Magnetic resonance imaging in perinatal asphyxia.

Martin, Ernst; Barkovich, A. James

doi:10.1136/fn.72.1.f62

Cited by 75 publications

(31 citation statements)

References 55 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Due to the brevity of the therapeutic window, early detection of injury and early determination of those infants who are likely candidates for treatment are crucial (15). In this regard, traditional early indicators of brain injury, including Apgar scores, umbilical artery acidosis, and fetal heart rate monitoring, suffer from poor specificity (7,31), and more specific indicators of injury, such as magnetic resonance imaging and spectroscopy, are insensitive or difficult to implement within the therapeutic window (6,21).…”

mentioning

confidence: 99%

Cerebral metabolic rate of oxygen and amplitude-integrated electroencephalography during early reperfusion after hypoxia-ischemia in piglets

Tichauer¹,

Elliott²,

Hadway³

et al. 2009

Journal of Applied Physiology

View full text Add to dashboard Cite

Tichauer KM, Elliott JT, Hadway JA, Lee T, St. Lawrence KS. Cerebral metabolic rate of oxygen and amplitude-integrated electroencephalography during early reperfusion after hypoxia-ischemia in piglets. J Appl Physiol 106: 1506 -1512. First published March 19, 2009 doi:10.1152/japplphysiol.91156.2008.-The therapeutic window following perinatal hypoxia-ischemia is brief, and early clinical signs of injury can be subtle. Electroencephalography (EEG) represents the most promising early diagnostic of hypoxia-ischemia; however, some studies have questioned the sensitivity and specificity of EEG. The present study investigated the use of both near-infrared spectroscopy (NIRS) measurements of the cerebral metabolic rate of oxygen (CMRO 2) and amplitude-integrated EEG (aEEG) to detect the severity of hypoxia-ischemia after 1 h of reperfusion in newborn piglets (10 insult, 3 control). The CMRO2 was measured before and after 1 h of reperfusion from hypoxia-ischemia, the duration of which was varied from piglet to piglet with a range of 3-24 min, under fentanyl/nitrous oxide anesthesia to mimic awake-like levels of cerebral metabolism. EEG data were collected throughout the study. On average, the CMRO2 and mean aEEG background signals were significantly depressed following the insult (P Ͻ 0.05). Mean CMRO 2 and mean aEEG background were 2.61 Ϯ 0.11 ml O2 ⅐ min Ϫ1 ⅐ 100 g Ϫ1 and 20.4 Ϯ 2.7 V before the insult and 1.58 Ϯ 0.09 ml O2⅐min Ϫ1 ⅐100 g Ϫ1 and 11.8 Ϯ 2.9 V after 1 h of reperfusion, respectively. Both CMRO2 and aEEG displayed statistically significant correlations with duration of ischemia (P Ͻ 0.05; r ϭ 0.71 and r ϭ 0.89, respectively); however, only CMRO2 was sensitive to milder injuries (Ͻ5 min). This study highlights the potential for combining NIRS measures of CMRO2 with EEG in the neonatal intensive care unit to improve early detection of perinatal hypoxia-ischemia. near-infrared spectroscopy; piglet; hypoxia-ischemia; electroencephalography PERINATAL HYPOXIC-ISCHEMIC encephalopathy is a substantial cause of infant mortality and morbidity. It remains a detrimental factor in roughly 1 of every 500 live term births in developed nations, leading to long-term neurological and developmental disabilities (20). Recent clinical trials have demonstrated that the incidence of death and disability from hypoxia-ischemia in newborns can be significantly reduced by initiating treatment strategies, hypothermia, for example, after birth and within a 6-h therapeutic window (9,11,14,32). Due to the brevity of the therapeutic window, early detection of injury and early determination of those infants who are likely candidates for treatment are crucial (15). In this regard, traditional early indicators of brain injury, including Apgar scores, umbilical artery acidosis, and fetal heart rate monitoring, suffer from poor specificity (7, 31), and more specific indicators of injury, such as magnetic resonance imaging and spectroscopy, are insensitive or difficult to implement within the therapeutic window (6, 21).To this point, the most...

show abstract

mentioning

confidence: 99%

Cerebral metabolic rate of oxygen and amplitude-integrated electroencephalography during early reperfusion after hypoxia-ischemia in piglets

Tichauer¹,

Elliott²,

Hadway³

et al. 2009

Journal of Applied Physiology

View full text Add to dashboard Cite

show abstract

“…Although cranial sonography has been widely used to evaluate hypoxic ischaemic brain damage in infants it also has its limitations. Studies have shown that cranial sonography can depict only 28 to 80% of histologically proved PVL [11], moreover differentiating a normal periventricular echotexture and early PVL may be difficult using sonography. Furthermore, the severity of periventricular echogenicity A1am and Sahu may not be accurately assessed by this modality.…”

Section: Discussionmentioning

confidence: 99%

Magnetic Resonance Imaging in Evaluation of Periventricular Leukomalacia

Alam

Sahu²

2010

Medical Journal Armed Forces India

View full text Add to dashboard Cite

Background: Improvements in perinatal care have resulted in increased survival ofiniants born prematurely, bowever neurological damage due to ischaemic inIarction of the periventricular white matter is a problem of enormous medical, social and economic importance. Such vascular insult leads to destruction of the periventricular white matter, termed periventricular leukomalacin (PVL). This abnormality is the leading cause of significant morbidity in the survivors of premature birth. Magnetic Resonance Imaging (MRI) is perhaps the ouly imaging modality, which can accurately detect and quantify periventricular leukomalacia. Methods: Magnctic Resonance Imaging was carried out in 45 children in the age group of 4 weeks tu 8 years, with history of premature birth and perinatul bypo:ria. These children had neurological deficits raaging from cortical blindness, spastic diplegia, spastic quadriplegia tu severe mental retardation. The procedure was carried out on a 1.5 Tesla (Siemens Magnetum Avanto) MR system using available protocols for imaging the paediatric brain. Result: Tbe study revealed that MR imaging could accurately identify areas of ischaemic inIarction of the periventricular white matter both in the early as well as in the late stuges. The pattern of abnormalities detected on MRI of the brain in these patients can be considered specific for PVL in tbe clinical background of premature birth and perinatal hypo:ria. Conclusion: MRI is the ideal imaging modality tu detect, quantify and accurately map the areas of brain alTected by this hypo:ricischaemic process. It is presently the gold standard for evaluating the neuroparenchyma in those with perinatal hypoxia. Advanced MR techniques like DilJusion Weighted Imaging (DWI), Proton MR Spectroscopy and DTI have shown great promise in our understanding of the pathophysiology and anatomic considerations of this disease process.

show abstract

“…CT can demonstrate diffuse cerebral oedema (Volpe 2000), injury to the cortex and white matter, and damage to central grey matter structures such as thalamus and basal ganglia (Roland 1998). MRI is superior to ultrasound and CT in assessing maturational changes because of its better visualisation of myelination and structural changes (Martin 1995). MRI is a useful tool in evaluating the extent of brain damage within the first 10 days of birth (Barkovich 1995) and is often used in conjunction with neurological assessment for prognostication of outcome.…”

Section: B a C K G R O U N Dmentioning

confidence: 99%

“…MRI is superior to ultrasound and CT in assessing maturational changes because of its better visualisation of myelination and structural changes (Martin 1995). MRI is a useful tool in evaluating the extent of brain damage within the first 10 days of birth (Barkovich 1995) and is often used in conjunction with neurological assessment for prognostication of outcome.…”

Section: B a C K G R O U N Dmentioning

confidence: 99%