Comparison of fractional anisotropy and apparent diffusion coefficient among hypoxic ischemic encephalopathy stages 1, 2, and 3 and with nonasphyxiated newborns in 18 areas of brain

Supriya Kushwah; Ashok Kumar; Ashish Verma; Sriparna Basu; Ashutosh Kumar

doi:10.4103/ijri.IJRI_384_16

Indian Journal of Radiology and Imaging, Table of Contents

CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2017; 27(04): 447-456
DOI: 10.4103/ijri.IJRI_384_16

Neuro/Head & Neck

Comparison of fractional anisotropy and apparent diffusion coefficient among hypoxic ischemic encephalopathy stages 1, 2, and 3 and with nonasphyxiated newborns in 18 areas of brain

Supriya Kushwah

Department of Paediatrics, Yenepoya Medical College, Mangalore, Karnataka, India

,

Ashok Kumar

Department of Paediatrics, Institute of Medical Sciences, Varanasi, Uttar Pradesh, India

,

Ashish Verma

Department of Paediatrics, Institute of Medical Sciences, Varanasi, Uttar Pradesh, India

,

Sriparna Basu

Department of Paediatrics, Institute of Medical Sciences, Varanasi, Uttar Pradesh, India

,

Ashutosh Kumar

Department of Anaesthesia, KMC, Mangalore, Karnataka, India

› Author Affiliations

Abstract

PDF Download

Abstract

Purpose: To determine the area and extent of injury in hypoxic encephalopathy stages by diffusion tensor imaging (DTI) using parameters apparent diffusion coefficient (ADC) and fractional anisotropy (FA) values and their comparison with controls without any evidence of asphyxia. To correlate the outcome of hypoxia severity clinically and significant changes on DTI parameter. Materials and Methods: DTI was done in 50 cases at median age of 12 and 20 controls at median age of 7 days. FA and apparent diffusion coefficient (ADC) were measured in several regions of interest (ROI). Continuous variables were analyzed using Student's t-test. Categorical variables were compared by Fisher's exact test. Comparison among multiple groups was done using analysis of variance (ANOVA) and post hoc Bonferroni test. Results: Abnormalities were more easily and accurately determined in ROI with the help of FA and ADC values. When compared with controls FA values were significantly decreased and ADC values were significantly increased in cases, in ROI including both right and left side of thalamus, basal ganglia, posterior limb of internal capsule, cerebral peduncle, corticospinal tracts, frontal, parietal, temporal, occipital with P value < 0.05. The extent of injury was maximum in stage-III. There was no significant difference among males and females. Conclusion: Compared to conventional magnetic resonance imaging (MRI), the evaluation of FA and ADC values using DTI can determine the extent and severity of injury in hypoxic encephalopathy. It can be used for early determination of brain injury in these patients.

Keywords

Apparent diffusion coefficient - diffusion tensor imaging - fractional anisotropy - hypoxic ischemic encephalopathy

PDF (1169 kb)

