Abstract
Background: Robust quantitative methods are needed to assess the severity of cerebral injury following perinatal hypoxia-ischaemia and to ascertain the efficacy of neuroprotective therapies.
Aim: To compare the prognostic efficacies of early magnetic resonance imaging (MRI) spin-spin (T2) relaxometry and proton (1H) magnetic resonance spectroscopy (MRS) in infants with neonatal encephalopathy (NE).
Methods: Twenty-three term infants with NE were studied with MRI and MRS at 2.4Tesla within 5 days of birth (mean age at scan 3.09 (sd 1.35) days). Mean MRI T2s were calculated for basal ganglia (BG) and thalamic (TH) regions of interest. Thalamic metabolite 1H-MRS peak area-ratios were determined using an 8ml cubic voxel (PRESS; echo time 270ms; repetition time 2s). Infants were divided into 3 outcome groups based on 1 year assessment: i) normal; ii) moderate outcome (neuromotor signs or Griffiths quotient (DQ) 75–84); iii) severe outcome (functional neuromotor deficit or DQ<75 or death). Logistic regression was used to examine the predictive efficacies of MRI T2 and MRS metabolite ratios at differentiating between normal and adverse outcome (moderate and severe groups combined). Prognostic sensitivities and specificities were determined using a threshold probability for group assignment of 50%.
Results: TH and BG T2 correlated with outcome (r=0.594, p=0.003; r=0.493, p=0.017 respectively). Thalamic lactate/ N-acetylaspartate (lac/NAA) and Lac/ total creatine (Cr) correlated positively and NAA/Cr correlated negatively with outcome (r=0.707, p<0.001; r=0.636, p=0.001; r= -0.668, p<0.001 respectively). TH and BG T2 were significant predictors for adverse outcome (p=0.002) as were Lac/NAA, Lac/Cr and NAA/Cr (all p<0.001). Lac/NAA demonstrated highest sensitivity and specificity (88% and 87% respectively) for adverse outcome and was better than TH and BG T2 (87% and 63%, and 80% and 63% respectively).
Discussion: Increased Lac/NAA was most predictive of outcome. However if 1H-MRS is unavailable, MRI T2 relaxometry can provide useful early prognostic information.
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Shanmugalingam, S., Thornton, J., Bainbridge, A. et al. 341 Prediction of Adverse Outcome by Thalamic and Basal Ganglia MRI T2 Relaxometry and Thalamic Proton Mrs in Neonatal Encephalopathy. Pediatr Res 58, 413 (2005). https://doi.org/10.1203/00006450-200508000-00370
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DOI: https://doi.org/10.1203/00006450-200508000-00370