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Brain MRI after therapeutic hypothermia in asphyxiated newborns: Predictive value at one year of imaging features

Abstract : Purpose: To compare early brain MRI using a composite imaging score and outcome at one year in asphyxiated newborns treated by hypothermia. Methods: This retrospective study included for two years consecutive asphyxiated term newborns treated by hypothermia for hypoxic-ischemic encephalopathy, and who had brain MRI before day 8. Therapeutic hypothermia was initiated within the first 6 h of life and continued for 72 h. Imaging protocol included T1 and T2 sequences, diffusion-weighted imaging (DWI), evaluated with a specific composite score, and spectroscopy. Clinical evaluation was performed at one year of age, outcome was classified as favorable/unfavorable. The primary endpoint was the correlation between our MRI score and outcome with the definition of a threshold. The secondary endpoints were to find the most relevant criteria within the score and to evaluate objective signal measurements to support subjective criteria. Results: Among the 33 included patients, 9 died during the first days of life, 20 had a favorable outcome, 4 an unfavorable one. MRI score was correlated to a poor clinical outcome (p < 0.001). Most of the criteria within the score and spectroscopy results were relevant (p < 0.05). Cerebral edema was objectively assessed by the signal intensity ratio of white matter compared to cerebrospinal fluid (CSF) on T2-weighted images (p < 0.001). Conclusion: MRI score was predictive of neurodevelopmental outcome at one year. The most relevant criteria within the score were DWI abnormalities in basal ganglia and thalami and loss of white-cortical grey matter differentiation. Signal intensity ratio between white matter and CSF higher than 0.75 supports the presence of edema.
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https://hal-cnrs.archives-ouvertes.fr/hal-03366061
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Submitted on : Tuesday, October 5, 2021 - 5:48:06 PM
Last modification on : Wednesday, October 6, 2021 - 3:41:59 AM

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Clémentine Brocard, Yaniss Belaroussi, Justine Labat, Jean Delmas, Olivier Brissaud, et al.. Brain MRI after therapeutic hypothermia in asphyxiated newborns: Predictive value at one year of imaging features. European Journal of Radiology, Elsevier, 2021, 139, pp.109724. ⟨10.1016/j.ejrad.2021.109724⟩. ⟨hal-03366061⟩

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