior patterns by using cine data of longer duration and for volumetric quantification of free intrauterine space. RESULTS The optimized cine sequence, with TR/TE of 3.21/1.59 ms, coupled with parallel imaging and partial-Fourier imaging, resulted in a section-acquisition time of 0.303 seconds. Anatomic coverage was enhanced by using a combination of thick sagittal sections (30-40 mm) and multisection acquisitions to display movements in all fetal limbs, head, and trunk simultaneously. All expected motor patterns were observed throughout this gestational period, and a significant decreasing trend in overall movement frequency with age was demonstrated (r = -0.514, P = .0011). Also a significant negative correlation was found between overall movement frequency and the total intrauterine free space (r = -0.703, P = .0001). Furthermore, a significant decrease in the frequency of leg movements was shown in fetuses older then 30 weeks' GA compared with those younger than that (P = .015). CONCLUSIONS Cine MR imaging is effective for observing fetal movements from midgestation with near full-body coverage. Also, reductions in free space with increasing GA appear to be a factor in the gradual reductions in overall levels of fetal activity as well as in restrictions in movement within specific regions of the fetal anatomy.
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Affiliation(s)
- T T A Hayat
- Perinatal Imaging Group, MRC Clinical Sciences Centre, Hammersmith Hospital, London, United Kingdom.
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18
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Boardman JP, Craven C, Valappil S, Counsell SJ, Dyet LE, Rueckert D, Aljabar P, Rutherford MA, Chew ATM, Allsop JM, Cowan F, Edwards AD. A common neonatal image phenotype predicts adverse neurodevelopmental outcome in children born preterm. Neuroimage 2010; 52:409-14. [PMID: 20451627 DOI: 10.1016/j.neuroimage.2010.04.261] [Citation(s) in RCA: 129] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2009] [Revised: 04/05/2010] [Accepted: 04/28/2010] [Indexed: 11/17/2022] Open
Affiliation(s)
- J P Boardman
- Institute of Clinical Sciences, Imperial College London and MRC Clinical Sciences Centre, Hammersmith Hospital, Du Cane Road, London W12 0NN, UK.
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Poretti A, Huisman TAGM, Cowan FM, Del Giudice E, Jeannet PY, Prayer D, Rutherford MA, du Plessis AJ, Limperopoulos C, Boltshauser E. Cerebellar cleft: confirmation of the neuroimaging pattern. Neuropediatrics 2009; 40:228-33. [PMID: 20221959 DOI: 10.1055/s-0030-1248265] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
We recently described the neuroimaging and clinical findings in 6 children with cerebellar clefts and proposed that they result from disruptive changes following prenatal cerebellar hemorrhage. We now report an additional series of 9 patients analyzing the clinical and neuroimaging findings. The clefts were located in the left cerebellar hemisphere in 5 cases, in the right in 3, and bilaterally in one child who had bilateral cerebellar hemorrhages as a preterm infant at 30 weeks gestation. In one patient born at 24 weeks of gestation a unilateral cerebellar hemorrhage has been found at the age of 4 months. Other findings included disordered alignment of the folia and fissures, an irregular gray/white matter junction, and abnormal arborization of the white matter in all cases. Supratentorial abnormalities were found in 4 cases. All but 2 patients were born at term. We confirm the distinct neuroimaging pattern of cerebellar clefts. Considering the documented fetal cerebellar hemorrhage in our first series, we postulate that cerebellar clefts usually represent residual disruptive changes after a prenatal cerebellar hemorrhage. Exceptionally, as now documented in 2 patients, cerebellar clefts can be found after neonatal cerebellar hemorrhages in preterm infants. The short-term outcome in these children was variable.
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Affiliation(s)
- A Poretti
- Department of Pediatric Neurology, University Children's Hospital of Zurich, Zurich, Switzerland.
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20
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Malamateniou C, Adams ME, Srinivasan L, Allsop JM, Counsell SJ, Cowan FM, Hajnal JV, Rutherford MA. The anatomic variations of the circle of Willis in preterm-at-term and term-born infants: an MR angiography study at 3T. AJNR Am J Neuroradiol 2009; 30:1955-62. [PMID: 19643922 DOI: 10.3174/ajnr.a1724] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE It has been shown that the brain of a preterm infant develops differently from that of a term infant, but little is known about the neonatal cerebrovascular anatomy. Our aims were to establish reference data for the prevalence of the anatomic variations of the neonatal circle of Willis (CoW) and to explore the effect of prematurity, MR imaging abnormality, vascular-related abnormality, laterality, and sex on these findings. MATERIALS AND METHODS We scanned 103 infants with an optimized MR angiography (MRA) protocol. Images were analyzed for different variations of the CoW, and results were compared for the following: 1) preterm-at-term and term-born infants, 2) infants with normal and abnormal MR imaging, 3) infants with and without a vascular-related abnormality, 4) boys and girls, and 5) left- and right-sided occurrence. RESULTS The most common anatomic variation was absence/hypoplasia of the posterior communicating artery. Preterm infants at term had a higher prevalence of a complete CoW and a lower prevalence of anatomic variations compared with term-born infants; this finding was significant for the anterior cerebral artery (P = .02). There was increased prevalence of variations of the major cerebral arteries in those infants with vascular-related abnormalities, statistically significant for the posterior cerebral artery (P = .004). There was no statistically significant difference between boys and girls and left/right variations. CONCLUSIONS Prematurity is associated with more complete CoWs and fewer anatomic variations. In vascular-related abnormalities, more variations involved major arterial segments, but fewer variations occurred in the communicating arteries. Overall reference values of the variations match those of the general adult population.
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Affiliation(s)
- C Malamateniou
- Department of Imaging Sciences, Imperial College London, London, UK.
