Abstract
Aim: To determine the altered pattern of fractional anisotropy (FA) and mean diffusivity (MD) change in brain parenchyma in serially studied neonates with mild or moderate hypoxic ischemic injury (HIE) within 7 days after birth and again at the age of three months. Methods: Serial diffusion tensor imaging (DTI) was performed at two-time points in term neonates with mild (n = 7) and moderate (n = 10) HIE and age/sex-matched controls (n = 7). Neurodevelopmental outcome was assessed at the time of the 2nd study. Results: On comparing FA and MD changes over time using two-way analysis of variance between neonates with HIE and controls, we observed significant differences in age-related FA increase (p < 0.05) in anterior limb of internal capsule and periventricular white matter of parietal, occipital, and temporal lobes. Significant differences in age-related MD decrease (p < 0.05) was observed in the caudate nuclei, and temporal white matter among these groups. Significant positive correlation was observed between neurodevelopmental outcome and FA. Conclusion: The results suggest that abnormal FA and MD values help in early and more accurate assessment of microstructural damage in HIE that may have predictive value for long-term neurofunctional outcome in these neonates.
Key words
Brain - diffusion tensor imaging - fractional anisotropy - hypoxic-ischemic injury - magnetic resonance imaging
References
-
1
Aida N, Nishimura G, Hachiya Y, Matsui K, Takeuchi M, Itani Y.
MR imaging of perinatal brain damage: comparison of clinical outcome with initial and follow-up MR findings.
AJNR Am J Neuroradiol.
1998;
19
1909-1921
-
2
Back S A, Han B H, Luo N L, Chricton C A, Xanthoudakis S, Tam J. et al .
Selective vulnerability of late oligodendrocytes progenitors to hypoxia-ischemia.
The Journal of Neuroscience.
2002;
22
455-463
-
3
Barkovich A J, Miller S P, Bartha A, Newton N, Hamrick S E, Mukherjee P. et al .
MR imaging, MR spectroscopy, and diffusion tensor imaging of sequential studies in neonates with encephalopathy.
AJNR Am J Neuroradiol.
2006;
27
533-547
-
4
Belet N, Belet U, İncesu L, Uysal S, Özinal S, Keskin T. et al .
Hypoxic-ischemic encephalopathy: correlation of serial MRI and outcome.
Pediatric Neurology.
2004;
31
267-275
-
5
Buffoon F, Malko N, Hervé D, Porcher R, Denghien I, Pappata S. et al .
Longitudinal diffusion changes in cerebral hemispheres after MCA infarcts.
Journal of Cerebral Blood Flow & Metabolism.
2005;
25
641-650
-
6
Byrne P, Welch R, Johnson M A, Darrah J, Piper M.
Serial magnetic resonance imaging in neonatal hypoxic-ischemic encephalopathy.
J Pediatr.
1990;
117
694-700
-
7
Gupta R K, Hasan K M, Mishra A M, Jha D, Husain M, Prasad K N. et al .
High fractional anisotropy in brain abscesses versus other cystic intracranial lesions.
AJNR Am J Neuroradiol.
2005;
26
1107-1114
-
8
Hasan K M, Parker D L, Alexander A L.
Comparison of gradient encoding schemes for diffusion-tensor MRI.
J Magn Reson Imaging.
2001;
13
769-780
-
9
Hunt R W, Neil J J, Coleman L T, Kean M J, Inder T E.
Apparent diffusion coefficient in the posterior limb of the internal capsule predicts outcome after perinatal asphyxia.
Pediatrics.
2004;
114
999-1003
-
10
Huppi P S, Barnes P D.
Magnetic resonance techniques in the evaluation of the newborn brain.
Clin Perinatol.
1997;
24
693-723
-
11
Huppi P S, Inder T E.
Magnetic resonance techniques in the evaluation of the perinatal brain: recent advances and future directions.
Semin Neonatol.
