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Imaging of Hypoxic-Ischemic Encephalopathy in the Full-Term Neonate

  • Amit M. Mathur
  • Robert C. McKinstry
Chapter

Key Points

■ Clinical neurological evaluation of the neonate with depression and/or encephalopathy is nonspecific. The neonatal course may suggest hypoxic-ischemic insult but the clinical examination cannot fully evaluate the extent or severity of the brain injury (moderate evidence).

■ The role of ultrasound (US) and computed tomography (CT) in the evaluation of hypoxic-ischemic brain injury at term is limited. Ultrasound could be used to evaluate neonates in the neonatal ICU if the patient is too sick to travel to the MR scanner. CT can be used to assess for traumatic brain injury if there is a history of complicated delivery. CT also plays a role in the acute management of suspected acute intracranial hemorrhage. However, CT and US fall short of MR imaging in the evaluation of the parenchymal changes of hypoxic-ischemic injury (moderate evidence).

■ Conventional MR imaging with T1-weighted, T2-weighted and T2*-weighted imaging is more sensitive than US and at least as sensitive as CT for HIE (moderate evidence).

■ Diffusion-weighted imaging (DWI) is complementary to conventional MR imaging, improving sensitivity to ischemic injuries during the first week after the ischemic insult (moderate to strong evidence).

■ MR spectroscopy (MRS) may detect injuries in the first week after the insult that are otherwise occult. Elevated lactate and decreased NAA predict a poor clinical outcome (moderate to strong evidence).

■ FLAIR and contrast-enhanced imaging sequences do not improve sensitivity of the MR exam beyond the other conventional sequences, DWI and MRS (moderate evidence).

■ MR imaging holds promise for evaluating prognosis, triaging patients for neuroprotective therapies, and serving as early predication of therapeutic efficacy (limited to moderate evidence).