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21
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Dudink J, Mercuri E, Al-Nakib L, Govaert P, Counsell SJ, Rutherford MA, Cowan FM. Evolution of unilateral perinatal arterial ischemic stroke on conventional and diffusion-weighted MR imaging. AJNR Am J Neuroradiol 2009; 30:998-1004. [PMID: 19193752 DOI: 10.3174/ajnr.a1480] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND PURPOSE Knowledge of the sequence of signal-intensity (SI) changes on conventional and diffusion-weighted MR imaging (DWI) following perinatal arterial ischemic stroke (PAIS) is limited, adding to the difficulty in timing the onset of PAIS. We hypothesized that SI changes seen on early sequential MR imaging following PAIS should follow a similar time course. The aim of this study was to evaluate the time course of SI changes by using a simple classification that could be assessed visually from conventional imaging and DWI in term-born neonates with symptomatic unilateral PAIS. MATERIALS AND METHODS Infants > or =36 weeks gestation with unilateral PAIS in the territory of a main cerebral artery with a first MR imaging performed within the first postnatal month were included in this study. All subsequent scans up to 3 months postnatal age were also evaluated. For the conventional MR imaging scans, a visual SI scoring system was used (-1 = lower, 0 = equal, 1 = higher) compared with the contralesional hemisphere. For the DWIs, SI of the infarcted tissue was classified into the 3 groups: 1) severe hyperintensity (HI), 2) moderate and mild HI, and 3) no HI. RESULTS We analyzed 43 scans (mean age at first scanning, 4 days) from 21 term infants. Changes in SI on conventional T1 and T2 images were remarkably consistent among infants. The cortex was of low SI on T1 and high SI on T2 until day 6 when SIs reversed and cortical highlighting was seen for 1-2 months. The white matter was high SI on T1 in the first 8-9 days and on T2 for >2 weeks before becoming low SI. Secondary SI changes remote from the infarction were seen in the thalamus and brain stem in the first week, and atrophy was seen after 4 weeks. All DWIs showed high SI of the affected region until at least day 4, which fell to equal or below that of the contralesional hemisphere by day 12. CONCLUSIONS The pattern of SI change on conventional imaging and DWI following PAIS was remarkably consistent among patients, suggesting that PAIS in symptomatic term-born infants occurs within a very limited timeframe around birth.
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Affiliation(s)
- J Dudink
- Robert Steiner MR Unit, Imaging Sciences Department, Medical Research Council Clinical Sciences Centre, Hammersmith Campus, Imperial College London, UK. j.dudink@ erasmusmc.nl
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Foran A, Cinnante C, Groves A, Azzopardi DV, Rutherford MA, Cowan FM. Patterns of brain injury and outcome in term neonates presenting with postnatal collapse. Arch Dis Child Fetal Neonatal Ed 2009; 94:F168-77. [PMID: 18981034 DOI: 10.1136/adc.2008.140301] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To document perinatal events, brain imaging, neurophysiology and clinical outcome in term infants with early postnatal collapse (PNC). DESIGN Tertiary referral centre, retrospective case review (1993-2006). PATIENTS Infants born at > or =36 weeks' gestation with early (<72 h) PNC. Peri-partum and post-collapse data were collated with clinical, electrophysiological, neuroimaging and autopsy data and neurodevelopmental outcome. RESULTS Twelve infants were studied; median gestation 39 weeks (36-41), birth weight 3150 g (1930-4010). Ten were born vaginally (including occipitoposterior (1), breech (2), water birth (2), ventouse/forceps (3)), and two by emergency caesarean section. Median Apgar scores were 9 (3-9) and 10 (8-10) at 1 and 5 min; median cord pH was 7.29 (7.18-7.34). All were thought to be well after birth. The median age at PNC was 75 min (10 min to 55 h). All infants required extensive resuscitation. The median pH after PNC was 6.75 (6.39-7.05). Seven infants became severely encephalopathic, with severely abnormal EEG/aEEG recorded within 12 h. MRI showed acute severe hypoxic-ischaemic injury. All died. One infant showed rapid recovery, had mild encephalopathy, and good outcome. Four infants had severe respiratory illness, normal background EEG, and MRI showing slight white matter change (n = 3) or a small infarction (n = 1). All had a good 2-year outcome. CONCLUSIONS In this term cohort, early PNC was generally followed by severe encephalopathy, acute central grey matter injury and poor outcome, or severe respiratory illness, slight white matter change and good outcome. Early EEG and MRI predicted outcome accurately. However, no antepartum, intrapartum or other aetiological factors were identified. Further investigation is needed in larger PNC cohorts.
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Affiliation(s)
- A Foran
- Imaging Sciences Department, Imperial College, London, UK
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23
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O’Donoghue K, Rutherford MA, Engineer N, Wimalasundera RC, Cowan FM, Fisk NM. Transfusional fetal complications after single intrauterine death in monochorionic multiple pregnancy are reduced but not prevented by vascular occlusion. BJOG 2009; 116:804-12. [DOI: 10.1111/j.1471-0528.2009.02128.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Dudink J, Larkman DJ, Kapellou O, Boardman JP, Allsop JM, Cowan FM, Hajnal JV, Edwards AD, Rutherford MA, Counsell SJ. High b-value diffusion tensor imaging of the neonatal brain at 3T. AJNR Am J Neuroradiol 2008; 29:1966-72. [PMID: 18687746 DOI: 10.3174/ajnr.a1241] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Diffusion-weighted MR imaging studies of the adult brain have shown that contrast between lesions and normal tissue is increased at high b-values. We designed a prospective study to test the hypothesis that diffusion tensor imaging (DTI) obtained at high b-values increases image contrast and lesion conspicuity in the neonatal brain. MATERIALS AND METHODS We studied 17 neonates, median (range) age of 10 (2-96) days, who were undergoing MR imaging for clinical indications. DTI was performed on a Philips 3T Intera system with b-values of 350, 700, 1500, and 3000 s/mm(2). Image contrast and lesion conspicuity at each b-value were visually assessed. In addition, regions of interest were positioned in the central white matter at the level of the centrum semiovale, frontal and occipital white matter, splenium of the corpus callosum, posterior limb of the internal capsule, and the thalamus. Apparent diffusion coefficient (ADC) and fractional anisotropy (FA) values for these regions were calculated. RESULTS Isotropic diffusion image contrast and lesion-to-normal-tissue contrast increased with increasing b-value. ADC values decreased with increasing b-value in all regions studied; however, there was no change in FA with increasing b-value. CONCLUSIONS Diffusion image contrast increased at high b-values may be useful in identifying lesions in the neonatal brain.
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Affiliation(s)
- J Dudink
- Imaging Sciences Department, MRC Clinical Sciences Centre, Imperial College London, Hammersmith Campus, London, United Kingdom
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Atkinson J, Braddick O, Anker S, Nardini M, Birtles D, Rutherford MA, Mercuri E, Dyet LE, Edwards AD, Cowan FM. Cortical vision, MRI and developmental outcome in preterm infants. Arch Dis Child Fetal Neonatal Ed 2008; 93:F292-7. [PMID: 18334617 DOI: 10.1136/adc.2007.116988] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To test two measures of visual cortical function in the first year of life as early markers of functionally significant brain damage in infants born preterm: orientation-reversal visual event-related potentials (OR-VERP) and a behavioural test of cortically controlled visual attention-fixation shifts under competition (FS). Also to examine how these measures relate to (1) perinatal brain insults identified by MRI, and (2) later neurodevelopmental status. PATIENTS AND METHODS After neonatal and term-age-equivalent MRI, 26 preterm infants (<32 weeks of gestational age, mean 28.1 weeks) were given the OR-VERP and FS tests before 12 months post-term age and a neurodevelopmental assessment (Griffiths Scales) at 2 years. MRI scans examined for parenchymal lesions, intraventricular haemorrhage, ventricular dilatation and diffuse excessive high signal intensity were classified into three categories of severity. Cortical visual test results were compared across these categories and examined as predictors of developmental status at 2 years. RESULTS 26 infants were studied. 13/25 infants showed significant OR-VERP responses. 12/26 showed normal FS performance. On both tests, the proportion of infants meeting these criteria decreased significantly with MRI severity. As predictors of Griffiths developmental quotient < or =80, the FS test had a sensitivity of 100%, a specificity of 61%, and positive and negative predictive values of 50% and 100%, respectively; corresponding values for OR-VERP were 86%, 65%, 50% and 92% . CONCLUSIONS Visual cortical tests can provide early indicators of the functional impact of perinatal brain damage in the preterm infant.
