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Prognostic value of brain proton MR spectroscopy and diffusion tensor imaging in newborns with hypoxic-ischemic encephalopathy treated by brain cooling

  • Paediatric Neuroradiology
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Abstract

Introduction

MRI, proton magnetic resonance spectroscopy (1H-MRS), and diffusion tensor imaging (DTI) have been shown to be of great prognostic value in term newborns with moderate–severe hypoxic-ischemic encephalopathy (HIE). Currently, no data are available on 1H-MRS and DTI performed in the subacute phase after hypothermic treatment. The aim of the present study was to assess their prognostic value in newborns affected by moderate–severe HIE and treated with selective brain cooling (BC).

Methods

Twenty infants treated with BC underwent conventional MRI and 1H-MRS at a mean (SD) age of 8.3 (2.8) days; 15 also underwent DTI. Peak area ratios of metabolites and DTI variables, namely mean diffusivity (MD), axial and radial diffusivity, and fractional anisotropy (FA), were calculated. Clinical outcome was monitored until 2 years of age.

Results

Adverse outcome was observed in 6/20 newborns. Both 1H-MRS and DTI variables showed higher prognostic accuracy than conventional MRI. N-acetylaspartate/creatine at a basal ganglia localisation showed 100 % PPV and 93 % NPV for outcome. MD showed significantly decreased values in many regions of white and gray matter, axial diffusivity showed the best predictive value (PPV and NPV) in the genu of corpus callosum (100 and 91 %, respectively), and radial diffusivity was significantly decreased in fronto white matter (FWM) and fronto parietal (FP) WM. The decrement of FA showed the best AUC (0.94) in the FPWM.

Conclusion

Selective BC in HIE neonates does not affect the early and accurate prognostic value of 1H-MRS and DTI, which outperform conventional MRI.

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Conflict of interest

We declare that we have no conflict of interest.

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Authors and Affiliations

  1. Neonatal Intensive Care Unit, Department of Mother and Infant Infermi Hospital of Rimini, Rimini, Italy

    G. Ancora

  2. MR Functional Unit, Department of Biomedical and Neuromotor Sciences University of Bologna, Bologna, Italy

    C. Testa, C. Tonon, D. N. Manners, L. L. Gramegna & R. Lodi

  3. Neonatology Unit, Department of Woman, Child and Adolescent Health, University of Bologna, Bologna, Italy

    S. Grandi, F. Sbravati, S. Savini, L. T. Corvaglia & G. Faldella

  4. Radiology Unit, Department of Woman, Child and Adolescent Health, University of Bologna, Bologna, Italy

    G. Tani

  5. Department of Pharmacy and Biotechnologies, University of Bologna, Bologna, Italy

    E. Malucelli

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  1. G. Ancora
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  2. C. Testa
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  3. S. Grandi
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  11. L. T. Corvaglia
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  13. R. Lodi
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Corresponding author

Correspondence to G. Ancora.

Additional information

G. Ancora and C. Testa contributed equally to this study.

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Ancora, G., Testa, C., Grandi, S. et al. Prognostic value of brain proton MR spectroscopy and diffusion tensor imaging in newborns with hypoxic-ischemic encephalopathy treated by brain cooling. Neuroradiology 55, 1017–1025 (2013). https://doi.org/10.1007/s00234-013-1202-5

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  • DOI: https://doi.org/10.1007/s00234-013-1202-5

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