Katsumi Hayakawa1,2, Sachiko Koshino3, Koichi Tanda4, Akira Nishimura4, Osamu Sato3, Hiroyuki Morishita3, Takaaki Ito3. 1. Department of Radiology, Red Cross Kyoto Daiichi Hospital, 15-749 Hon-machi, Higashiyama-ku, Kyoto, 605-0981, Japan. hayakawakatsumi2006@yahoo.co.jp. 2. Department of Radiology, Iwate Prefectural Kamaishi Hospital, Kyoto, Japan. hayakawakatsumi2006@yahoo.co.jp. 3. Department of Radiology, Red Cross Kyoto Daiichi Hospital, 15-749 Hon-machi, Higashiyama-ku, Kyoto, 605-0981, Japan. 4. Department of Neonatology, Red Cross Kyoto Daiichi Hospital, Kyoto, Japan.
Abstract
BACKGROUND: Pseudonormalization of diffusion-weighted magnetic resonance imaging (MRI) can lead to underestimation of brain injury in newborns with hypoxic-ischemic encephalopathy (HIE), posing a significant problem. We have noticed that some neonates show pseudonormalization negativity on diffusion-weighted imaging. OBJECTIVE: To compare pseudonormalization negativity with clinical outcomes. MATERIALS AND METHODS: Seventeen term neonates with moderate or severe HIE underwent therapeutic hypothermia. They were examined by MRI twice at mean ages of 3 days and 10 days. We evaluated the presence of restricted diffusion, and also the presence or absence of pseudonormalization, by diffusion-weighted imaging at the time of the second MRI, and correlated the results with clinical outcome. RESULTS: DWI demonstrated no abnormality in seven neonates. Among the 10 neonates with abnormal diffusion-weighted imaging findings, 2 were positive for pseudonormalization and 8 were negative. Among neonates with normal diffusion-weighted imaging findings and with positivity for pseudonormalization, none had major disability. Among the eight neonates with pseudonormalization negativity, all but one, who was lost to follow-up, had major disability. CONCLUSION: Abnormal diffusion-weighted imaging with pseudonormalization negativity might be predictive of severe brain injury and major disability. The second-week MRI is important for the judgment of pseudonormalization.
BACKGROUND: Pseudonormalization of diffusion-weighted magnetic resonance imaging (MRI) can lead to underestimation of brain injury in newborns with hypoxic-ischemicencephalopathy (HIE), posing a significant problem. We have noticed that some neonates show pseudonormalization negativity on diffusion-weighted imaging. OBJECTIVE: To compare pseudonormalization negativity with clinical outcomes. MATERIALS AND METHODS: Seventeen term neonates with moderate or severe HIE underwent therapeutic hypothermia. They were examined by MRI twice at mean ages of 3 days and 10 days. We evaluated the presence of restricted diffusion, and also the presence or absence of pseudonormalization, by diffusion-weighted imaging at the time of the second MRI, and correlated the results with clinical outcome. RESULTS: DWI demonstrated no abnormality in seven neonates. Among the 10 neonates with abnormal diffusion-weighted imaging findings, 2 were positive for pseudonormalization and 8 were negative. Among neonates with normal diffusion-weighted imaging findings and with positivity for pseudonormalization, none had major disability. Among the eight neonates with pseudonormalization negativity, all but one, who was lost to follow-up, had major disability. CONCLUSION: Abnormal diffusion-weighted imaging with pseudonormalization negativity might be predictive of severe brain injury and major disability. The second-week MRI is important for the judgment of pseudonormalization.
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