2001;
6
195-210
-
12
McKinstry R C, Miller J H, Synder A Z, Mathur A, Schefft G L, Almli C R. et al .
A prospective longitudinal diffusion tensor imaging study of brain injury in newborns.
Neurology.
2002;
59
824-833
-
13
Miller S P, Vigneron D B, Henry R G, Bohland M A, 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
621-632
-
14
Mukherjee P, Miller J H, Shimony J S, Conturo T E, Lee B CP, Almli C R. et al .
Normal brain maturation during childhood: developmental trends characterized with diffusion-tensor MR imaging.
Radiology.
2001;
2021
349-358
-
15
Neil J J, Shiran S I, McKinstry R C, Schefft G L, Snyder A Z, Almli C R. et al .
Normal brain in human newborns: apparent diffusion coefficient and diffusion anisotropy measured by using diffusion tensor MR imaging.
Radiology.
1998;
209
57-66
-
16 Phatak P. Developmental Assessment Scales for Indian Infants (DASII) (Revised Baroda Norms, 1997): Manual. Pune; Anand Agencies 1997
-
17
Robertson C, Finer N.
Term infants with hypoxic-ischemic encephalopathy: outcome at 3.5 years.
Dev Med Child Neurol.
1985;
27
473-484
-
18
Robertson C M, Finer N N, Grace M G.
School performance of survivors of neonatal encephalopathy associated with birth asphyxia at term.
J Pediatr.
1989;
114
753-760
-
19
Roelants-van Rijn A M, Nikkels P GJ, Groenendaal F, Barth P G, Snoeck I, Beek F JA. et al .
Neonatal diffusion-MR imaging: relation with histopathology or follow-up MR examination.
Neuropediatrics.
2001;
32
286-294
-
20
Rutherford M, Counsell S, Allsop J, Boardman J, Kapellou O, Larkman D. et al .
Diffusion-weighted magnetic resonance imaging in term perinatal brain injury: a comparison with site of lesion and time from birth.
Pediatrics.
2004;
114
1004-1014
-
21
Rutherford M A, Pennock J M, Counsell S J, Mercuri E, Cowan F M, Dubowitz L MS.
Abnormal magnetic resonance signal in the internal capsule predicts poor neurodevelopmental outcome in infants with hypoxic-ischemic encephalopathy.
Pediatrics.
1998;
102
323-328
-
22
Sarnat H B, Sarnat M S.
Neonatal encephalopathy following fetal distress. A clinical and electroencephalographic study.
Arch Neurol.
1976;
33
696-705
-
23
Schneider J FL, Il'yasov K A, Hennig J, Martin E.
Fast quantitative diffusion-tensor imaging of cerebral white matter from the neonatal period to adolescence.
Neuroradiology.
2004;
46
258-266
-
24
Staudt M, Niemann G, Grodd W, Krageloh-Mann I.
The pyramidal tracts in congenital hemiparesis: relationship between morphology and function in periventricular lesion.
Neuropediatrics.
2000;
31
257-264
-
25 Stoll B J, Kliegman R M. Hypoxia-ischemia. Behrman RE, Kliegman RM, Jenson HB Nelson Textbook of Pediatrics. Philadelphia; Saunders 2004: 566-568
-
26 Volpe J J. Neurology of the Newborn, 4th ed. Philadelphia; WB Saunders 2001
-
27
Ward P, Counsell S, Allsop J, Cowan F, Yuji S, Edwards D.
Reduced fractional anisotropy on diffusion tensor magnetic resonance imaging after hypoxic ischemic encephalopathy.
Pediatrics.
2006;
117
e619-e630
Professor Dr. M.D. Rakesh K. Gupta
MR Section
Department of Radiodiagnosis
Sanjay Gandhi Post Graduate Institute of Medical Sciences
Lucknow, UP
India-226014
Email: rakeshree@hotmail.com; rgupta@sgpgi.ac.in
