Evaluation of Perinatal Hypoxic Encephalopathy with Advanced MR Sequences
Author(s): Imtiyaz Khan, Nadia Khurshid*, Irshad Paul, Feroze Shaheen and Mushtaq Bhat
Abstract
Background
Perinatal hypoxic encephalopathy among important causes of neurological morbidity and mortality in full-term neonates. Identifying ischemic injury clinically usually is difficult in the immediate postnatal period, nonspecific clinical features are present and considerations regarding initiation of active life preserving therapies are needed. MR imaging is the most sensitive and specific imaging technique available for the assessment of perinatal birth asphyxia related brain injury in term-born neonates. This study investigates the utility of MR spectroscopy peak ratios, ADC values along with conventional MRI.
Objectives
To compare the association of encephalopathy following hypoxia in term neonates with proton MRS ratios and ADC values.
Materials and Methods
Conventional MRI (T1 and T2) along with DWI followed by MR Spectroscopy was done in 25 term neonates with clinical and neurological features of encephalopathy following perinatal asphyxia. MRS peak ratios, DWI with ADC values and conventional MRI findings were compared with each grade of HIE.
Results
Among 25 patients suspected cases of hypoxic encephalopathy, 15 patients had early positive conventional MR findings, 16 patients had late positive conventional MR findings, 19 patients had positive DWI, and 22 patients had positive MRS with high lactate/choline and lactate/NAA ratio. Higher association was found between spectroscopy findings and hypoxic ischemic injury compared to MR imaging and ADC.
ConclusionThe combination of MRS, DWI with ADC values and conventional MRI may assist in localizing and predicting the severity of ischemic injury in HIE patients.