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Affiliation(s)
- J Atkinson
- Visual Development Unit, Department of Psychology, University College London, Gower Street, London WC1E 6BT, UK.
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26
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Poretti A, Leventer RJ, Cowan FM, Rutherford MA, Steinlin M, Klein A, Scheer I, Huisman TAGM, Boltshauser E. Cerebellar cleft: a form of prenatal cerebellar disruption. Neuropediatrics 2008; 39:106-12. [PMID: 18671186 DOI: 10.1055/s-2008-1081460] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
In contrast to malformations, cerebellar disruptions have attracted little interest in the literature. We draw attention for the first time to the hypothesis that cerebellar clefts are residual changes following a prenatal cerebellar insult, and represent disruptions. We reviewed the clinical records and MR findings of six patients with a cerebellar cleft, two of whom also had prenatal MRI at 24 weeks of gestation. The clefts were located in the left cerebellar hemisphere in five cases, in the right in one patient. Other typical findings included disorderly alignment of the cerebellar folia and fissures, irregular gray/white matter junction, and abnormal arborization of the white matter in all patients. The cerebellar cleft extended into the fourth ventricle in three cases, and in two children cystic cortical lesions were seen. Supratentorial schizencephaly was found in two patients. In two patients there was a documented fetal cerebellar hemorrhage at 24 weeks of gestation. We conclude that cerebellar clefts are residual changes resulting from a prenatal cerebellar insult and consequently represent disruptions rather than primary malformations. The supratentorial findings are also in agreement with an acquired lesion. The outcome in these children was variable, mainly depending of the presence of supratentorial lesions.
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Affiliation(s)
- A Poretti
- Department of Neurology, University Children's Hospital of Zurich, Zurich, Switzerland
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27
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Aljabar P, Bhatia KK, Murgasova M, Hajnal JV, Boardman JP, Srinivasan L, Rutherford MA, Dyet LE, Edwards AD, Rueckert D. Assessment of brain growth in early childhood using deformation-based morphometry. Neuroimage 2007; 39:348-58. [PMID: 17919930 DOI: 10.1016/j.neuroimage.2007.07.067] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2007] [Revised: 07/17/2007] [Accepted: 07/30/2007] [Indexed: 11/29/2022] Open
Abstract
We present methods for the quantitative analysis of brain growth based on the registration of longitudinal MR image data with the use of Jacobian determinant maps to characterise neuroanatomical changes. The individual anatomies, growth maps and tissue classes are also spatially normalised in an 'average space' and aggregated to provide atlases for the population at each timepoint. The average space representation is obtained using the average intersubject transformation within each timepoint. In an exemplar study, this approach is used to assess brain development in 25 infants between 1 and 2 years, and we show consistency in growth estimates between registration and segmentation approaches.
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Affiliation(s)
- P Aljabar
- Visual Information Processing Group, Department of Computing, Imperial College London, and Department of Paediatrics, Hammersmith Hospital, London, UK.
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28
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Leijser LM, de Vries LS, Rutherford MA, Manzur AY, Groenendaal F, de Koning TJ, van der Heide-Jalving M, Cowan FM. Cranial ultrasound in metabolic disorders presenting in the neonatal period: characteristic features and comparison with MR imaging. AJNR Am J Neuroradiol 2007; 28:1223-31. [PMID: 17698520 PMCID: PMC7977655 DOI: 10.3174/ajnr.a0553] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Brain imaging is an integral part of the diagnostic work-up for metabolic disorders, and the bedside availability of cranial ultrasonography (cUS) allows very early brain imaging in symptomatic neonates. Our aim was to investigate the role and range of abnormalities seen on cUS in neonates presenting with metabolic disorders. A secondary aim, when possible, was to address the question of whether brain MR imaging is more informative by comparing cUS to MR imaging findings. MATERIALS AND METHODS Neonates with a metabolic disorder who had at least 1 cUS scan were eligible. cUS images were reviewed for anatomic and maturation features, cysts, calcium, and other abnormalities. When an MR imaging scan had been obtained, both sets of images were compared. RESULTS Fifty-five infants (35 also had MR imaging) were studied. The most frequent findings were in oxidative phosphorylation disorders (21 cUS and 12 MR imaging): ventricular dilation (11 cUS and 6 MR imaging), germinolytic cysts (GLCs; 7 cUS and 5 MR imaging), and abnormal white matter (7 cUS and 6 MR imaging); in peroxisomal biogenesis disorders (13 cUS and 9 MR imaging): GLCs (10 cUS and 6 MR imaging), ventricular dilation (10 cUS and 5 MR imaging), abnormal cortical folding (8 cUS and 7 MR imaging), and lenticulostriate vasculopathy (8 cUS); in amino acid metabolism and urea cycle disorders (14 cUS and 11 MR imaging): abnormal cortical folding (9 cUS and 4 MR imaging), abnormal white matter (8 cUS and 8 MR imaging), and hypoplasia of the corpus callosum (7 cUS and 6 MR imaging); in organic acid disorders (4 cUS and 2 MR imaging): periventricular white matter echogenicity (2 cUS and 1 MR imaging); and in other disorders (3 cUS and 1 MR imaging): ventricular dilation (2 cUS and 1 MR imaging). cUS findings were consistent with MR imaging findings. cUS was better for visualizing GLCs and calcification. MR imaging was more sensitive for subtle tissue signal intensity changes in the white matter and abnormality in areas difficult to visualize with cUS, though abnormalities of cortical folding suggestive of polymicrogyria were seen on cUS. CONCLUSION A wide range of abnormalities is seen using cUS in neonatal metabolic disorders. cUS is a reliable bedside tool for early detection of cysts, calcium, structural brain abnormalities, and white matter echogenicity, all suggestive of metabolic disorders.
