Radiological Findings in Term-neonates with Hypoxic-ischemic Encephalopathy


Authors: L. Bakaj Zbrožková 1;  J. Hálek 2,3;  K. Michálková 1;  M. Heřman 1
Authors‘ workplace: Radiologická klinika LF UP a FN Olomouc 1;  Novorozenecké oddělení, FN Olomouc 2;  Dětská klinika LF UP a FN Olomouc 3
Published in: Cesk Slov Neurol N 2017; 80/113(3): 291-299
Category: Original Paper

Práce byla podpořena grantem UP: IGA_LF_2016_004 a RVO: LF UP 61989592.

Overview

Aim:
The analysis of ultrasonographic and MRI brain findings in term neonates with hypoxic-ischemic encephalopathy referred for therapeutic hypothermia.

Material and methods:
The study included 39 neonates (25 boys and 14 girls). In 32 cases (82%) US was done during the therapeutic hypothermia, in seven cases (18%) after it ‘s completition. The brain MRI was performed after the therapy in all cases. Subsequently the results from the imaging methods were analyzed.

Results:
The most common pathological US findings were low value of the resistive index (53.1% during the hypothermia, 42.9% after it’s completition), the basal ganglia and thalamus injury (15.6% during the hypothermia, 28.6% after it’s completition) and diffuse increased echogenicity of the brain parenchyma (12.8% during the hypothermia). The dominant findings on the brain MRI were the basal ganglia and thalami injuries (82.1%), followed by cortical and subcortical lesions (35.9%) and changes of the posterior limb of the internal capsula (30.8%). The haemorrhage occured in high percentage (35.9%).

Conclusion:
Pathological US brain findings in neonates with hypoxic-ischemic encephalopathy performed during the therapy and after the treatment were present in 68.7% and 57.1%, resp. MRI examinations depicted pathology in 82.1%.

Key words:
hypoxic-ischemic encephalopathy – magnetic resonance imaging – neonate – ultrasonography

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.


Chinese summary - 摘要



缺氧缺血性脑病新生患儿放射学检查结果

目标:

超声检查(US)和MRI脑组织发现缺氧缺血性脑病的新生儿分为治疗性低温。

材料和方法:

该研究包括39名新生儿(25名男孩和14名女孩)。 32例(82%)超声检查在治疗低温期间完成,7例(18%)完成后完成。在所有情况下,在治疗后进行脑部MRI扫描。随后,分析了脑影像结果。

结果:

最常见的病理学超声检查研究结果是阻力指数(低体温53.1%,完成后为42.9%),基底神经节和丘脑损伤(低体温15.6%,完成完成后为28.6%);扩散增加脑实质的回声(12.8%在低体温)。脑MRI的主要发现是基底神经节和丘脑损伤(82.1%),其次是皮层和皮质下病变(35.9%),内囊囊后肢变化(30.8%)。出血发生率高达35.9%。

结论:

在治疗期间和治疗后进行的缺氧缺血性脑病的新生儿的超声检查大脑病理学发现分别为68.7%和57.1%。 MRI检查显示病变在82.1%。

关键词:

缺氧缺血性脑病 - 磁共振成像 - 新生儿超声检查


Sources

1. Van Handel M, Swaab H, de Vries LS, et al. Long-term cognitive and behavioral consequences of neonatal encephalopathy fol­low­ing perinatal asphyxia: a review. Eur J Pediatr 2007;166(7):645– 54.

2. Shankaran S. Neonatal encephalopathy: treatment with hypothermia. J Neurotrauma 2009;26(3):437– 43. doi: 10.1089/ neu.2008.0678.

3. Barkovich AJ. The encephalopathic neonate: choos­ing the proper imag­ing technique. AJNR Am J Neuroradiol 1997;18(10):1816– 20.

4. Jacobs SE, Morley CJ, Inder TE, et al. Whole-body hypothermia for term and near-term newborns with hypoxic-ischemic encephalopathy: a randomized controlled trial. Arch Pediatr Adolesc Med 2011;165(8):692−700.

5. Thoresen M, Whitelaw A. Therapeutic hypothermia for hypoxic-ischaemic encephalopathy in the newborn infant. Curr Opin Neurol 2005;18(2):111– 6.

6. Jacobs SE, Berg M, Hunt R, et al. Cool­ing for newborns with hypoxic ischaemic encephalopathy. Cochrane Database Syst Rev 2013;(1):CD003311.

7. Shah PS. Hypothermia: a systematic review and meta-analysis of clinical trials. Semin Fetal Neonatal Med 2010;15(5):238– 46. doi: 10.1016/ j.siny.2010.02.003.

8. Shankaran S, Laptook AR, Ehrenkranz RA, et al. Whole-body hypothermia for neonates with hypoxic-ischemic encephalopathy. N Engl J Med 2005;353(15):1574– 84.

9. Azzopardi DV, Strohm B, Edwards AD, et al. Moderate hypothermia to treat perinatal asphyxial encephalopathy. N Engl J Med 2009;361(14):1349– 58. doi: 10.1056/ NEJMoa0900854.

10. Edwards AD, Brocklehurst P, Gunn AJ, et al. Neurological outcomes at 18 months of age after moderate hypothermia for perinatal hypoxic ischaemic encephalopathy: synthesis and meta-analysis of trial data. BMJ 2010;340:c363. doi: 10.1136/ bmj.c363.

