MR imaging and outcome of term neonates with perinatal asphyxia: value of diffusion-weighted MR imaging and ¹H MR spectroscopy.

To compare the association between neurodevelopmental outcome in neonates with hypoxic-ischemic encephalopathy following perinatal asphyxia and (a) apparent diffusion coefficients (ADCs) in the thalamus and basal ganglia at diffusion-weighted (DW) magnetic resonance (MR) imaging and (b) hydrogen 1 (¹H) MR spectroscopic measurements in the basal ganglia. This retrospective study was approved by the local ethics committee, and the requirement to obtain informed consent was waived. Eighty-one term neonates with perinatal asphyxia underwent conventional and DW cranial MR imaging (median age, 4 days; age range, 1-14 days); 51 neonates also underwent ¹H MR spectroscopy. Neurodevelopment was assessed from 18 to 46 months. Patients with favorable and adverse outcomes were compared. Receiver operating characteristics analysis was performed in all patients, and uni- and multivariate logistic regression analyses were performed in 44 patients examined within 7 days of birth by using MR imaging scores, ADCs in the basal ganglia and thalamus, and ¹H MR spectroscopic measurements in the basal ganglia. An adverse outcome was seen in 28 of all 81 neonates (20 died, seven developed cerebral palsy, and one had severe mental retardation) and 22 of the 44 neonates examined within 7 days of birth with both ADC and ¹H MR spectroscopy. Poor outcome was associated with (a) lower ADCs in the basal ganglia (P < .001) and thalamus (P = .001) of neonates examined within 7 days of birth and (b) a higher lactate (Lac)-N-acetylaspartate (NAA) ratio in the basal ganglia (P < .001). Multivariate analysis showed that MR imaging score combined with Lac/NAA ratios or ADCs in the basal ganglia within the 1st week of life had a better association with outcome than did MR imaging alone (P = .006, area under the receiver operating characteristic curve [AUC] = 0.85 with Lac/NAA ratio; P < .0001, AUC = 0.93 with ADCs in basal ganglia). The combination of MR imaging score with ADCs or Lac/NAA ratios in the basal ganglia has a better association with outcome of asphyxiated term neonates than does MR imaging alone.

Alderliesten T ，de Vries LS ，Benders MJ ，Koopman C ，Groenendaal F ... -  《-》

Term neonate prognoses after perinatal asphyxia: contributions of MR imaging, MR spectroscopy, relaxation times, and apparent diffusion coefficients.

Boichot C ，Walker PM ，Durand C ，Grimaldi M ，Chapuis S ，Gouyon JB ，Brunotte F ... -  《RADIOLOGY》

MRI and spectroscopy in (near) term neonates with perinatal asphyxia and therapeutic hypothermia.

Previous studies have demonstrated the association of abnormalities on diffusion-weighted MRI (DW-MRI) and proton magnetic resonance spectroscopy (1H-MRS) in infants with perinatal asphyxia. The use of therapeutic hypothermia might change this association. To study the association between DW-MRI and 1H-MRS and outcome after perinatal asphyxia and therapeutic hypothermia in infants with a gestational age of ≥36 weeks. Infants with perinatal asphyxia and therapeutic hypothermia (n=88) were included when an MR examination was performed within 7 days after birth. Apparent diffusion coefficient (ADC) values of the basal ganglia and thalamus were calculated, as were lactate/N-acetylaspartate (LAC/NAA) and N-acetylaspartate/choline (NAA/Cho) ratios. Death or an abnormal neurodevelopment at ≥24 months was considered an adverse outcome. Receiver operating characteristic analysis was performed to determine cut-off levels. Of the 88 infants, 22 died and 7 had an adverse neurodevelopmental outcome. In infants with an adverse outcome, ADC values of the basal ganglia and thalamus were significantly lower, and Lac/NAA ratios were significantly higher than in infants with a normal outcome. Areas under the curve of ADC of the basal ganglia, thalami and Lac/NAA ratio were 0.89, 0.88 and 0.87, respectively. NAA/Cho ratios were in this cohort not associated with outcome. During and after therapeutic hypothermia, low ADC values and high Lac/NAA ratios of the basal ganglia and thalamus are associated with an adverse outcome in infants with perinatal asphyxia.

Alderliesten T ，de Vries LS ，Staats L ，van Haastert IC ，Weeke L ，Benders MJ ，Koopman-Esseboom C ，Groenendaal F ... -  《-》

Early diffusion-weighted MRI and 1H-Magnetic Resonance Spectroscopy in asphyxiated full-term neonates.

L'Abee C ，de Vries LS ，van der Grond J ，Groenendaal F ... -  《biology of the neonate》

Hypoxic-ischemic encephalopathy: diagnostic value of conventional MR imaging pulse sequences in term-born neonates.

Liauw L ，van der Grond J ，van den Berg-Huysmans AA ，Palm-Meinders IH ，van Buchem MA ，van Wezel-Meijler G ... -  《-》