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Affiliation(s)
- L M Leijser
- Department of Paediatrics and Neonatal Medicine, Imperial College, Hammersmith Hospital, London, United Kingdom
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29
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Nicholl RM, Balasubramaniam VP, Urquhart DS, Sellathurai N, Rutherford MA. Postmortem brain MRI with selective tissue biopsy as an adjunct to autopsy following neonatal encephalopathy. Eur J Paediatr Neurol 2007; 11:167-74. [PMID: 17270474 DOI: 10.1016/j.ejpn.2006.12.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2006] [Revised: 12/04/2006] [Accepted: 12/13/2006] [Indexed: 10/23/2022]
Abstract
Following the death of a neonate it is essential that parents are given full and accurate information about the probable cause of death. Perinatal autopsy often adds new information or may even change the presumed diagnosis [Cartlidge PH, Dawson AT, Stewart JH, Vujanic GM. Value and quality of perinatal and infant postmortem examinations: cohort analysis of 400 consecutive deaths. Br Med J 1995;310(6973):155-8; Khong TY. Falling neonatal autopsy rates. Br Med J 2002;324(7340):749-50] informing decisions regarding the management of any future pregnancy. Autopsy can be considered the "gold standard" for the identification of antecedent events leading to a neonatal death. However, recent events in the UK have added to an already declining rate in neonatal autopsies [Brodlie M, Laing IA. Ten years of neonatal autopsies in tertiary referral centre: retrospective study. Br Med J 2002;324(7340):761-3]. To try and redress this balance the Chief Medical Officer has recommended that research should be commissioned into the use of non-invasive imaging to provide a similar standard of information [The Chief Medical Officer. The removal, retention and use of human organs and tissues from post mortem examination. London, England: The Stationary Office, Department of Health; 2001]. Previous publications on postmortem MRI have focused largely on investigation of the foetus and of still birth [Griffiths PD, Variend D, Evans M, Jones A, Wilkinson ID, Paley MNJ, et al. Postmortem MR imaging of the fetal and stillborn central nervous system. Am J Neuroradiol 2003;24(1):22-7; Whitby EH, Paley MN, Cohen M, GriffithsPD. Postmortem MR imaging of the fetus: an adjunct or a replacement for conventional autopsy? Semin Fetal Neonatal Med 2005;10(5):475-83]. We report our experience on the use of postmortem brain MRI combined with selective tissue biopsy, in six neonatal deaths in the setting of a large district general hospital.
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Affiliation(s)
- R M Nicholl
- Neonatal Unit, Northwick Park Hospital, North West London Hospitals NHS Trust, London, UK.
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30
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Hand JW, Li Y, Thomas EL, Rutherford MA, Hajnal JV. Prediction of specific absorption rate in mother and fetus associated with MRI examinations during pregnancy. Magn Reson Med 2006; 55:883-93. [PMID: 16508913 DOI: 10.1002/mrm.20824] [Citation(s) in RCA: 121] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
There is uncertainty regarding the risk posed by magnetic resonance imaging (MRI) examinations to pregnant patients. The most frequently used methods, such as single-shot fast spin echo (ssFSE), often require operation at the specific absorption rate (SAR) limits imposed by safety guidelines. With the introduction of higher-field systems, such limits will be even more significant for fetal imaging. An electromagnetic solver based on the time domain finite integration technique (FIT) was used to predict SAR in an anatomically realistic model of a pregnant patient (28 weeks' gestation) associated with the radiofrequency (RF) fields from birdcage body coils typical of 1.5 T and 3 T MRI systems (i.e., operating at approximately 64 and 127 MHz, respectively). The results suggest that 1) the highest local SAR is in the mother, with the fetus being exposed to a peak of approximately 40-60% of that value at 64 MHz, increasing to approximately 50-70% at 127 MHz; 2) compliance with U.S. Food and Drug Administration (FDA) and International Commission on Non-Ionizing Radiation Protection (ICNIRP) guidelines requires control of SAR values averaged over 1 g or 10 g of tissue, respectively; and 3) compliance with Medical Device Agency (MDA) guidelines requires control of the maximum SAR(10g) within the fetus.
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Affiliation(s)
- J W Hand
- Imaging Sciences Department, MRC Clinical Sciences Centre, Hammersmith Hospital, Imperial College, London, UK.
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Abstract
Magnetic resonance imaging (MRI) has proved to be a valuable tool for monitoring development and pathology in the preterm brain. This imaging modality is useful for assessing numerous pathologies including periventricular leukomalacia, intraventricular haemorrhage/germinal layer haemorrhage, and periventricular haemorrhagic infarction, and can help to predict outcome in these infants. MRI has also allowed the detection of posterior fossa lesions, which are not easily seen with ultrasound. Additionally, and perhaps most relevant, quantitative MR studies have shown differences between the normal appearing preterm brain at term equivalent age and term born infants, confirming that the brain develops differently in the ex utero environment. Further studies using quantifiable MR techniques will improve our understanding of the effects of the ex utero environment, including aspects of neonatal intensive care on the developing brain.
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Affiliation(s)
- S J Counsell
- Robert Steiner Magnetic Resonance Unit, Imaging Sciences Department, MRC Clinical Sciences Centre, London, UK
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Duggan PJ, Maalouf EF, Watts TL, Sullivan MH, Counsell SJ, Allsop J, Al-Nakib L, Rutherford MA, Battin M, Roberts I, Edwards AD. Intrauterine T-cell activation and increased proinflammatory cytokine concentrations in preterm infants with cerebral lesions. Lancet 2001; 358:1699-700. [PMID: 11728550 DOI: 10.1016/s0140-6736(01)06723-x] [Citation(s) in RCA: 179] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Brain injury is common in very preterm infants, and intrauterine infection is a frequent antecedent of preterm birth. We examined the relation of cerebral damage to intrauterine antigen exposure and inflammation in 50 infants who were born at 23-29 weeks' gestation. Higher concentrations of cytokines (tumour necrosis factor alpha [TNF-alpha], and interleukins [IL], 1beta, 6, and 10) and CD45RO(+) T lymphocytes in umbilical blood predicted cerebral lesions detected by magnetic resonance imaging very soon after delivery. Our results suggest that infants who mount an immune response in utero are at higher risk of cerebral lesions.
