Magnetic resonance imaging and spectroscopy in evaluation of hypoxic ischemic encephalopathy in pediatric age group

Magnetic resonance imaging and spectroscopy in evaluation of hypoxic ischemic encephalopathy in pediatric age group

Background Hypoxic ischemic encephalopathy is a major cause of pediatric mortality and morbidity, with possible long-term neurologic sequel, such as cerebral palsy. With improvements in care of at-risk neonates, more children survive. This makes it increasingly important to assess, soon after birth,...

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Bibliographic Details
Published in:Egyptian journal of radiology and nuclear medicine Vol. 52; no. 1; pp. 198 - 13
Main Authors: Elshal, Fatma Ibrahim Soliman, Elshehaby, Walid Ahmed, Dawoud, Mahmoud Abd elaziz, Shaban, Ekhlas Abdelmonem
Format: Journal Article
Language:English
Published: Cairo Springer 10-08-2021
Springer Nature B.V
SpringerOpen
Subjects:
Age groups
Asphyxia neonatorum
Biomarkers
Brain damage
Cerebral palsy
Encephalopathy
Health aspects
Hypoxia
Hypoxic ischemic encephalopathy
Infants (Newborn)
Injuries
Localization
Magnetic resonance imaging
Metabolism
Metabolites
Mortality
Nuclear magnetic resonance spectroscopy
Pediatric
Pediatrics
Prognosis
Ratios
Spectroscopy
Spectrum analysis
Statistical analysis
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Summary:Background Hypoxic ischemic encephalopathy is a major cause of pediatric mortality and morbidity, with possible long-term neurologic sequel, such as cerebral palsy. With improvements in care of at-risk neonates, more children survive. This makes it increasingly important to assess, soon after birth, the prognosis of children with hypoxic-ischemic encephalopathy. The aim of the study was to assess the additive role of magnetic resonance spectroscopy over conventional MRI in diagnosis and early prediction of pathological motor development in neonates with hypoxic ischemic encephalopathy. Results MRS ratios showed significant difference between unfavorable and normal outcome infants. MRS ratios as Lac/Cr, NAA/Cr and NAA/Cho within basal ganglia, thalamus and white matter can significantly differentiate between patients with normal and pathological outcome at 1 year. Lac/Cr positively correlates with the severity of HIE. Both NAA/Cr and NAA/Cho negatively correlate with the severity of the disease. Ratios cutoff values as Lac/Cr above 0.38 and 0.42 in basal ganglia and white matter, respectively, NAA/Cr below 0.9 and 0.8 in basal ganglia and occipital white matter, respectively, and NAA/Cho below 0.29 and 0.31 in basal ganglia and frontal white matter, respectively, were significantly predictive of pathological outcome. Conclusion High Lac/Cr, low NAA/Cr and low NAA/Cho ratios within examined regions of the brain including deep grey matter nuclei as well as white matter are associated with an adverse outcome in infants with perinatal asphyxia. MRS is an accurate quantitative MR biomarker within the neonatal period for prediction of neurodevelopmental outcome after perinatal HIE. MRS may be useful in early clinical management decisions, and counseling parents thereby ensuring appropriate early intervention and rehabilitation.
ISSN:0378-603X
2090-4762
DOI:10.1186/s43055-021-00578-y