Keywords

Brain Injury Apparent Diffusion Coefficient Cerebral Palsy Hypoxic Ischemic Encephalopathy Moderate Evidence 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Shankaran S, Laptook AR. Clin Obstet Gynecol Sep 2007;50(3):624–635.CrossRefPubMedGoogle Scholar
  2. 2.
    Jacobs S, Hunt R, Tarnow-Mordi W, Inder T, Davis P. Cochrane Database Syst Rev 2007(4):CD003311.Google Scholar
  3. 3.
    Lorek A, Takei Y, Cady EB et al. Pediatr Res Dec 1994;36(6):699–706.CrossRefPubMedGoogle Scholar
  4. 4.
    Penrice J, Cady EB, Lorek A et al. Pediatr Res Jul 1996;40(1):6–14.CrossRefPubMedGoogle Scholar
  5. 5.
    Gluckman PD, Williams CE. Dev Med Child Neurol Nov 1992;34(11):1010–1014.CrossRefPubMedGoogle Scholar
  6. 6.
    Gunn AJ, Thoresen M. NeuroRx Apr 2006;3(2):154–169.CrossRefPubMedGoogle Scholar
  7. 7.
    Siesjo BK. Magnesium 1989;8(5–6):223–237.PubMedGoogle Scholar
  8. 8.
    Fellman V, Raivio KO. Pediatr Res May 1997;41(5):599–606.CrossRefPubMedGoogle Scholar
  9. 9.
    Liu XH, Kwon D, Schielke GP, Yang GY, Silverstein FS et al. J Cereb Blood Flow Metab Oct 1999;19(10):1099–1108.CrossRefPubMedGoogle Scholar
  10. 10.
    Tan WK, Williams CE, During MJ et al. Pediatr Res May 1996;39(5):791–797.CrossRefPubMedGoogle Scholar
  11. 11.
    Gynecologists ACoOa. Neonatal Encephalopathy and Cerebral Palsy: Defining the Pathogenesis and Pathophysiology 2003.Google Scholar
  12. 12.
    Wu YW, Backstrand KH, Zhao S, Fullerton HJ, Johnston SC. Pediatrics Dec 2004;114(6):1584–1590.CrossRefPubMedGoogle Scholar
  13. 13.
    Hull J, Dodd KL. Br J Obstet Gynaecol May 1992;99(5):386–391.CrossRefPubMedGoogle Scholar
  14. 14.
    Smith J, Wells L, Dodd K. Bjog Apr 2000;107(4):461–466.PubMedGoogle Scholar
  15. 15.
    Thornberg E, Thiringer K, Odeback A, Milsom I. Acta Paediatr Aug 1995;84(8):927–932.CrossRefPubMedGoogle Scholar
  16. 16.
    Volpe JJ. Ment Retard Dev Disabil Res Rev 2001;7(1):56–64.CrossRefPubMedGoogle Scholar
  17. 17.
    Derrick M, Drobyshevsky A, Ji X, Tan S. Stroke Feb 2007;38(2 Suppl):731–735.CrossRefPubMedGoogle Scholar
  18. 18.
    Sarnat HB, Sarnat MS. Arch Neurol Oct 1976;33(10):696–705.PubMedGoogle Scholar
  19. 19.
    Volpe JJ. Neurology of the Newborn, 5th ed. Philadelphia: Saunders, 2008,414–427.Google Scholar
  20. 20.
    Barkovich AJ, Hajnal BL, Vigneron D et al. Am J Neuroradiol Jan 1998;19(1):143–149.PubMedGoogle Scholar
  21. 21.
    Kaufman SA, Miller SP, Ferriero DM, Glidden DH, Barkovich AJ et al. Pediatr Neurol May 2003;28(5):342–346.CrossRefPubMedGoogle Scholar
  22. 22.
    Barkovich AJ, Westmark KD, Bedi HS, Partridge JC, Ferriero DM et al. Am J Neuroradiol Oct 2001;22(9):1786–1794.PubMedGoogle Scholar
  23. 23.
    Hanrahan JD, Cox IJ, Azzopardi D et al. Dev Med Child Neurol Feb 1999;41(2):76–82.CrossRefPubMedGoogle Scholar
  24. 24.
    Coskun A, Lequin M, Segal M, Vigneron DB, Ferriero DM et al. Am J Neuroradiol Feb 2001;22(2):400–405.PubMedGoogle Scholar
  25. 25.
    McKinstry RC, Miller JH, Snyder AZ et al. Neurology Sep 24 2002;59(6):824–833.PubMedGoogle Scholar
  26. 26.
    Jissendi Tchofo P, Christophe C, David P, Metens T, Soto Ares G et al. J Neuroradiol Jan 2005;32(1):10–19.CrossRefPubMedGoogle Scholar
  27. 27.
    Barkovich AJ. Pediatric Neuroimaging, 4th ed. Philadelphia: Lippincott Williams & Wilkins, 2005, 226.Google Scholar
  28. 28.
    Cowan FM, de Vries LS. Semin Fetal Neonatal Med Oct 2005;10(5):461–474.PubMedGoogle Scholar
  29. 29.
