Kim V Annink1, Lilly Meerts1,2, Niek E van der Aa1, Thomas Alderliesten1, Peter G J Nikkels3, Cora H A Nijboer2, Floris Groenendaal1, Linda S de Vries1, Manon J N L Benders1, Freek E Hoebeek2, Jeroen Dudink4. 1. Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht Brain Center, University Utrecht, Utrecht, The Netherlands. 2. Department of Developmental Origins of Disease, University Medical Center Utrecht Brain Centre, University Utrecht, Utrecht, The Netherlands. 3. Department of Pathology, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands. 4. Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht Brain Center, University Utrecht, Utrecht, The Netherlands. j.dudink@umcutrecht.nl.
Abstract
BACKGROUND: Postmortem examinations frequently show cerebellar injury in infants with severe hypoxic-ischemic encephalopathy (HIE), while it is less well visible on MRI. The primary aim was to investigate the correlation between cerebellar apparent diffusion coefficient (ADC) values and histopathology in infants with HIE. The secondary aim was to compare ADC values in the cerebellum of infants with HIE and infants without brain injury. METHODS: ADC values in the cerebellar vermis, hemispheres and dentate nucleus (DN) of (near-)term infants with HIE (n = 33) within the first week after birth were compared with neonates with congenital non-cardiac anomalies, normal postoperative MRIs and normal outcome (n = 22). Microglia/macrophage activation was assessed using CD68 and/or HLA-DR staining and Purkinje cell (PC) injury using H&E-stained slices. The correlation between ADC values and the histopathological measures was analyzed. RESULTS: ADC values in the vermis (p = 0.021) and DN (p < 0.001) were significantly lower in infants with HIE compared to controls. ADC values in the cerebellar hemispheres were comparable. ADC values in the vermis were correlated with the number and percentage of normal PCs; otherwise ADC values and histology were not correlated. CONCLUSION: Histopathological injury in the cerebellum is common in infants with HIE. ADC values underestimate histopathological injury. IMPACT: ADC values might underestimate cerebellar injury in neonates with HIE. ADC values in the vermis and dentate nucleus of infants with HIE are lower compared to controls, but not in the cerebellar hemispheres. Abnormal ADC values are only found when cytotoxic edema is very severe. ADC values in the vermis are correlated with Purkinje cell injury in the vermis; furthermore, there were no correlations between ADC values and histopathological measures.
BACKGROUND: Postmortem examinations frequently show cerebellar injury in infants with severe hypoxic-ischemic encephalopathy (HIE), while it is less well visible on MRI. The primary aim was to investigate the correlation between cerebellar apparent diffusion coefficient (ADC) values and histopathology in infants with HIE. The secondary aim was to compare ADC values in the cerebellum of infants with HIE and infants without brain injury. METHODS: ADC values in the cerebellar vermis, hemispheres and dentate nucleus (DN) of (near-)term infants with HIE (n = 33) within the first week after birth were compared with neonates with congenital non-cardiac anomalies, normal postoperative MRIs and normal outcome (n = 22). Microglia/macrophage activation was assessed using CD68 and/or HLA-DR staining and Purkinje cell (PC) injury using H&E-stained slices. The correlation between ADC values and the histopathological measures was analyzed. RESULTS: ADC values in the vermis (p = 0.021) and DN (p < 0.001) were significantly lower in infants with HIE compared to controls. ADC values in the cerebellar hemispheres were comparable. ADC values in the vermis were correlated with the number and percentage of normal PCs; otherwise ADC values and histology were not correlated. CONCLUSION: Histopathological injury in the cerebellum is common in infants with HIE. ADC values underestimate histopathological injury. IMPACT: ADC values might underestimate cerebellar injury in neonates with HIE. ADC values in the vermis and dentate nucleus of infants with HIE are lower compared to controls, but not in the cerebellar hemispheres. Abnormal ADC values are only found when cytotoxic edema is very severe. ADC values in the vermis are correlated with Purkinje cell injury in the vermis; furthermore, there were no correlations between ADC values and histopathological measures.
Authors: John P Welsh; Genevieve Yuen; Dimitris G Placantonakis; Toan Q Vu; Florent Haiss; Elizabeth O'Hearn; Mark E Molliver; Sue A Aicher Journal: Adv Neurol Date: 2002
Authors: Elisabeth Le Strange; Nadeem Saeed; Frances M Cowan; A David Edwards; Mary A Rutherford Journal: AJNR Am J Neuroradiol Date: 2004-03 Impact factor: 3.825
Authors: Jessica L Wisnowski; Pia Wintermark; Sonia L Bonifacio; Christopher D Smyser; A James Barkovich; A David Edwards; Linda S de Vries; Terrie E Inder; Vann Chau Journal: Semin Fetal Neonatal Med Date: 2021-10-29 Impact factor: 3.726
Authors: Rosario Baltazar-Lara; Janeth Mora Zenil; Martha Carranza; José Ávila-Mendoza; Carlos G Martínez-Moreno; Carlos Arámburo; Maricela Luna Journal: Int J Mol Sci Date: 2022-09-30 Impact factor: 6.208