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Abstract
Diffusion-weighted imaging (DWI) has become an invaluable tool in the management of patients with stroke. DWI relies on detecting the random diffusion of water molecules. In normal tissues this movement may be restricted by the presence of cellular structures, which provide a barrier to free movement. This occurs in myelinated white matter, where movement is restricted more across than along fibres. This directional dependence is termed anisotropic restricted diffusion. The diffusion of water molecules can be made the dominant contrast mechanism within an image by applying large magnetic field gradients. The pulsed gradient spin echo (PGSE) sequence provides sensitivity to diffusion with gradient pulses either side of the 180 degrees refocusing pulse. This sequence is generally heavily T2 weighted. In order to detect normal anisotropic properties within the different components of the medullary core, association, commissural and projection fibres, DWI must be performed with sensitisation in at least three directions. PGSE sequences have been used to obtain the diffusion coefficient (D*), a measure of mobility at the molecular level within tissue. In acute infarction D* is increased; in brain death it is decreased. Diffusion contrast needs to be optimised in relation to the highly T2-dependent nature of PGSE sequences. This also requires a more detailed knowledge of how D* changes in disease, but information on nonischaemic neurological conditions is still very limited.
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Affiliation(s)
- G M Bydder
- The Robert Steiner Magnetic Resonance Unit, MRC Clinical Sciences Centre, Hammersmith Hospital, London, UK
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35
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Abstract
Diffusion-weighted imaging (DWI) can readily be performed in the neonate, although currently studies remain a few years behind-those carried out on adults. DWI relies on the random diffusion of water molecules. As for the adult population, a pulsed gradient spin echo sequence (PGSE) with cardiac gating can be used to exploit the effect of diffusion on image contrast and to determine the apparent diffusion coefficient (D*) for tissues or fluids. Anisotropic properties caused by the restriction of the movement of water molecules may be demonstrated. In the neonatal brain restricted motion can be detected in both myelinated and unmyelinated white matter tracts. DWI has been used to study changes in global and focal ischaemic injury to the neonatal brain. A decreased D* may be documented after an ischaemic insult followed by a gradual increase. These changes are consistent with animal data but show a slower time course. Intervention following perinatal ischaemic injury must be started within hours. DWI detects early ischaemic injury and may therefore be a useful tool for identifying those infants who could benefit from intervention.
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Affiliation(s)
- G M Bydder
- The Robert Steiner Magnetic Resonance Unit, MRC Clinical Sciences Centre, Hammersmith Hospital, London, UK
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Maalouf EF, Duggan PJ, Counsell SJ, Rutherford MA, Cowan F, Azzopardi D, Edwards AD. Comparison of findings on cranial ultrasound and magnetic resonance imaging in preterm infants. Pediatrics 2001; 107:719-27. [PMID: 11335750 DOI: 10.1542/peds.107.4.719] [Citation(s) in RCA: 240] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To compare findings on hard copies of cranial ultrasound (US) and magnetic resonance imaging (MRI) obtained between birth and term in a group of preterm infants. PARTICIPANTS AND METHODS Infants born at or below a gestational age of 30 weeks who underwent cranial US scan and MRI on the same day were eligible for this study. Infants underwent, whenever possible, 3 scans between birth and term. We calculated the predictive probability (PP) of US findings as a predictor of findings on MRI. RESULTS Sixty-two paired MRI and US studies were performed between birth and term in 32 infants born at a median gestational age of 27 (range: 23-30) weeks and a median birth weight of 918 (530-1710) grams. US predicted some MRI findings accurately: germinal layer hemorrhage (GLH) on US had a PP of 0.8 with a 95% confidence interval of (0.70-0.90) for the presence of GLH on MRI, intraventricular hemorrhage (IVH) on US had a PP of 0.85 (0.76-0.94) for the presence of IVH on MRI, and severe white matter (WM) echogenicity on US had a PP of 0.96 (0.92-1.0) for the presence of WM hemorrhagic parenchymal infarction on MRI. Other MRI changes were less well-predicted: mild or no WM echogenicity on US had a PP of 0.54 (0.41-0.66) for the presence of normal WM signal intensity on MRI, and moderate or severe WM echogenicity on US had a PP of 0.54 (0.42-0.66) for the presence of small petechial WM hemorrhage and/or diffuse excessive high-signal intensity (DEHSI) in the WM on T2-weighted images on MRI. However, mild/moderate or severe WM echogenicity on US scans performed at >/=7 days after birth had a PP of 0.72 (0.58-0.87) for the presence of WM hemorrhage and/or DEHSI on MRI. There were no cases of cystic periventricular leukomalacia. CONCLUSION US accurately predicted the presence of GLH, IVH, and hemorrhagic parenchymal infarction on MRI. However, its ability to predict the presence of DEHSI and small petechial hemorrhages in the WM on T2 weighted images is not as good, but improves on scans performed at >/=7 days after birth. In addition, normal WM echogenicity on US is not a good predictor of normal WM signal intensity on MRI.
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Affiliation(s)
- E F Maalouf
- Department of Paediatrics, Imperial College School of Medicine, Hammersmith Hospital, London, United Kingdom
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Bydder GM, Rutherford MA. Diffusion-weighted imaging of the brain in neonates and infants. Magn Reson Imaging Clin N Am 2001; 9:83-98, viii. [PMID: 11278184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Diffusion-weighted imaging provides novel and interesting insights into normal development and pathologic processes occurring in neonates and infants. Both myelinated and unmyelinated white matter show restricted diffusion. Focal infarction in perinatal stroke and more global injury associated with hypoxic ischemia encephalopathy produce high-signal lesions in the brain, in the acute phase. Diffusion-weighted imaging also demonstrates abnormalities of a variety of other diseases, when conventional imaging is relatively uninformative.
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Affiliation(s)
- G M Bydder
- MRC Clinical Sciences Centre, Hammersmith Hospital, London, England, United Kingdom.
