Quantitative Cranial Magnetic Resonance Imaging in Neonatal Hypoxic-Ischemic Encephalopathy

Mulkey, Sarah B.; Yap, Vivien; Swearingen, Christopher J.; Riggins, Melissa S.; Kaiser, Jeffrey R.; Schaefer, Gerald

doi:10.1016/j.pediatrneurol.2012.05.009

Cited by 15 publications

(17 citation statements)

References 23 publications

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“…Contrary to our hypothesis, trend towards smaller absolute or normalized CC surface areas in preterm patients compared to controls did not reach significance. Although previous structural MRI studies in infants established feasibility of manual cross-sectional CC surface area analysis 15,[44][45][46][47] , it is possible 2-D surface area analysis (proxy of CC thickness) requires higher statistical power that is not met in our cohort.…”

Section: Discussionmentioning

confidence: 83%

Infant Corpus Callosum Size After Surgery and Critical Care for Long-Gap Esophageal Atresia: Qualitative and Quantitative MRI

Mongerson

Jaimes

Zurakowski

et al. 2020

Sci Rep

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previous studies in preterm infants report white matter abnormalities of the corpus callosum (cc) as an important predictor of neurodevelopmental outcomes. our cross-sectional study aimed to describe qualitative and quantitative cc size in critically ill infants following surgical and critical care for longgap esophageal atresia (LGeA)-in comparison to healthy infants-using MRi. non-sedated brain MRi was acquired for full-term (n = 13) and premature (n = 13) patients following treatment for LGEA, and controls (n = 20) <1 year corrected age. A neuroradiologist performed qualitative evaluation of T1weighted images. ITK-SNAP was used for linear, 2-D and 3-D manual CC measures and segmentations as part of CC size quantification. Qualitative MRI analysis indicated underdeveloped CC in both patient groups in comparison to controls. We show no group differences in mid-sagittal CC length. Although 2-D results were inconclusive, volumetric analysis showed smaller absolute (F(2,42) = 20.40, p < 0.001) and normalized (F(2,42) = 16.61, p < 0.001) CC volumes following complex perioperative treatment for LGeA in both full-term and premature patients, suggesting delayed or diminished cc growth in comparison to controls, with no difference between patient groups. Future research should look into etiology of described differences, neurodevelopmental outcomes, and role of the CC as an early marker of neurodevelopment in this unique infant population.

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Section: Discussionmentioning

confidence: 83%

Infant Corpus Callosum Size After Surgery and Critical Care for Long-Gap Esophageal Atresia: Qualitative and Quantitative MRI

Mongerson

Jaimes

Zurakowski

et al. 2020

Sci Rep

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“…Two main patterns of injury in neonatal HIE are well documented in the literature: deep nuclear gray matter and water-shed injury (involving intervascular boundary-zone white matter, plus cortical gray matter) [5, 12, 16, 24, 25]. The association of the predominant pattern of injury on MRI is a strong predictor of neurodevelopmental outcome [5].…”

Section: Discussionmentioning

confidence: 99%

“…In 2002, Barnett et al [26] concluded that moderate or severe basal ganglia lesions were the best predictor of cerebral palsy. Mulkey et al [25] described the effect of injury in deep nuclear gray matter on long-term neurodevelopmental outcome and cerebral palsy in a cohort of neonates with HIE enrolled as part of the CoolCap Trial. Due to the prior literature documenting the effect of deep nuclear gray matter and posterior limb of the internal capsule injury on neurodevelopmental outcome, we developed our scoring system to be weighted for such injury.…”

Section: Discussionmentioning

confidence: 99%

A validated clinical MRI injury scoring system in neonatal hypoxic-ischemic encephalopathy

