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Observational Study
. 2014 Jul 8:14:177.
doi: 10.1186/1471-2431-14-177.

Early identification of brain injury in infants with hypoxic ischemic encephalopathy at high risk for severe impairments: accuracy of MRI performed in the first days of life

Thais Agut  1 , Marisol León, Mónica Rebollo, Jordi Muchart, Gemma Arca, Alfredo Garcia-Alix
Affiliations
Observational Study

Early identification of brain injury in infants with hypoxic ischemic encephalopathy at high risk for severe impairments: accuracy of MRI performed in the first days of life

Thais Agut et al. BMC Pediatr. .

Abstract

Background: Despite therapeutic hypothermia 30-70% of newborns with moderate or severe hypoxic ischemic encephalopathy will die or survive with significant long-term impairments. Magnetic resonance imaging (MRI) in the first days of life is being used for early identification of these infants and end of life decisions are relying more and more on it. The purpose of this study was to evaluate how MRI performed around day 4 of life correlates with the ones obtained in the second week of life in infants with hypoxic-ischemic encephalopathy (HIE) treated with hypothermia.

Methods: Prospective observational cohort study between April 2009 and July 2011. Consecutive newborns with HIE evaluated for therapeutic hypothermia were included. Two sequential MR studies were performed: an 'early' study around the 4th day of life and a 'late' study during the second week of life. MRI were assessed and scored by two neuroradiologists who were blinded to the clinical condition of the infants.

Results: Forty-eight MRI scans were obtained in the 40 newborns. Fifteen infants underwent two sequential MR scans. The localization, extension and severity of hypoxic-ischemic injury in early and late scans were highly correlated. Hypoxic-ischemic injury scores from conventional sequences (T1/T2) in the early MRI correlated with the scores of the late MRI (Spearman ρ = 0.940; p < .001) as did the scores between diffusion-weighted images in early scans and conventional images in late MR studies (Spearman ρ = 0.866; p < .001). There were no significant differences in MR images between the two sequential scans.

Conclusions: MRI in the first days of life may be a useful prognostic tool for clinicians and can help parents and neonatologist in medical decisions, as it highly depicts hypoxic-ischemic brain injury seen in scans performed around the second week of life.

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Figures

Figure 1
Figure 1
Sequential MR studies in a newborn with severe HIE and a central pattern of injury (ID number 12). A. Early MR study. A.a. Axial diffusion-weighted image: restricted diffusion in the thalami; A.b. Axial T1 weighted images: abnormal high intensity within the basal ganglia and thalami (BGT) and loss of the normal intensity of the posterior limb of the internal capsule. A.c. Axial T2 weighted image. Low and high signal intensity within the basal ganglia and thalami. B. Late MRI study confirmed the previous findings. Sagittal (B.a.) and axial (B.b.) T1 weighted images showing an abnormal widespread high intensity of BGT and confirming the absence of the normal intensity of the posterior limb of the internal capsule. Cortical highlighting around central fissure. B.c. Axial T2 weighted images with heterogeneity of the signal in BGT more evident than in the early MRI.
See this image and copyright information in PMC

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