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Abstract
BACKGROUND There is extensive experimental evidence to support the investigation of treatment with mild hypothermia after birth asphyxia. However, clinical studies have been delayed by the difficulty in predicting long-term outcome very soon after birth and by concern about adverse effects of hypothermia. OBJECTIVES The objectives of this study were to determine whether it is feasible to select infants with a bad neurological prognosis and to begin hypothermic therapy within 6 hours of birth, and to observe the effect of this therapy on relevant physiologic variables. METHODS Sixteen newborn infants with clinical features of birth asphyxia (median cord blood pH: 6.74; range: 6.58-7.08) were assessed by amplitude integrated electroencephalography (aEEG), and mild whole body hypothermia was instituted within 6 hours of birth in the 10 infants with an aEEG prognostic of a bad outcome. Rectal temperature was maintained at 33.2 +/- (standard deviation).6 degrees C for 48 hours. Rectal and tympanic membrane temperature, blood pressure, heart rate, blood gases, blood lactate, full blood count, blood electrolytes, high and low shear rate viscosity, and coagulation studies were monitored during and after cooling. A preliminary assessment of neurological outcome was made by repeated magnetic resonance imaging (MRI) and neurological examination. RESULTS All infants selected to receive hypothermia developed convulsions and a severe encephalopathy. During 48 hours of hypothermia infants had prolonged metabolic acidosis (median pH: 7.30; base excess: -6.3 mmol x L(-1), a high blood lactate (median lactate: 5.3 mmol x L(-1)) and low blood potassium levels (median value: 3.9 mmol x L(-1)) x Hypothermia was associated with lower heart rate and higher mean blood pressure. However, these changes did not seem to be clinically relevant and no significant complication of hypothermia was encountered. Blood viscosity and coagulation studies were similar during and after cooling. Unusual MRI findings were noted in 3 infants: transverse sinus thrombosis with subsequent small cerebellar infarct; probable thrombosis in the straight sinus; and hemorrhagic cerebral infarction. Six of the 10 cooled infants had minor abnormalities only or normal follow-up neurological examination; 3 infants died and 1 had major abnormalities. None of the 6 infants with a normal aEEG developed severe neonatal encephalopathy or neurological sequel. CONCLUSIONS After birth asphyxia infants can be objectively selected by aEEG and hypothermia started within 6 hours of birth in infants at high risk of developing severe neonatal encephalopathy. Prolonged mild hypothermia to 33 degrees C to 34 degrees C is associated with minor physiologic abnormalities. Further studies of both the safety and efficacy of mild hypothermia, including further neuroimaging studies, are warranted.
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Affiliation(s)
- D Azzopardi
- Department of Paediatrics, Imperial College School of Medicine, London, United Kingdom.
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Abstract
Most growth in cortical connections and complexity occurs after 25 weeks. The cerebral cortex of extremely preterm infants when imaged at gestational age 38-42 weeks had less cortical surface area and was less complex than in normal infants born around term (p<0.0148 and p<0.0002, respectively), despite similar term-corrected cerebral tissue volumes. Since deficits acquired during critical periods of brain development may be permanent, these results suggest a neural substrate for the neurocognitive impairment that is frequent among such preterm infants.
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Mercuri E, Ricci D, Cowan FM, Lessing D, Frisone MF, Haataja L, Counsell SJ, Dubowitz LM, Rutherford MA. Head growth in infants with hypoxic-ischemic encephalopathy: correlation with neonatal magnetic resonance imaging. Pediatrics 2000; 106:235-43. [PMID: 10920145 DOI: 10.1542/peds.106.2.235] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES The aims of the study were to establish the relationship between head growth in the first year of life with the pattern on injury on neonatal magnetic resonance imaging (MRI) in infants with hypoxic-ischemic encephalopathy (HIE) and to relate these to the neurodevelopmental outcome. METHODS Fifty-two term infants who presented at birth with a neonatal encephalopathy consistent with HIE and who had neonatal brain MRI were entered into the study. Head circumference charts were evaluated retrospectively and the head growth over the first year of life compared with the pattern of brain lesions on MRI and with the neurodevelopmental outcome at 1 year of age. Suboptimal head growth was classified as a drop of >2 standard deviations across the percentiles with or without the development of microcephaly, which was classified as a head circumference below the third percentile. RESULTS There was no statistical difference between the neonatal head circumferences of the infants presenting with HIE and control infants. At 12 months, microcephaly was present in 48% of the infants with HIE, compared with 3% of the controls. Suboptimal head growth was documented in 53% of the infants with HIE, compared with 3% of the controls. Suboptimal head growth was significantly associated with the pattern of brain lesions, in particular to involvement of severe white matter and to severe basal ganglia and thalamic lesions. Suboptimal head growth predicted abnormal neurodevelopmental outcome with a sensitivity of 79% and a specificity of 78%, compared with the presence of microcephaly at 1 year of age, which had a sensitivity of only 65% and a specificity of 73%. The exceptions were explained by infants with only moderate white matter abnormalities who had suboptimal head growth but normal outcome at 1 year of age and by infants with moderate basal ganglia and thalamic lesions only who had normal head growth but significant motor abnormality.
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Affiliation(s)
- E Mercuri
- Department of, Imperial College of Science, Technology and Medicine, Hammersmith Campus, London, United Kingdom
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Maalouf EF, Duggan PJ, Rutherford MA, Counsell SJ, Fletcher AM, Battin M, Cowan F, Edwards AD. Magnetic resonance imaging of the brain in a cohort of extremely preterm infants. J Pediatr 1999; 135:351-7. [PMID: 10484802 DOI: 10.1016/s0022-3476(99)70133-2] [Citation(s) in RCA: 246] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
To define magnetic resonance imaging (MRI) appearances of the brain in extremely preterm infants between birth and term, a sequential cohort of infants born at a gestational age <30 weeks was studied with a dedicated neonatal magnetic resonance scanner. Images of infants (n = 41) with a median gestational age of 27 weeks (range 23 to 29 weeks) were initially obtained at a median age of 2 days (range 1 to 20 days) and then repeatedly studied; 29 (71%) infants had MRI at a median gestational age of 43 weeks (range 38 to 52 weeks) (term MRI). On the initial MRI scan 28 of 41 infants had abnormalities: either intraventricular hemorrhage, germinal layer hemorrhage, ventricular dilatation, or diffuse and excessive high signal intensity in the white matter on T(2)-weighted images. When magnetic resonance images for preterm infants at term gestation were compared with those of infants in the control group born at term, 22 of 29 infants had dilatation of the lateral ventricles, 24 of 29 had squaring of the anterior or posterior horns of the lateral ventricles, 11 of 29 had a widened interhemispheric fissure or extracerebral space, and 22 of 29 had diffuse and excessive high signal intensity in the white matter. There were no cases of cystic periventricular leukomalacia. We conclude that MRI abnormalities are commonly seen in the brain of preterm infants on whom images are obtained within 48 hours of birth and that further abnormalities develop between birth and term. A characteristic appearance of diffuse and excessive high signal intensity in the white matter on T(2)-weighted images is associated with the development of cerebral atrophy and may be a sign of white matter disease. These MRI appearances may help account for the high incidence of neurodevelopmental impairment in extremely preterm infants.
