G Ancora1, C Testa2, S Grandi3, C Tonon2, F Sbravati3, S Savini3, D N Manners2, L L Gramegna2, G Tani4, E Malucelli5, L T Corvaglia3, G Faldella3, R Lodi2. 1. Neonatal Intensive Care Unit, Department of Mother and Infant Infermi Hospital of Rimini, Rimini, Italy. gina.ancora@auslrn.net. 2. MR Functional Unit, Department of Biomedical and Neuromotor Sciences University of Bologna, Bologna, Italy. 3. Neonatology Unit, Department of Woman, Child and Adolescent Health, University of Bologna, Bologna, Italy. 4. Radiology Unit, Department of Woman, Child and Adolescent Health, University of Bologna, Bologna, Italy. 5. Department of Pharmacy and Biotechnologies, University of Bologna, Bologna, Italy.
Abstract
INTRODUCTION: MRI, proton magnetic resonance spectroscopy (¹H-MRS), and diffusion tensor imaging (DTI) have been shown to be of great prognostic value in term newborns with moderate-severe hypoxic-ischemic encephalopathy (HIE). Currently, no data are available on ¹H-MRS and DTI performed in the subacute phase after hypothermic treatment. The aim of the present study was to assess their prognostic value in newborns affected by moderate-severe HIE and treated with selective brain cooling (BC). METHODS: Twenty infants treated with BC underwent conventional MRI and (1)H-MRS at a mean (SD) age of 8.3 (2.8) days; 15 also underwent DTI. Peak area ratios of metabolites and DTI variables, namely mean diffusivity (MD), axial and radial diffusivity, and fractional anisotropy (FA), were calculated. Clinical outcome was monitored until 2 years of age. RESULTS: Adverse outcome was observed in 6/20 newborns. Both ¹H-MRS and DTI variables showed higher prognostic accuracy than conventional MRI. N-acetylaspartate/creatine at a basal ganglia localisation showed 100% PPV and 93% NPV for outcome. MD showed significantly decreased values in many regions of white and gray matter, axial diffusivity showed the best predictive value (PPV and NPV) in the genu of corpus callosum (100 and 91%, respectively), and radial diffusivity was significantly decreased in fronto white matter (FWM) and fronto parietal (FP) WM. The decrement of FA showed the best AUC (0.94) in the FPWM. CONCLUSION: Selective BC in HIE neonates does not affect the early and accurate prognostic value of ¹H-MRS and DTI, which outperform conventional MRI.
INTRODUCTION: MRI, proton magnetic resonance spectroscopy (¹H-MRS), and diffusion tensor imaging (DTI) have been shown to be of great prognostic value in term newborns with moderate-severe hypoxic-ischemicencephalopathy (HIE). Currently, no data are available on ¹H-MRS and DTI performed in the subacute phase after hypothermic treatment. The aim of the present study was to assess their prognostic value in newborns affected by moderate-severe HIE and treated with selective brain cooling (BC). METHODS: Twenty infants treated with BC underwent conventional MRI and (1)H-MRS at a mean (SD) age of 8.3 (2.8) days; 15 also underwent DTI. Peak area ratios of metabolites and DTI variables, namely mean diffusivity (MD), axial and radial diffusivity, and fractional anisotropy (FA), were calculated. Clinical outcome was monitored until 2 years of age. RESULTS: Adverse outcome was observed in 6/20 newborns. Both ¹H-MRS and DTI variables showed higher prognostic accuracy than conventional MRI. N-acetylaspartate/creatine at a basal ganglia localisation showed 100% PPV and 93% NPV for outcome. MD showed significantly decreased values in many regions of white and gray matter, axial diffusivity showed the best predictive value (PPV and NPV) in the genu of corpus callosum (100 and 91%, respectively), and radial diffusivity was significantly decreased in fronto white matter (FWM) and fronto parietal (FP) WM. The decrement of FA showed the best AUC (0.94) in the FPWM. CONCLUSION: Selective BC in HIE neonates does not affect the early and accurate prognostic value of ¹H-MRS and DTI, which outperform conventional MRI.
Authors: Maria K Zarifi; Loukas G Astrakas; Tina Young Poussaint; Adré du Plessis Ad; David Zurakowski; A Aria Tzika Journal: Radiology Date: 2002-12 Impact factor: 11.105
Authors: A J Barkovich; K D Westmark; H S Bedi; J C Partridge; D M Ferriero; D B Vigneron Journal: AJNR Am J Neuroradiol Date: 2001-10 Impact factor: 3.825
Authors: Alistair J Gunn; John S Wyatt; Andrew Whitelaw; John Barks; Denis Azzopardi; Roberta Ballard; A David Edwards; Donna M Ferriero; Peter D Gluckman; Richard A Polin; Charlene M Robertson; Marianne Thoresen Journal: J Pediatr Date: 2007-10-24 Impact factor: 4.406
Authors: Stephanie L Merhar; Elveda Gozdas; Jean A Tkach; Nehal A Parikh; Beth M Kline-Fath; Lili He; Weihong Yuan; Mekibib Altaye; James L Leach; Scott K Holland Journal: Am J Perinatol Date: 2019-03-27 Impact factor: 1.862
Authors: An N Massaro; Iordanis Evangelou; Ali Fatemi; Gilbert Vezina; Robert Mccarter; Penny Glass; Catherine Limperopoulos Journal: Dev Med Child Neurol Date: 2014-12-10 Impact factor: 5.449
Authors: Francesco T Mangano; Mekibib Altaye; Robert C McKinstry; Joshua S Shimony; Stephanie K Powell; Jannel M Phillips; Holly Barnard; David D Limbrick; Scott K Holland; Blaise V Jones; Jonathan Dodd; Sarah Simpson; Deanna Mercer; Akila Rajagopal; Sarah Bidwell; Weihong Yuan Journal: J Neurosurg Pediatr Date: 2016-05-20 Impact factor: 2.375