Trivedi¹,

Vesoulis²,

Rao³

et al. 2017

Pediatr Radiol

104

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Background Deep nuclear gray matter injury in neonatal hypoxic-ischemic encephalopathy (HIE) is associated with worse neurodevelopmental outcomes. We previously published a qualitative MRI injury scoring system utilizing serial T1-weighted, T2-weighted and diffusion-weighted imaging (DWI), weighted for deep nuclear gray matter injury. Objectives To establish the validity of the MRI scoring system with neurodevelopmental outcome at 18–24 months. Materials and methods MRI scans from neonates with moderate to severe HIE treated with therapeutic hypothermia were evaluated. Signal abnormality was scored on T1-weighted, T2-weighted and DWI sequences and assessed using an established system in five regions: (a) subcortical: caudate nucleus, globus pallidus and putamen, thalamus and the posterior limb of the internal capsule; (b) white matter; (c) cortex,(d) cerebellum and (e) brainstem. MRI injury was graded as none, mild, moderate or severe. Inter-rater reliability was tested on a subset of scans by two independent and blinded neuroradiologists. Surviving infants underwent the Bayley Scales of Infant and Toddler Development-III (Bayley-III) at 18–24 months. Data were analyzed using univariate and multivariate linear and logistic regression. Results Fifty-seven eligible neonates underwent at least one MRI scan in the first 2 weeks of life. Mean postnatal age at scan 1 was 4±2 days in 50/57 (88%) neonates and 48/54 (89%) surviving infants underwent scan 2 at 10±2 days. In 54/57 (95%) survivors, higher MRI injury grades were significantly associated with worse outcomes in the cognitive, motor and language domains of the Bayley-III. Conclusion A qualitative MRI injury scoring system weighted for deep nuclear gray matter injury is a significant predictor of neurodevelopmental outcome at 18–24 months in neonates with HIE.

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“…Twenty-two studies reported scoring methods to assess cerebral injury using T1-and T2-weighted imaging [4,18,20,23,27,34,35,38,39,[51][52][53][54][55][56][57][58][59][60][61][62][63]. Thirteen of those studies also used diffusion-weighted imaging (DWI) or [67] in 1 study, and a new score in the study of Weeke et al [63].…”

Section: Magnetic Resonance Imagingmentioning

confidence: 99%

Predictors of Outcomes in Hypoxic-Ischemic Encephalopathy following Hypothermia: A Meta-Analysis

et al. 2020

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Introduction: Prediction of neurodevelopmental outcome in infants with hypoxic-ischemic encephalopathy remains an important challenge. Various studies have shown that the predictive ability of different modalities changed after the introduction of therapeutic hypothermia. This paper reviews the diagnostic test accuracy of the different modalities that are being used to predict neurodevelopmental outcomes following therapeutic hypothermia. Methods: A systematic literature search was performed using Embase and PubMed. Two reviewers independently included eligible studies and extracted data. The quality of the studies was assessed using the Quality in Prognosis Studies Tool. Meta-analyses were performed where possible. Results: Forty-seven articles and 3 conference abstracts were included, reporting on 3,072infants of whom 39% died or had an adverse neurodevelopmental outcome. A meta-analysis could be performed using 37 articles on (amplitude-integrated) electroencephalography (EEG), conventional magnetic resonance imaging (MRI), diffusion-weighted imaging (DWI), and proton magnetic resonance spectroscopy (1H-MRS). Amplitude-integrated EEG (aEEG) at 24 and 72 h showed similar high diagnostic OR, while aEEG at 6 h and EEG performed less, both due to a low specificity. For MRI, most studies reported scoring systems in which early (<8 days) MRI performed better than late (≥8 days) MRI. Injury to the posterior limb of the internal capsule on MRI or to the thalami on DWI were strong individual predictors, as was an increased lactate/N-acetylaspartate peak on 1H-MRS. Conclusions: In the era of therapeutic hypothermia, the different modalities remain good predictors of neurodevelopmental outcome. However, timing should be taken into account. aEEG may initially be false positive and gets more reliable after 24 h. In contrast, MRI should be used during the first week, as its predictive value decreases afterwards.

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Quantitative Cranial Magnetic Resonance Imaging in Neonatal Hypoxic-Ischemic Encephalopathy

Cited by 15 publications

References 23 publications

Infant Corpus Callosum Size After Surgery and Critical Care for Long-Gap Esophageal Atresia: Qualitative and Quantitative MRI

Infant Corpus Callosum Size After Surgery and Critical Care for Long-Gap Esophageal Atresia: Qualitative and Quantitative MRI

A validated clinical MRI injury scoring system in neonatal hypoxic-ischemic encephalopathy

Predictors of Outcomes in Hypoxic-Ischemic Encephalopathy following Hypothermia: A Meta-Analysis

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