Cerebral Pulsed Arterial Spin Labeling Perfusion Weighted Imaging Predicts Language and Motor Outcomes in Neonatal Hypoxic-Ischemic Encephalopathy

Abstract

Rationale and Objectives: To compare cerebral pulsed arterial spin labeling (PASL) perfusion among controls, hypoxic ischemic encephalopathy (HIE) neonates with normal conventional MRI(HIE/MRI⊕), and HIE neonates with abnormal conventional MRI(HIE/MRI⊖). To create a predictive machine learning model of neurodevelopmental outcomes using cerebral PASL perfusion. Materials and Methods: A total of 73 full-term neonates were evaluated. The cerebral perfusion values were compared by permutation test to identify brain regions with significant perfusion changes among 18 controls, 40 HIE/MRI⊖ patients, and 15 HIE/MRI⊕ patients. A machine learning model was developed to predict neurodevelopmental outcomes using the averaged perfusion in those identified brain regions. Results: Significantly decreased PASL perfusion in HIE/MRI⊖ group, when compared with controls, were found in the anterior corona radiata, caudate, superior frontal gyrus, precentral gyrus. Both significantly increased and decreased cerebral perfusion changes were detected in HIE/MRI⊕ group, when compared with HIE/MRI⊖ group. There were no significant perfusion differences in the cerebellum, brainstem and deep structures of thalamus, putamen, and globus pallidus among the three groups. The machine learning model demonstrated significant correlation (p < 0.05) in predicting language(r = 0.48) and motor(r = 0.57) outcomes in HIE/MRI⊖ patients, and predicting language(r = 0.76), and motor(r = 0.53) outcomes in an additional group combining HIE/MRI⊖ and HIE/MRI⊕. Conclusion: Perfusion MRI can play an essential role in detecting HIE regardless of findings on conventional MRI and predicting language and motor outcomes in HIE survivors. The perfusion changes may also reveal important insights into the reperfusion response and intrinsic autoregulatory mechanisms. Zheng et al. Outcome Prediction in Neonatal HIE Our results suggest that perfusion imaging may be a useful adjunct to conventional MRI in the evaluation of HIE in clinical practice.

Predictive modelling of hypoxic ischaemic encephalopathy risk following perinatal asphyxia

“…This improves the ability to diagnose and grade severity in areas where specialists are not available for EEG readings. Machine learning has also been applied to aid in the interpretation of MRI readings in order to predict mortality and long-term neurological disability [33,34,35]. Despite benefits in determining long term neurological outcomes these methods are not accessible without the use of specialised equipment (EEG, MRI) and will not aid in identifying those in need of treatment from therapeutic hypothermia within the 6-hour treatment window.…”

Altered resting-state cerebral blood flow and functional connectivity mediate suicidal ideation in major depressive disorder

“…Each participant’s relative CBF was the normalization of their absolute CBF to create uniformity of the CBF values across participants. 32…”

“…Each participant's relative CBF was the normalization of their absolute CBF to create uniformity of the CBF values across participants. 32 CBF-based abnormal functional connectivity analyses. Data were preprocessed using the SPM12 and Data Processing & Analysis for Brain Imaging (DPABI 5.1).…”

Brain contrast-enhanced ultrasonography and elastography in infants

“…Evaluation of brain perfusion is also important for monitoring post-injury reperfusion, which can be beneficial or harmful depending on its extent and duration [ 7 , 8 , 19 , 20 ]. Sustained hypo- or hyper-perfusion after a hypoxic-ischemic injury is associated with permanent brain damage.…”

“…In the infant brain, CEUS has been used to evaluate a variety of neurologic disorders [4][5][6] and offers advantages over grayscale and color Doppler ultrasonography and other conventional imaging techniques. CEUS can better delineate focal and/or diffuse abnormalities than grayscale and color Doppler, and it facilitates longitudinal tracking of cerebral perfusion changes following a medical or surgical intervention or neurologic insult [3,7,8]. Further research is needed to validate the clinical utility of infant brain CEUS.…”