Cerebral perfusion in infants and neonates: preliminary results obtained using dynamic susceptibility contrast enhanced magnetic resonance imaging

Tanner, Steven F.; Cornette, Luc; Ramenghi, Luca A.; Miall, Lawrence; Ridgway, John P.; Smith, M. A.; Levene, Malcolm I.

doi:10.1136/fn.88.6.f525

Cited by 32 publications

(19 citation statements)

References 7 publications

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“…These findings are supported by a recent study that measured dynamic cerebral perfusion in premature as well as mature neonates compared with that of adults using susceptibility contrast enhancement magnetic resonance imaging techniques (21). The investigators observed that images of relative cerebral blood flow from mature infants were comparable to adults, whereas relative cerebral blood flow data in premature infants showed perfusion voids predominantly in white matter and well-detected perfusion in gray matter.…”

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confidence: 75%

Anatomic Analysis of Blood Vessels in Germinal Matrix, Cerebral Cortex, and White Matter in Developing Infants

2004

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The germinal matrix (GM) located in the thick subependymal cell layer of the thalamostriate groove is a major site of cerebral hemorrhage in premature infants. Comparing the morphology of vasculature among GM, gray and white matter of the brain may help in understanding the pathogenesis of GM hemorrhage and also of periventricular leukomalacia. The objective of the present study was to determine the morphology of blood vessels in the GM, gray matter, and white matter and to examine maturational changes in the morphology of these vessels as a function of gestational age. We measured vessel density, percentage of blood vessel area, mean surface area, length, breadth, perimeter, radius, and shape of blood vessels in coronal sections of the GM, gray matter, and white matter in postmortem human brain samples for 17 fetuses and premature infants of gestational age 16 -40 wk and 2 adults. We performed immunohistochemical staining using anti-laminin primary antibody, confocal microscopy to acquire images, and analysis using Metamorph version 6.1. Vessel density and the percentage of blood vessel area increased as a function of gestational age in the GM, gray matter, and white matter (p Ͻ 0.001 each). The blood vessel density and the percentage of blood vessel area were largest in the GM followed by gray matter and then white matter in all of the gestational age categories (p Ͻ 0.001 for all comparisons). Increased vascularity of the GM compared with gray and white matter may play a role in GM hemorrhage, whereas a relatively low vascularity of white matter may increase the propensity for the occurrence of periventricular leukomalacia in premature infants (Pediatr Germinal matrix hemorrhage (GMH)-intraventricular hemorrhage (IVH) continues to be an important cause of mortality and morbidity in premature infants (1,2). The pathogenesis of IVH is not well understood. However, some theories concerning IVH include venous origin of hemorrhage (3), poorly developed tight junctions (4), greater lumenal areas (5), and low cerebral blood flow (6). Premature infants primarily bleed in the GM and not in gray and white matter, suggesting that there is an intrinsic weakness in the blood vessels of GM compared with blood vessels in other areas of the brain. Thus, this study is based on the premise that maturational changes in the morphology of GM blood vessels and difference in GM vasculature compared with gray and white matter may reveal reasons for the vulnerability of the GM blood vessels to hemorrhage. In addition, development of white matter vasculature may be of importance with respect to the pathogenesis of periventricular leukomalacia (PVL), a white matter disease of premature newborns that is considered to be of hypoxicischemic origin (7).The morphology of GM blood vessels has been studied by a number of investigators in beagle pups (8 -10), rabbits (11), monkey fetuses (12), and premature human infants (5,13). Studies on human infants have examined the pattern of vascularization (14), glial ensheathment of cerebral cortical ...

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confidence: 75%

Anatomic Analysis of Blood Vessels in Germinal Matrix, Cerebral Cortex, and White Matter in Developing Infants

2004

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“…There have been fewer studies of DSC-MR imaging in children, and particularly neonates, than in adults. [56][57][58][59] Hand injections are preferred over power injections in infants, with less reproducibility. Wintermark et al 58 were the first to assess PWI in 5 term neonates with HIE on early (days 2-4) and late MR imaging (days 9 -11).…”