References

References
1 Whitelaw A, Thoresen M. Clinical trials of treatments after perinatal asphyxia. Curr Opin Pediatr 2002;14:664-8.
2 Shankaran S, Laptook AR. Hypothermia as a treatment for birth asphyxia. Clin Obstet Gynecol 2007;50:624-35.
3 Gonzalez FF, Ferriero DM. Therapeutics for neonatal brain injury. Pharmacol Ther 2008;120:43-53.
4 Rennie JM, Leigh B. The legal framework for end-of-life decisions in the UK. Semin Fetal Neonatal Med 2008;13:296-300.
5 Odd DE, Lewis G, Whitelaw A, Gunnell D. Resuscitation at birth and cognition at 8 years of age: A cohort study. Lancet 2009;373:1615-22.
6 Rutherford MA, Cowan FM, Manzur AY, Dubowitz LM, Pennock JM, Hajnal JV, et al. MR imaging of anisotropically restricted diffusion in the brain of neonates and infants. J Comput Assist Tomogr 1991;15:188-98.
7 Sakuma H, Nomura Y, Takeda K, Tagami T, Nakagawa T, Tamagawa Y, et al. Adult and neonatal human brain: Diffusional anisotropy and myelination with diffusion-weighted MR imaging. Radiology 1991;180:229-33.
8 Neil JJ, Miller J, Mukherjee P, Huppi PS. Diffusion tensor imaging of normal and injured developing human brain-A technical review. NMR Biomed 2002;15:543-52.
9 Ralph Heinz E, James MP. Imaging findings in neonatal hypoxia: A practical review. Am J Roentgenol 2009;192:41-7.
10 Fenichel GM. Hypoxic ischemic encephalopathy in the newborn. Arch Neurol 1983;40:261-6.
11 Ferriero DM. Neonatal brain injury. N Engl J Med 2004;351:1985-95.
12 Ferriero DM, Miller SP. Imaging selective vulnerability in the developing nervous system. J Anat 2010;2:29-435.
13 Yoshiura T, Wu O, Zaheer A, Reese TG, Sorensen AG. Highly diffusion-sensitized MRI of brain: Dissociation of gray and white matter. Magn Reson Med 2001;45:734-40.
14 Chahboune H, Ment LR, Stewart WB, Rothman DL, Vaccarino FM, Hyder F, et al. Hypoxic injury during neonatal development in murine brain: Correlation between in vivo DTI findings and behavioral assessment. Cereb Cortex 2009;19:2891-901.
15 Yakovlev PI, Lecours AR. The myelogenetic cycles of regional maturation of the brain. In: Minkowski A, editor. Regional development of the brain in early life. Oxford: Blackwell Scientific; 1967. p. 3-70.
16 Brody BA, Kinney HC, Kloman AS, Gilles FH. Sequence of central nervous system myelination in human infancy: I. An autopsy study of myelination. J Neuropathol Exp Neurol 1987;46:283-301.
17 Miller SP, Vigneron DB, Henry RG, Bohland MA, Ceppi-Cozzio C, Hoffman C, et al. Serial quantitative diffusion tensor MRI of the premature brain: Development in newborns with and without injury. J Magn Reson Imaging 2002;16:621-32.
18 Le Bihan D, Breton E, Lallemand D, Grenier P, Cabanis E, Laval-Jeantet M. MR imaging of intravoxel incoherent motions: Application to diffusion and perfusion in neurologic disorders. Radiology 1986;161:401-7.
19 Moseley ME, Cohen Y, Kucharczyk J, Mintorovitch J, Asgari HS, Wendland MF, et al. Diffusion-weighted MR imaging of anisotropic water diffusion in cat central nervoussystem. Radiology 1990;176:439-45.
20 Thornton JS, Ordidge RJ, Penrice J, Cady EB, Amess PN, Punwani S, et al. Anisotropic water diffusion in white and gray matter of the neonatal piglet brain before and after transient hypoxia-ischaemia. Magn Res Imag 1997;15:433-40.
21 Basser PJ, Mattiello J, Le Bihan D. MR diffusion tensor spectroscopy and imaging. Biophys J 1994;66:259-67.
22 Brissaud O, Amirault M, Villega F, Periot O, Chateil JF, Allard M. Efficiency of fractional anisotropy and apparent diffusion coefficient on diffusion tensor imaging in prognosis of neonates with hypoxic-ischemic encephalopathy: A methodologic prospective pilot study. AJNR Am J Neuroradiol 2010;31:282-7.
23 Wolf RL, Zimmerman RA, Clancy R, Haselgrove JH. Quantitative apparent diffusion coefficient measurements in term neonates for early detection of hypoxicischemic brain injury: Initial experience. Radiology 2001;218:825-33.
24 Rutherford M, Counsell S, Allsop J, Boardman J, Kapellou O, Lartkman D, et al. Diffusion weighted magnetic resonance imaging intermperinatal brain injury: A comparison with site oflesion and time from birth. Pediatrics 2004;114:1004-14.
25 Hanrahan JD, Cox IJ, Azzopardi D, Cowan FM, Bryant DJ, Edwards AD, et al. Relation between proton magnetic resonance spectroscopy within 18 hours of birth asphyxia and neurodevelopment at 1 year of age. Dev Med Child Neurol 1999;41:76-82.
26 Ward P, Counsell S, Allsop J, Cowan F, Shen Y, Edwards D, et al. Reduced fractional anisotropy on diffusion tensor magnetic resonance imaging after hypoxic–ischemic encephalopathy. Pediatrics 2006;117:e619-30.
27 Forbes KP, Pipe JG, Bird R. Neonatal hypoxic-ischemic encephalopathy: Detection with diffusion-weighted MR Imaging. AJNR Am J Neuroradiol 2000;21:1490-6.
28 Tusor N, Wusthoff C, Smee N, Merchant N, Arichi T, Edwards AD, et al. Prediction of neurodevelopmental out-come after hypoxic-ischemic encephalopathy treated with hypothermia by diffusion tensor imaging analyzed using tract-based spatial statistics. Pediatr Res 2012;72:63-9.
29 Cowan FM, Pennock JM, Hanrahan JD, Manji KP, Edwards AD, et al. Early detection of cerebral infarction and hypoxic ischemic encephalopathy in neonates using diffusion weighted magnetic resonance imaging. Neuropediatrics 1994;25:172-5.
30 Dudink J, Mercuri E, Al Nakib L, Govaert P, Counsell SJ, Rutherford MA, et al. Evolution of Unilateral perinatal arterial ischemic stroke on conventional and diffusion-weighted mr imaging. AJNR Am J Neuroradiol 2009;30:998-1004.
31 Adams E, Chau V, Poskitt KJ, Grunau RE, Synnes A, Miller SP. Tractography-based quantification of corticospinal tract development in premature newborns. J Pediatr 2010;156:882-8.
32 Bax M, Tydeman C, Flodmark O. Clinical and MRI correlates of cerebral palsy: The european cerebral palsy study. JAMA 2006;296:1602-8.
33 Murakami A, Yamada K, Morimoto M, Kizu O, Nishimura A, Nishimura T, et al. Fiber-tracking techniques can predict degree of neurologic impairment for periventricular leukomalacia. Pediatrics 2008;122:500-6.
34 Porter EJ, Counsell SJ, Edwards AD, Allsop J, Azzopardi D. Tract-based spatial statistics of magnetic resonance images to assess disease and treatment effects in perinatal asphyxial encephalopathy. Pediatr Res 2010;68:205-9.
35 Ancora G, Testa C, Grandi S, Tonon C, Sbravati F, Lodi R, et al. Prognostic value of brain proton MR spectroscopy and diffusion tensor imaging in newborns with hypoxic-ischemic encephalopathy treated by brain cooling. Neuroradiology 2013;55:1017-25.
36 Lemmon ME, Wagner MW, Bosemani T, Carson KA, Northington FJ, Huisman TA, et al. Diffusion tensor imaging detects occult cerebellar injury in severe neonatal hypoxic-ischemic encephalopathy. Dev Neurosci 2017.
37 Zhang F, Liu C, Qian L, Hou H, Guo Z. Diffusion tensor imaging of white matter injury caused by prematurity-induced hypoxic-ischemic brain damage. Med Sci Monit 2016;22:2167-74.