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Affiliation(s)
- E F Maalouf
- Department of Paediatrics and The Robert Steiner MR Unit and MRC Clinical Science Centre, Imperial College School of Medicine, Hammersmith Hospital, Du Cane Road, London, England
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Felderhoff-Mueser U, Rutherford MA, Squier WV, Cox P, Maalouf EF, Counsell SJ, Bydder GM, Edwards AD. Relationship between MR imaging and histopathologic findings of the brain in extremely sick preterm infants. AJNR Am J Neuroradiol 1999; 20:1349-57. [PMID: 10472997 PMCID: PMC7055990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/1998] [Accepted: 04/01/1999] [Indexed: 02/13/2023]
Abstract
BACKGROUND AND PURPOSE MR imaging can now be used safely in extremely preterm infants. The aim of this study was to compare the MR imaging appearance of the immature brain with neuropathologic findings at postmortem examination. METHODS Seven extremely sick preterm infants, born at a median of 24 weeks' gestation, were studied using T1- and T2-weighted MR sequences. Infants died at a median of 3 days after initial MR imaging, and postmortem examinations were carried out. RESULTS The cortex and germinal matrix were seen as areas of low signal intensity on T2-weighted images, which corresponded to their highly cellular histologic appearance. The periventricular and subcortical layers of white matter had a high signal intensity, corresponding to high fiber and relatively low cellular density; the intermediate layer of low signal intensity corresponded to a dense band of migrating cells. Regions of acute hemorrhage were seen as low signal intensity and regions of infarction as high signal intensity on T2-weighted images. One infant with mild periventricular leukomalacia had some low signal intensity on T1-weighted images, but no focal changes on T2-weighted images. Regions of neuronal mineralization, seen in association with infarction and capillary proliferation, within the basal ganglia and thalami were characterized by very low signal intensity on T2-weighted images and by very high signal intensity on T1-weighted images. There were no imaging abnormalities detected in regions with more subtle histologic abnormalities, such as increased glial or apoptotic cells. CONCLUSION MR imaging can be used to observe normal developing brain anatomy in extremely premature infants; it can detect areas of hemorrhage and infarction within the developing brain, but conventional MR imaging may not detect more subtle histologic abnormalities.
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Affiliation(s)
- U Felderhoff-Mueser
- Department of Pediatrics, Imperial College School of Medicine, Hammersmith Hospital, London, UK
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Jouvet P, Cowan FM, Cox P, Lazda E, Rutherford MA, Wigglesworth J, Mehmet H, Edwards AD. Reproducibility and accuracy of MR imaging of the brain after severe birth asphyxia. AJNR Am J Neuroradiol 1999; 20:1343-8. [PMID: 10472996 PMCID: PMC7055988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
BACKGROUND AND PURPOSE MR imaging of the brain can be used to detect cerebral damage after suspected hypoxic-ischemic injury. This study examines the reproducibility and accuracy of MR imaging soon after severe birth asphyxia. METHODS During a 48-month period, full-term newborn neonates, who died within the first week as a result of severe hypoxic ischemic encephalopathy, were included in the study if they had undergone early (<5 days old) MR imaging and postmortem neuropathologic studies. Two trained observers assessed reproducibility by examining multiple brain regions independently with current criteria and then defining and applying improved criteria. Accuracy of MR findings was tested by comparing the brain regions about which the two imaging raters agreed to those regions about which the two pathologists agreed. RESULTS Eight neonates, with a median gestational age of 40 weeks (range, 38-40 weeks) and who suffered severe birth asphyxia, were included in the study. In the reproducibility study, MR imaging agreement was moderate when current criteria were used (k = .44). Using the improved criteria, agreement increased considerably (k = .62). Much of this improvement was due to limiting the analyses to the posterior limb of the internal capsule, thalamus, parietal cortex, hippocampus, and medulla. The posterior limb of the internal capsule was the most reliable region analyzed. MR imaging agreement was similar to that achieved by two experienced pathologists reviewing the histologic sections (k = .66). In the accuracy study, MR imaging abnormality was predictive of pathologic abnormality with a sensitivity of .79 and a positive predictive value of 1.0. The predictive value of a single MR imaging abnormality was .79 (95% confidence interval, .61-.96). CONCLUSION Criteria that provide substantial reproducibility and accuracy for the interpretation of MR imaging findings very early after birth asphyxia can be derived.
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Affiliation(s)
- P Jouvet
- Department of Pediatrics, Imperial College School of Medicine, Hammersmith Hospital, London, England
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Abstract
Magnetic resonance imaging (MRI) was performed on an infant born, at 28 weeks gestational age who suffered a sudden episode of bradycardia and desaturation on the 3rd day of life. Imaging demonstrated bilateral germinal layer haemorrhage and intraventricular haemorrhage, with parenchymal involvement in a fan-shaped pattern in the periventricular white matter on the left. These appearances are consistent with a combination of intravascular thrombi and perivascular haemorrhage along the course of the medullary veins. We believe that this is the first report of the MRI appearance of an acute periventricular haemorrhagic infarct associated with a germinal layer haemorrhage/intraventricular haemorrhage in a preterm neonate.
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Affiliation(s)
- S J Counsell
- The Robert Steiner MR Unit, Imperial College School of Medicine, Hammersmith Hospital, London, UK
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Hanrahan JD, Cox IJ, Edwards AD, Cowan FM, Sargentoni J, Bell JD, Bryant DJ, Rutherford MA, Azzopardi D. Persistent increases in cerebral lactate concentration after birth asphyxia. Pediatr Res 1998; 44:304-11. [PMID: 9727705 DOI: 10.1203/00006450-199809000-00007] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In this prospective study proton magnetic resonance spectroscopy (1H MRS) was used to test the hypothesis that lactate can be detected later than 1 mo after birth in the brains of infants who display severe neurodevelopmental impairment 1 y after transient perinatal hypoxia-ischemia. Data were obtained from three groups of infants: 1) eight infants suffering birth asphyxia followed by perinatal encephalopathy and abnormal neurodevelopmental outcome at 1 y of age (defined as major neurologic impairment, Griffiths quotient <85%, and low optimality score); 2) 10 infants with signs of perinatal hypoxia-ischemia but normal neurodevelopmental outcome at 1 y; and 3) six control infants with uneventful perinatal courses and normal neurodevelopment at 1 y. Between one and four examinations (median 1) were performed at median (range) 11 (4-68) wk after birth, and the cerebral concentration ratio of lactate to creatine plus phosphocreatine (Cr) calculated from each spectrum. Lactate was detected later than the 1st mo after birth in seven of eight infants with abnormal neurodevelopmental outcome [maximum detected lactate/Cr was median (range) 0.44 (0.24-0.67)]. No lactate was detected later than the 1st mo after birth in infants with normal neurodevelopmental outcome, nor in five of six control subjects, although a small amount of lactate was detected in one control infant (lactate/Cr=0.04). These results suggest that the pathologic postasphyxial process, indicated by persistent cerebral lactate, may not be confined to the period immediately after injury.
