Early identification of hypoxic-ischemic encephalopathy by combination of magnetic resonance (MR) imaging and proton MR spectroscopy

Abstract

Brain damage following a perinatal hypoxic-ischemic encephalopathy (HIE) can be diagnosed by different techniques. The aim of the present study was to combine magnetic resonance (MR) imaging with proton MR spectroscopy in HIE diagnosis and to evaluate their correlation with outcome. A prospective observational cohort study was performed between February 2012 and February 2013. Consecutive newborns, 24 full-term neonates with HIE (mild to moderate and severe group) and 5 normal neonates, were included. Two sequential MR studies were performed; a conventional MR imaging for observation in T1 weighted image (WI) and T2WI, and proton MR spectroscopy for observation in the left or right basal ganglia and thalamus. MR images were assessed and scored by two neuroradiologists who were blinded to the clinical condition of the infants. The mild to moderate group (n=13) and severe group (n=11) were similar in the visualization of punctate hyperintensity lesions on T1WI and brain edema on T2WI. The differences of N-acetylaspartate/creatine (Cr), choline/Cr and lactate/Cr in the basal ganglia and thalamus in the HIE group were significantly different (P<0.05) compared with the control group, while no significant difference was identified between the mild to moderate and severe group (P>0.05). In conclusion, MR spectroscopy is a complementary tool for the diagnosis of HIE.

Measurement of Lactate Content and Amide Proton Transfer Values in the Basal Ganglia of a Neonatal Piglet Hypoxic-Ischemic Brain Injury Model Using MRI

“…However, when the brain is exposed to a hypoxicischemic (HI) environment, aerobic energy metabolism is interrupted [5][6][7] and becomes anaerobic. During anaerobic metabolism, lactate is produced, causing an increase of lactate in brain tissue.…”

Feature Extraction and Classification to Diagnose Hypoxic-Ischemic Encephalopathy Patients by Using Susceptibility-Weighted MRI Images

“…However the score predicted by the method proposed in [3] has a 0.84 correlation coefficient. The other type of MRIs, which is T1W1 and proton MR spectroscopy is useful to distinguish between HIE and normal infants, However the study presented in [20] is performed manually on MRIs. In my opinion, these two areas have been not evaluated on large datasets or fail to give a good result for the largest number of images in screening processing.…”

Neurodevelopmental effect of intracranial hemorrhage observed in hypoxic ischemic brain injury in hypothermia-treated asphyxiated neonates - an MRI study

“…It is important to note, that we excluded those patients whose first MRI was performed after the first week of life, given the main body of HIE-related literature [34, 38, 40] this can be considered as a shortcoming, however our goal was to investigate the early and transient signs of HIE on MRI alongside with the presence of ICH. The fact that our findings on the outcome-modifying effects of HIE signs present on MRI are in line with the literature obtained on later acquired imaging data [3, 4, 6, 7] justifies the appropriateness of our selection criteria.…”

“…Trained pediatric radiologist blinded to the clinical history and neurodevelopmental results retrospectively evaluated the imaging signs of HIE and the presence and type of hemorrhage. HIE related abnormality was reported, when a lactate peak and relatively low values of normal metabolites (represented by Lac/NAA height ratios measured on MRS with TE = 144 ms) were present on MR-spectroscopy [34, 35] AND/OR HIE related diffusion restriction or signal abnormalities on T1- and T2 weighted images were present [36–38]. Predominantly basal-ganglia-thalamus pattern was reported when central grey matter nuclei and perirolandic cortex involvement was seen bilaterally with or without associated hippocampal and brain stem involvement and the absence of a normal high-signal intensity of the posterior limb of the internal capsule [37].…”