Comparison of early and late MRI in neonatal hypoxic–ischemic encephalopathy using three assessment methods

Abstract

Early MRI may provide valuable information about brain injury to help parents and neonatologists in intensive-care decisions at the end of hypothermia treatment.

Early MRI in neonatal hypoxic-ischaemic encephalopathy treated with hypothermia: Prognostic role at 2-year follow-up

“…In this study, we confirmed that early MRI had a predictive value at least as good as late MRI, as was expected given the excellent agreement between early and late MRIs [8][9][10][11]. Our results were inconsistent with the results of a meta-analysis which suggested that the discriminatory power of late MRI (days 8-30) was higher than that In our study, the ADC measurements added little to the visual analysis as a prognostic tool.…”

“…Yet, the median time to follow-up remained within our limit of two years of age. There were also some technical limitations previously identified, particularly as we used two different coils with different parameters for T1-weighted imaging [11].…”

“…Assessment of brain injury was based on a previously described simplified classification (Appendix) [11]. It distinguished normal/subnormal MR images including normal MRI, punctate periventricular white matter injuries (PPWMI) and watershed pattern with a Watershed (W) score ≤2 on the scoring system described by Barkovich et al (single infarction or abnormal signal in anterior or posterior watershed white matter) [15], and abnormal MRI including watershed pattern with W score >2, central or diffuse patterns.…”

“…Recent studies demonstrated that early MRI (performed in the first week of life) could reliably predict the extent and severity of brain injury observed on later MRI (performed after day 7, considering the first day of life as day 1) in asphyxiated neonates treated with hypothermia [7][8][9][10][11]. Nevertheless, to our knowledge, the prognostic value of early and late MRI had not been compared in these neonates.…”

A Controversial Medicolegal Issue: Timing the Onset of Perinatal Hypoxic-Ischemic Brain Injury

“…Rather than being a real prognostic tool, it helps to the interpretation of subtle findings when clear pathological patterns are not evident. This is the same for the discussed “prognostic” value of signal changes in the posterior limb of the internal capsule (PLIC) [ 103 ].…”