Section: Brain Perfusion Measurements By Using Mr Imagingmentioning

confidence: 99%

Brain Perfusion Imaging in Neonates: An Overview

Proisy

Mitra

Uria-Avellana

et al. 2016

AJNR Am J Neuroradiol

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SUMMARY:The development of cognitive function in children has been related to a regional metabolic increase and an increase in regional brain perfusion. Moreover, brain perfusion plays an important role in the pathogenesis of brain damage in high-risk neonates, both preterm and full-term asphyxiated infants. In this article, we will review and discuss several existing imaging techniques for assessing neonatal brain perfusion. ABBREVIATIONS:ASL ϭ arterial spin-labeling; HIE ϭ hypoxic-ischemic encephalopathy; NIRS ϭ near-infrared spectroscopy

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“…The pathophysiologic explanation for these different patterns remains unclear, but alterations of cerebral perfusion may be a major factor. Perfusionweighted imaging (PWI) has been used only occasionally in newborns so far (2)(3)(4). Furthermore, brain perfusion associated with these different patterns of neonatal encephalopathy has received little attention.…”

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confidence: 99%

Perfusion‐weighted magnetic resonance imaging patterns of hypoxic–ischemic encephalopathy in term neonates

Wintermark¹,

Moessinger²,

Gudinchet³

et al. 2008

Magnetic Resonance Imaging

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Purpose:To determine whether an early magnetic resonance imaging (MRI) study using perfusion-weighted imaging (PWI) may define the pattern of brain injury in term neonatal hypoxic-ischemic (HI) encephalopathy. Materials and Methods:Five newborns with HI encephalopathy or a marker of perinatal depression, and 2 controls underwent an early MRI (at 2 to 4 days), including PWI. Relative cerebral blood flow (rCBF) values were measured.Results: On early (Յ4 days) PWI-MRI, marked hyperperfusion was seen in areas of HI brain damage, allowing the classification of the children into different patterns according to the predominant site of injury: 1 with a "normal pattern"; 1 with a "watershed pattern" with increased rCBF ratios in white matter; 1 with a "basal ganglia pattern" with increased rCBF ratios in basal ganglia; and 2 with a "total cortical pattern" with increased rCBF ratios in cortical gray matter, white matter, and basal ganglia. These patterns were confirmed in all infants on late (9 to 11 days) conventional MRI (T2-weighted images) (4 of 5 patients) or on postmortem examination (1 of 5 patients). Conclusion:PWI is technically feasible in neonates with HI encephalopathy in a reproducible way, permitting comparisons between children. It provides a practical means to identify early after birth the future definitive ischemic areas that may be shown on conventional MRI only later. MAGNETIC RESONANCE IMAGING (MRI) is increasingly being used to better understand the heterogeneity of hypoxic-ischemic (HI) brain injury associated with neonatal encephalopathy. Patterns of brain injury in term neonatal encephalopathy have thus been determined and have been associated with different clinical presentations and neurodevelopmental outcomes (1). The pathophysiologic explanation for these different patterns remains unclear, but alterations of cerebral perfusion may be a major factor. Perfusionweighted imaging (PWI) has been used only occasionally in newborns so far (2-4). Furthermore, brain perfusion associated with these different patterns of neonatal encephalopathy has received little attention.The aim of this study was to assess brain perfusion patterns in term newborn infants with HI encephalopathy early after birth, in order to determine whether PWI correlates with the pattern of injury in neonatal encephalopathy observed later by conventional imaging. MATERIALS AND METHODSWe studied 5 term newborn infants who had neonatal HI encephalopathy or a marker of perinatal depression: seizures within 72 hours of birth or at least three of the following criteria: (1) late decelerations on fetal monitoring; (2) umbilical artery pH Ͻ 7.1; (3) 5-minute Apgar score Յ5; or (4) multiorgan failure. These inclusion criteria were chosen, according to previous studies (1,5), to encompass the entire range of neonatal encephalopathy, from normal to severe patterns. The infants underwent an early (range 2 to 4 days) complete magnetic resonance imaging (MRI) study (conventional MRI, perfusion-weighted imaging, and diffusion-weighted imaging) a...

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Cerebral perfusion in infants and neonates: preliminary results obtained using dynamic susceptibility contrast enhanced magnetic resonance imaging

Cited by 32 publications

References 7 publications

Anatomic Analysis of Blood Vessels in Germinal Matrix, Cerebral Cortex, and White Matter in Developing Infants

Anatomic Analysis of Blood Vessels in Germinal Matrix, Cerebral Cortex, and White Matter in Developing Infants

Brain Perfusion Imaging in Neonates: An Overview

Perfusion‐weighted magnetic resonance imaging patterns of hypoxic–ischemic encephalopathy in term neonates

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