TY - JOUR
T1 - MRI and spectroscopy in (near) term neonates with perinatal asphyxia and therapeutic hypothermia
AU - Alderliesten, Thomas
AU - de Vries, Linda S
AU - Staats, Liza
AU - van Haastert, Ingrid C
AU - Weeke, Lauren
AU - Benders, Manon J N L
AU - Koopman-Esseboom, Corine
AU - Groenendaal, Floris
N1 - Copyright:
Copyright 2017 Elsevier B.V., All rights reserved.
PY - 2017/3/1
Y1 - 2017/3/1
N2 - BACKGROUND: Previous studies have demonstrated the association of abnormalities on diffusion-weighted MRI (DW-MRI) and proton magnetic resonance spectroscopy ((1)H-MRS) in infants with perinatal asphyxia. The use of therapeutic hypothermia might change this association.AIM: To study the association between DW-MRI and (1)H-MRS and outcome after perinatal asphyxia and therapeutic hypothermia in infants with a gestational age of ≥36 weeks.PATIENTS AND METHODS: Infants with perinatal asphyxia and therapeutic hypothermia (n=88) were included when an MR examination was performed within 7 days after birth. Apparent diffusion coefficient (ADC) values of the basal ganglia and thalamus were calculated, as were lactate/N-acetylaspartate (LAC/NAA) and N-acetylaspartate/choline (NAA/Cho) ratios. Death or an abnormal neurodevelopment at ≥24 months was considered an adverse outcome. Receiver operating characteristic analysis was performed to determine cut-off levels.RESULTS: Of the 88 infants, 22 died and 7 had an adverse neurodevelopmental outcome. In infants with an adverse outcome, ADC values of the basal ganglia and thalamus were significantly lower, and Lac/NAA ratios were significantly higher than in infants with a normal outcome. Areas under the curve of ADC of the basal ganglia, thalami and Lac/NAA ratio were 0.89, 0.88 and 0.87, respectively. NAA/Cho ratios were in this cohort not associated with outcome.CONCLUSIONS: During and after therapeutic hypothermia, low ADC values and high Lac/NAA ratios of the basal ganglia and thalamus are associated with an adverse outcome in infants with perinatal asphyxia.
AB - BACKGROUND: Previous studies have demonstrated the association of abnormalities on diffusion-weighted MRI (DW-MRI) and proton magnetic resonance spectroscopy ((1)H-MRS) in infants with perinatal asphyxia. The use of therapeutic hypothermia might change this association.AIM: To study the association between DW-MRI and (1)H-MRS and outcome after perinatal asphyxia and therapeutic hypothermia in infants with a gestational age of ≥36 weeks.PATIENTS AND METHODS: Infants with perinatal asphyxia and therapeutic hypothermia (n=88) were included when an MR examination was performed within 7 days after birth. Apparent diffusion coefficient (ADC) values of the basal ganglia and thalamus were calculated, as were lactate/N-acetylaspartate (LAC/NAA) and N-acetylaspartate/choline (NAA/Cho) ratios. Death or an abnormal neurodevelopment at ≥24 months was considered an adverse outcome. Receiver operating characteristic analysis was performed to determine cut-off levels.RESULTS: Of the 88 infants, 22 died and 7 had an adverse neurodevelopmental outcome. In infants with an adverse outcome, ADC values of the basal ganglia and thalamus were significantly lower, and Lac/NAA ratios were significantly higher than in infants with a normal outcome. Areas under the curve of ADC of the basal ganglia, thalami and Lac/NAA ratio were 0.89, 0.88 and 0.87, respectively. NAA/Cho ratios were in this cohort not associated with outcome.CONCLUSIONS: During and after therapeutic hypothermia, low ADC values and high Lac/NAA ratios of the basal ganglia and thalamus are associated with an adverse outcome in infants with perinatal asphyxia.
UR - http://www.scopus.com/inward/record.url?scp=84984622262&partnerID=8YFLogxK
U2 - 10.1136/archdischild-2016-310514
DO - 10.1136/archdischild-2016-310514
M3 - Article
C2 - 27553589
SN - 1359-2998
VL - 102
SP - F147-F152
JO - Archives of Disease in Childhood Fetal and Neonatal Edition
JF - Archives of Disease in Childhood Fetal and Neonatal Edition
IS - 2
ER -