Near-infrared spectroscopy versus magnetic resonance imaging to study brain perfusion in newborns with hypoxic–ischemic encephalopathy treated with hypothermia

Abstract

Background The measurement of brain perfusion may provide valuable information for assessment and treatment of newborns with hypoxic-ischemic encephalopathy (HIE). While arterial spin labeled perfusion (ASL) magnetic resonance imaging (MRI) provides noninvasive and direct measurements of regional cerebral blood flow (CBF) values, it is logistically challenging to obtain. Near-infrared spectroscopy (NIRS) might be an alternative, as it permits noninvasive and continuous monitoring of cerebral hemodynamics and oxygenation at the bedside. Objective The purpose of this study is to determine the correlation between measurements of brain perfusion by NIRS and by MRI in term newborns with HIE treated with hypothermia. Design/Methods In this prospective cohort study, ASL-MRI and NIRS performed during hypothermia were used to assess brain perfusion in these newborns. Regional cerebral blood flow values (CBF), measured from 1–2 MRI scans for each patient, were compared to mixed venous saturation values (SctO2) recorded by NIRS just before and after each MRI. Analysis included groupings into moderate versus severe HIE based on their initial background pattern of amplitude-integrated electroencephalogram. Results Twelve concomitant recordings were obtained of seven neonates. Strong correlation was found between SctO2 and CBF in asphyxiated newborns with severe HIE (r = 0.88; p value = 0.0085). Moreover, newborns with severe HIE had lower CBF (likely lower oxygen supply) and extracted less oxygen (likely lower oxygen demand or utilization) when comparing SctO2 and CBF to those with moderate HIE. Conclusions NIRS is an effective bedside tool to monitor and understand brain perfusion changes in term asphyxiated newborns, which in conjunction with precise measurements of CBF obtained by MRI at particular times, may help tailor neuroprotective strategies in term newborns with HIE.

Simultaneous measurement of cerebral hemoglobin oxygen saturation and blood volume in asphyxiated neonates by near-infrared time-resolved spectroscopy

“…Developmental and HIE-related changes in cerebral hemodynamics between 24 and 72 h after birth are also major confounders, considering the variation in HIE severity among patients. Indeed, Wintermark et al reported a tendency for a greater decrease in both oxygen supply and demand or utilization over time in severely asphyxiated neonates compared with moderately asphyxiated neonates during HT [14].…”

“…[2][3][4]14,15].Toet et al and Ancona et al reported increased cerebral oxygenation (increased Table 2A Mean CBV and ScO 2 values (± SD) at 6, 24, 48, and 72 h after birth according to clinical outcome.…”

Brain oxygen saturation assessment in neonates using T2-prepared blood imaging of oxygen saturation and near-infrared spectroscopy

“…We can, however, not exclude pathological conditions associated with differences in CBF, such as hypoxic-ischemic encephalopathy and PAIS, from influencing the results. 1,39,40 The largest bias (i.e. rScO 2-NIRS À SO 2-T2-BIOS ¼ À20%) was shown on the affected side in the infant with unilateral ventricular dilatation.…”

The Experimental Study of Stress-Related Pathological Changes in Cerebral Venous Blood Flow in Newborn Rats Assessed by Doct

“…The most accepted are positron emission tomography (PET), 31,32 magnetic resonance imaging (MRI) (including functional MRI), 33À36 Doppler ultrasound and near-infrared spectroscopy (NIRS). 37,38 MRI provides high-resolution structural images but needs much time for data acquisition and processing and does not supply with information about blood°ow parameters. fMRI and PET use radioactive contrast agents to retrieve the data concerning with blood°ow and blood volume in the sample and have relatively low spatial and temporal resolution.…”