    Groenendaal F, Benders MJ, de Vries LS. Semin Perinatol Jun 2006;30(3):146–150.CrossRefPubMedGoogle Scholar
  30. 30.
    Mazumdar A, Mukherjee P, Miller JH, Malde H, McKinstry RC. Am J Neuroradiol Jun–Jul 2003;24(6):1057–1066.PubMedGoogle Scholar
  31. 31.
    Neil JJ, Inder TE. J Child Neurol Feb 2006;21(2):115–118.CrossRefPubMedGoogle Scholar
  32. 32.
    Winter JD, Lee DS, Hung RM et al. Pediatr Neurol Oct 2007;37(4):255–262.CrossRefPubMedGoogle Scholar
  33. 33.
    Ward P, Counsell S, Allsop J et al. Pediatrics Apr 2006;117(4):e619–e630.CrossRefPubMedGoogle Scholar
  34. 34.
    Ment LR, Bada HS, Barnes P et al. Neurology Jun 25 2002;58(12):1726–1738.PubMedGoogle Scholar
  35. 35.
    Akter M, Hirai T, Hiai Y et al. Acad Radiol Sep 2007;14(9):1011–1019.CrossRefPubMedGoogle Scholar
  36. 36.
    de Souza JM, Domingues RC, Cruz LC, Jr., Domingues FS, Iasbeck T et al. Am J Neuroradiol Jan 2008;29(1):154–158.CrossRefPubMedGoogle Scholar
  37. 37.
    Liang L, Korogi Y, Sugahara T et al. Am J Neuroradiol Sep 1999;20(8):1527–1534.PubMedGoogle Scholar
  38. 38.
    Liauw L, van der Grond J, van den Berg-Huysmans AA, Palm-Meinders IH, van Buchem MA et al. Radiology Apr 2008;247(1):204–212.CrossRefPubMedGoogle Scholar
  39. 39.
    Sie LT, Barkhof F, Lafeber HN, Valk J, van der Knaap MS. VEur Radiol 2000;10(10):1594–1601.CrossRefGoogle Scholar
  40. 40.
    Cowan FM, Pennock JM, Hanrahan JD, Manji KP, Edwards AD. Neuropediatrics Aug 1994;25(4):172–175.CrossRefPubMedGoogle Scholar
  41. 41.
    Dag Y, Firat AK, Karakas HM, Alkan A, Yakinci C et al. Diagn Interv Radiol Sep 2006;12(3):109–114.PubMedGoogle Scholar
  42. 42.
    Forbes KP, Pipe JG, Bird R. Am J Neuroradiol Sep 2000;21(8):1490–1496.PubMedGoogle Scholar
  43. 43.
    Johnson AJ, Lee BC, Lin W. Am J Roentgenol Jan 1999;172(1):219–226.Google Scholar
  44. 44.
    Khong PL, Tse C, Wong IY et al. J Child Neurol Nov 2004;19(11):872–881.PubMedGoogle Scholar
  45. 45.
    Krishnamoorthy KS, Soman TB, Takeoka M, Schaefer PW. J Child Neurol Sep 2000;15(9):592–602.CrossRefPubMedGoogle Scholar
  46. 46.
    Malik GK, Trivedi R, Gupta RK et al. Neuropediatrics Dec 2006;37(6):337–343.CrossRefPubMedGoogle Scholar
  47. 47.
    Rutherford M, Counsell S, Allsop J et al. Pediatrics Oct 2004;114(4):1004–1014.CrossRefPubMedGoogle Scholar
  48. 48.
    Soul JS, Robertson RL, Tzika AA, du Plessis AJ, Volpe JJ. Pediatrics Nov 2001;108(5):1211–1214.Google Scholar
  49. 49.
    Takeoka M, Soman TB, Yoshii A et al. Pediatr Neurol Apr 2002;26(4):274–281.CrossRefPubMedGoogle Scholar
  50. 50.
    Thornton JS, Ordidge RJ, Penrice J et al. Magn Reson Med Jun 1998;39(6):920–927.CrossRefPubMedGoogle Scholar
  51. 51.
    Wolf RL, Zimmerman RA, Clancy R, Haselgrove JH. Radiology Mar 2001;218(3):825–833.PubMedGoogle Scholar
  52. 52.
    Zarifi MK, Astrakas LG, Poussaint TY, Plessis Ad A, Zurakowski D et al. Radiology Dec 2002;225(3):859–870.CrossRefGoogle Scholar
  53. 53.
    van Pul C, Buijs J, Janssen MJ, Roos GF, Vlaardingerbroek MT et al. Am J Neuroradiol Mar 2005;26(3):469–481.PubMedGoogle Scholar
  54. 54.
    Daneman A, Epelman M, Blaser S, Jarrin JR. Pediatr Radiol Jul 2006;36(7):636–646.CrossRefGoogle Scholar
  55. 55.
    Blankenberg FG, Loh NN, Bracci P et al. Am J Neuroradiol Jan 2000;21(1):213–218.PubMedGoogle Scholar
  56. 56.
    Robertson RL, Robson CD, Zurakowski D, Antiles S, Strauss K et al. Pediatr Radiol Jul 2003;33(7):442–449.CrossRefGoogle Scholar