11. Gunn AJ, Wyatt JS, Whitelaw A, et al. Therapeutic hypothermia changes the prognostic value of clinical evaluation of neonatal encephalopathy. J Pediatr 2008;152(1):55– 8.

12. Hálek J, Dubrava L, Kamtor L. Léčebná hypotermie v léčbě hypoxicko-iscchemické encefalopatie u novorozenců. Pediatr Praxi 2011;12(6):390– 3.

13. Ment LR, Bada HS, Barnes P et al. Practice parameter: neuroimag­ing of the neonate: report of the Quality Standards Subcom­mittee of the American Academy of Neurology and the Practice Com­mittee of the Child Neurology Society. Neurology 2002;58(12):1726– 38.

14. Daneman A, Epelman M, Blaser S, et al. Imag­ing of the brain in ful­l-term neonates: does sonography still play a role? Pediatr Radiol 2006;36(7):636– 46.

15. Prager A, Roychowdhury S. Magnetic resonance imag­ing of the neonatal brain. Indian J Pediatr 2007;74(2):173– 84.

16. Černoch Z, et al. Neuroradiologie. Hradec Králové: Nucleus HK 2000:585.

17. Dinan D, Daneman A, Guimaraes CV, et al. Easily overlooked sonographic findings in the evaluation of neonatal encephalopathy: les­sons learned from magnetic resonance imaging. Semin Ultrasound CT MR 2014;35(6):627– 51.

18. Stark JE, Seibert JJ. Cerebral artery Doppler ultrasonography for prediction of outcome after perinatal asphyxia. J Ultrasound Med 1994;13(8):595– 600.

19. Jongel­ing BR, Badawi N, Kurinczuk JJ, et al. Cranial ultrasound as a predictor of outcome in term newborn encephalopathy. Pediatr Neurol 2002;26(1):37– 42.

20. Ilves P, Lintrop M, Metsvaht T, et al. Cerebral blood-flow velocities in predict­ing outcome of asphyxiated newborn infants. Acta Paediatr 2004;93(4):523– 8.

21. Epelman M, Daneman A, Kel­lenberger CJ, et al. Neonatal encephalopathy: a prospective comparison of head US and MRI. Pediatr Radiol 2010;40(10):1640– 50. doi: 10.1007/ s00247-010-1634-6.

22. Gerner GJ, Burton VJ, Poretti A, et al. Transfontanel­lar duplex brain ultrasonography resistive indices as a prog­nostic tool in neonatal hypoxic-ischemic encephalopathy before and after treatment with therapeutic hypothermia. J Perinatol 2016;36(3):202– 6. doi: 10.1038/ jp.2015.169.

23. Lawn JE, Lee AC, Kin­ney M, et al. Two mil­lion intrapartum-related stil­lbirths and neonatal deaths: where, why, and what can be done? Int J Gynaecol Obstet 2009;107(Suppl 1):5– 19.

24. Triulzi F, Baldoli C, Righhini A. Neonatal hypoxic-ischemic encephalopathy. In: Tortori-Donati P, Ros­si A, Biancheri R, eds. Pediatric Neuroradiology. Brain. Berlin: Springer-Verlag Heidelberg 2005:235– 55.

25. Chao CP, Zaleski CG, Patton AC. Neonatal hypoxic-ischemic encephalopathy: multimodality imag­ing find­ings. Radiographics 2006;26(Suppl 1):159– 72.

26. Shroff MM, Soares-Fernandes JP, Whyte H, et al. MR imag­ing for dia­gnostic evaluation of encephalopathy in the newborn. Radiographics 2010;30(3):763– 80. doi: 10.1148/ rg.303095126.

27. Okereafor A, Al­lsop J, Counsell SJ, et al. Pat­terns of brain injury in neonates exposed to perinatal sentinel events. Pediatrics 2008;121(5):906– 14. doi: 10.1542/ peds.2007-0770.

28. Jyoti R, O‘Neil R, Hur­rion E. Predict­ing outcome in term neonates with hypoxic-ischaemic encephalopathy us­ing simplified MR criteria. Pediatr Radiol 2006;36(1):38– 42.

29. Mil­ler SP, Ramaswamy V, Michelson D, et al. Patterns of brain injury in term neonatal encephalopathy. J Pediatr 2005;146(4):453– 60.

30. Van Wezel-Meijler G, Steggerda SJ, Leijser LM. Cranial ultrasonography in neonates: role and limitations. Semin Perinatol 2010;34(1):28– 38. doi: 10.1053/ j.semperi.2009.10.002.

31. Barnette AR, Horbar JD, Soll RF, et al. Neuroimag­ing in the evaluation of neonatal encephalopathy. Pediatrics 2014;133(6):1508– 17.

32. Bokiniec R, Bekiesińska-Figatowska M, Rudzińska I, et al. Sonographic and MRI findings in neonates fol­low­ing selective cerebral hypothermia. Ginekol Pol 2014;85(12):933– 8.

33. Heinz ER, Provenzale JM. Imag­ing findings in neonatal hypoxia: a practical review. AJR Am J Roentgenol 2009;192(1):41– 7. doi: 10.2214/ AJR.08.1321.

34. Li J, Funato M, Tamai H, et al. Predictors of neurological outcome in cooled neonates. Pediatr Int 2013;55(2):169– 76.

Labels
Paediatric neurology Neurosurgery Neurology

Article was published in

Czech and Slovak Neurology and Neurosurgery

Issue 3

2017 Issue 3

Most read in this issue
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account