Neonatal hypoglycaemic encephalopathy: diffusion-weighted imaging and proton MR spectroscopy

Area of Science:

• Neuroimaging
• Pediatric Neurology
• Medical Physics

Background:

• Neonatal hypoglycaemic encephalopathy (NHE) poses significant risks to infant brain development.
• Accurate early assessment of brain injury in NHE is crucial for timely intervention.
• Conventional Magnetic Resonance Imaging (MRI) may not always reveal subtle early changes.

Observation:

• Two infants with NHE underwent evaluation using conventional MRI, diffusion-weighted imaging (DWI), and proton MR spectroscopy (MRS).
• Abnormalities were predominantly observed in the parieto-occipital lobes and white matter, including the splenium of the corpus callosum, across all imaging modalities.
• DWI demonstrated restricted water diffusion in acute lesions, appearing more distinct than on conventional MRI.

Findings:

• Acute NHE lesions on DWI showed restricted water diffusion.
• Chronic NHE lesions on DWI exhibited increased water diffusion, correlating with atrophy seen on conventional MRI.
• Proton MRS revealed characteristic metabolic changes: an elevated lactate-lipid peak and a reduced N-acetylaspartate (NAA) peak in affected brain regions.

Implications:

• DWI and proton MRS are valuable tools for assessing the extent and presence of neuronal damage in NHE.
• These advanced MRI techniques can aid in earlier diagnosis and management of NHE.
• Findings highlight the utility of advanced neuroimaging in understanding the pathophysiology of neonatal brain injury.