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Affiliation(s)
- J D Hanrahan
- Section of Paediatrics, Imperial College School of Medicine, Hammersmith Hospital, London, United Kingdom
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Rutherford MA, Pennock JM, Counsell SJ, Mercuri E, Cowan FM, Dubowitz LM, Edwards AD. Abnormal magnetic resonance signal in the internal capsule predicts poor neurodevelopmental outcome in infants with hypoxic-ischemic encephalopathy. Pediatrics 1998; 102:323-8. [PMID: 9685433 DOI: 10.1542/peds.102.2.323] [Citation(s) in RCA: 241] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The aim of this study was to establish whether abnormal signal intensity in the posterior limb of the internal capsule (PLIC) on magnetic resonance imaging is an accurate predictor of neurodevelopmental outcome at 1 year of age in infants with hypoxic-ischemic encephalopathy (HIE). METHODS We have examined 73 term neonates with HIE between 1 and 17 days after birth with cranial magnetic resonance imaging and related the magnetic resonance imaging findings to neurodevelopmental outcome at 1 year of age. RESULTS All infants with an abnormal signal intensity in the PLIC developed neurodevelopmental impairment although in 4 infants with very early scans the abnormal signal was not apparent until up to 4 days after birth. A normal signal intensity was associated with a normal outcome in all but 4 cases; 3 of these infants had minor impairments and all had persistent imaging changes within the white matter. The 4th infant with a normal signal intensity on day 2 died before a further image could be obtained. The absence of normal signal predicted abnormal outcome in term infants with HIE with a sensitivity of 0.90, a specificity of 1.0, a positive predictive value of 1.0, and a negative predictive value of 0.87. The test correctly predicted outcome in 93% of infants with grade II HIE, according to the Sarnat system. Applying a Bayesian approach, the predictive probability of the test (the probability that the test would predict an outcome correctly) was distributed with a mean of 0.94 and 95% confidence limits of 0.89 to 1.0. CONCLUSION Abnormal signal intensity in the PLIC is an accurate predictor of neurodevelopmental outcome in term infants suffering HIE.
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Affiliation(s)
- M A Rutherford
- Robert Steiner Magnetic Resonance Unit, Imperial College of Science, Technology, and Medicine, Hammersmith Campus, London, England
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Battin MR, Maalouf EF, Counsell SJ, Herlihy AH, Rutherford MA, Azzopardi D, Edwards AD. Magnetic resonance imaging of the brain in very preterm infants: visualization of the germinal matrix, early myelination, and cortical folding. Pediatrics 1998; 101:957-62. [PMID: 9606219 DOI: 10.1542/peds.101.6.957] [Citation(s) in RCA: 114] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To investigate preterm infants, we have installed in our neonatal intensive care unit a dedicated magnetic resonance (MR) imaging system which was specifically designed for neonatal use. The aim of this study was to describe the MR appearances of the brain in preterm infants who were first scanned between 25 and 32 weeks gestational age (GA) and to outline changes to the brains of these infants between their first scan and term. METHODS Preterm infants of 25 to 32 weeks GA were imaged using the 1T neonatal MR system (Oxford Magnet Technology, Eyensham, Oxfordshire, England/Picker International, Cleveland, OH). The scanning protocol included T1-weighted conventional spin echo (repetition time [TR], 600; echo time, 20 ms), inversion recovery fast spin echo (TR, 3530; effective echo time, 30; inversion time, 950 ms), and T2-weighted fast spin echo (TR, 3500; effective echo time, 208 ms) sequences. RESULTS Seventeen infants of median 28 weeks GA (range, 24 to 31 weeks) at birth were imaged a total of 53 times between birth and term. The median number of images per infant was two (range, 1 to 9). In infants of < 30 weeks GA, the germinal matrix was visualized at the margins of the lateral ventricles. It had a short T1 and short T2 and the bulk of it involuted at between 30 and 32 weeks GA. The white matter had a relatively homogeneous low signal except for bands of altered signal (probably originating from regions containing radial glia and migrating cells) which were most apparent anterolateral and posterolateral to the lateral ventricles. Myelination was seen in the posterior brainstem, cerebellum, and region of the ventrolateral nuclei of the thalamus. Infants had very little cortical folding at 25 weeks GA but this developed later in an orderly fashion. CONCLUSION The neonatal MR system allowed extremely preterm infants to be studied safely with MR imaging. The images acquired demonstrated the germinal matrix, early myelination, and early cortical folding. Evolution of these features was demonstrated with serial studies.
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Affiliation(s)
- M R Battin
- Department of Pediatrics, Imperial College School of Medicine, Hammersmith Hospital, London, England
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Kistler HC, Alabouvette C, Baayen RP, Bentley S, Brayford D, Coddington A, Correll J, Daboussi MJ, Elias K, Fernandez D, Gordon TR, Katan T, Kim HG, Leslie JF, Martyn RD, Migheli Q, Moore NY, O'Donnell K, Ploetz RC, Rutherford MA, Summerell B, Waalwijk C, Woo S. Systematic Numbering of Vegetative Compatibility Groups in the Plant Pathogenic Fungus Fusarium oxysporum. Phytopathology 1998; 88:30-32. [PMID: 18944995 DOI: 10.1094/phyto.1998.88.1.30] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Rutherford MA, Pennock JM, Cowan FM, Saeed N, Hajnal JV, Bydder GM. Detection of subtle changes in the brains of infants and children via subvoxel registration and subtraction of serial MR images. AJNR Am J Neuroradiol 1997; 18:829-35. [PMID: 9159359 PMCID: PMC8338097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE To compare conventional two-dimensional multisection images with registered three-dimensional volume and subtraction images for detecting subtle changes in the brains of infants and children. METHODS Twenty-six patients (24 with hemorrhagic/ischemic lesions) and one each with perinatal infection and Sturge-Weber disease were examined on two or more occasions with conventional multisection T1- and T2-weighted sequences as well as with 3-D T1-weighted volume sequences. A registration program was used to match the volume images to subvoxel dimensions, and subtracted images (second volume set minus the first) were obtained. The multisection images were compared with the 3-D and subtracted images and graded for detection of changes in a variety of brain structures. RESULTS In 16% to 33% of comparisons of different structures, the multisection images and the 3-D registered and subtracted images showed changes equally well. The 3-D registered and subtracted images were better than the multisection images in 67% to 84% of comparisons for detection of changes in the cerebral hemispheres, ventricles, brain stem, cerebellum, and in lesions. Statistically significant differences were found between the graded performance of the registered 3-D images and the conventional 2-D images in detecting cerebral infarction and hypoxic ischemic encephalopathy. In the late phase following neonatal cerebral infarction (1 to 11 months), the 3-D registered and subtracted images revealed growth of the brain at the margins of the lesions. CONCLUSION Subvoxel registration of serial MR images may be of value in detecting subtle changes in the brains of infants and children.
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Affiliation(s)
- M A Rutherford
- Department of Paediatrics and Neonatal Medicine, Royal Postgraduate Medical School, Hammersmith Hospital, London, United Kingdom
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