  57. 57.
    Jyoti R, O‘Neil R, Hurrion E. Pediatr Radiol Jan 2006;36(1):38–42.CrossRefPubMedGoogle Scholar
  58. 58.
    Barkovich AJ. Am J Neuroradiol 1997 Nov–Dec; 18(10):1816–1820.PubMedGoogle Scholar
  59. 59.
    Rutherford MA, Pennock JM, Counsell SJ et al. Pediatrics Aug 1998;102(2 Pt 1):323–328.CrossRefPubMedGoogle Scholar
  60. 60.
    Bluml S, Friedlich P, Erberich S, Wood JC, Seri I et al. Radiology May 2004;231(2):594–601.CrossRefPubMedGoogle Scholar
  61. 61.
    Mathur AM, Neil JJ, McKinstry RC, Inder TE. Pediatr Radiol Mar 2008;38(3):260–264.CrossRefPubMedGoogle Scholar
  62. 62.
    Conturo TE, McKinstry RC, Akbudak E, Robinson BH. Magn Reson Med Mar 1996;35(3):399–412.PubMedGoogle Scholar
  63. 63.
    Le Bihan D, Mangin JF, Poupon C et al. J Magn Reson Imaging Apr 2001;13(4):534–546.CrossRefPubMedGoogle Scholar
  64. 64.
    Neil JJ, Shiran SI, McKinstry RC et al. Radiology Oct 1998;209(1):57–66.PubMedGoogle Scholar
  65. 65.
    Cappellini M, Rapisardi G, Cioni ML, Fonda C. Radiol Med (Torino) Oct 2002;104(4):332–340.Google Scholar
  66. 66.
    da Silva LF, Hoefel Filho JR, Anes M, Nunes ML. Pediatr Neurol May 2006;34(5):360–366.CrossRefPubMedGoogle Scholar
  67. 67.
    Kadri M, Shu S, Holshouser B et al. J Perinatol Apr–May 2003;23(3):181–185.CrossRefPubMedGoogle Scholar
  68. 68.
    Roland EH, Poskitt K, Rodriguez E, Lupton BA, Hill A. Ann Neurol Aug 1998;44(2):161–166.CrossRefPubMedGoogle Scholar
  69. 69.
    Hunt RW, Neil JJ, Coleman LT, Kean MJ, Inder TE. Pediatrics Oct 2004;114(4):999–1003.CrossRefPubMedGoogle Scholar
  70. 70.
    Kuenzle C, Baenziger O, Martin E et al. Neuropediatrics Aug 1994;25(4):191–200.CrossRefPubMedGoogle Scholar
  71. 71.
    Saint Hilaire MH, Burke RE, Bressman SB, Brin MF, Fahn S. Neurology Feb 1991;41(2 (Pt 1)):216–222.Google Scholar
  72. 72.
    Barnett A, Mercuri E, Rutherford M et al. Neuropediatrics Oct 2002;33(5):242–248.CrossRefPubMedGoogle Scholar
  73. 73.
    Rutherford MA, Ward P, Malamatentiou C. Semin Fetal Neonatal Med Oct 2005;10(5):445–460.PubMedGoogle Scholar
  74. 74.
    Pasternak JF, Gorey MT. Pediatr Neurol May 1998;18(5):391–398.CrossRefPubMedGoogle Scholar
  75. 75.
    Miller SP, Ramaswamy V, Michelson D et al. J Pediatr Apr 2005;146(4):453–460.CrossRefPubMedGoogle Scholar
  76. 76.
    Gonzalez FF, Miller SP. Arch Dis Child Fetal Neonatal Ed Nov 2006;91(6):F454–F459.CrossRefPubMedGoogle Scholar
  77. 77.
    Rutherford MA, Azzopardi D, Whitelaw A et al. Pediatrics Oct 2005;116(4):1001–1006.CrossRefPubMedGoogle Scholar
  78. 78.
    Inder TE, Hunt RW, Morley CJ et al. J Pediatr Dec 2004;145(6):835–837.CrossRefPubMedGoogle Scholar
  79. 79.
    Wang ZJ, Vigneron DB, Miller SP et al. Am J Neuroradiol Apr 2008;29(4):798–801.CrossRefPubMedGoogle Scholar
  80. 80.
    Wang J, Licht DJ. Neuroimaging Clin N Am Feb 2006;16(1):149–167, ix.CrossRefPubMedGoogle Scholar
  81. 81.
    Fair DA, Cohen AL, Dosenbach NU et al. Proc Natl Acad Sci U S A Mar 11 2008;105(10):4028–4032.CrossRefPubMedGoogle Scholar
  82. 82.
    Vendt BA, McKinstry RC, Ball WS et al. J Digit Imaging Apr 9 2009;22(3):326–343.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Department of Pediatrics/Newborn MedicineWashington University School of Medicine, St. Louis Children’s HospitalSt. LouisUSA
  2. 2.Department of Pediatric RadiologySt. Louis Children’s Hospital,Washington UniversitySt. LouisUSA

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