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Early detection of neonatal hypoxic-ischemic white matter injury: an MR diffusion tensor imaging study
Youngseob Seo1, Geun-Tae Kim, Jin Wook Choi
1aCenter for Medical Metrology, Korea Research Institute of Standards and Science bDepartment of Medical Physics, University of Science and Technology, Daejeon cDepartment of Internal Medicine, Kosin University College of Medicine, Busan dDepartment of Radiology, Ajou University School of Medicine, Suwon, Republic of Korea.
Insights
Diffusion tensor imaging (DTI) reveals significant differences in brain white matter metrics between healthy newborns and those treated for hypoxic-ischemic encephalopathy (HIE) or extracorporeal membrane oxygenation (ECMO). DTI can detect early signs of hypoxic-ischemic brain injury in infants.
Area of Science:
- Neuroimaging
- Neonatal Medicine
- Radiology
Background:
- Hypoxic-ischemic encephalopathy (HIE) and extracorporeal membrane oxygenation (ECMO) are critical conditions affecting neonates.
- Diffusion tensor imaging (DTI) provides insights into white matter integrity.
Purpose of the Study:
- To compare diffusion tensor metrics in normal neonates versus HIE and ECMO survivors.
- To assess the utility of DTI in identifying early brain injury in infants.
Main Methods:
- MRI at 3 Tesla was performed on 35 normal, 27 HIE, and 13 ECMO infants.
- Tract-based spatial statistics analyzed fractional anisotropy (FA), axial diffusivity (AD), and radial diffusivity (RD) in specific white matter tracts.
- Linear regression and t-tests assessed age and group differences.
Main Results:
- Statistically significant age effects on FA and RD were observed.
- Group differences in FA and RD were found between normal and HIE groups.
- Normal and ECMO groups showed differences in FA and RD in several brain regions.
Conclusions:
- DTI metrics, including FA, AD, and RD, can identify infants with abnormalities.
- Diffusion tensor imaging plays a significant role in detecting early hypoxic-ischemic brain injury in neonates.
Abstract:
The purpose of this study was to compare diffusion tensor metrics in normal age-matched neonates with survivors of hypoxic-ischemic encephalopathy (HIE) and extracorporeal membrane oxygenation (ECMO). Thirty-five normal, 27 HIE, and 13 ECMO infants underwent MRI at 3 T. Neurodevelopmental assessments were performed. Fractional anisotropy (FA), axial diffusivity (AD), and radial diffusivity (RD) of the inferior fronto-occipital fasciculus, inferior longitudinal fasciculus, anterior commissure, genu corpus callosum and splenium of the corpus callosum, anterior and posterior limb of the internal capsule, superior longitudinal fasciculus, and the centrum semiovale were analyzed with tract-based spatial statistics modified for use in neonates. Linear regression analysis was performed, and 95% confidence intervals were created for age effects on the tensor metrics with the control patients. Two-sample t-test was done to determine whether there was a difference in the tensor metrics between the normal and patient cohort. There was a statistically significant age effect on the FA and RD in the selected regions of the brain (F<0.05) and a group difference in the FA and RD between the normal and the HIE group (P<0.05). The group difference in the FA and RD between the normal and ECMO groups was seen in the anterior commissure, genu corpus callosum, right inferior longitudinal fasciculus, fronto-occipital fasciculus, centrum semiovale, and superior longitudinal fasciculus (P<0.05). Patients who were outside the 95% confidence intervals of the FA, AD, and RD overlapped with those with abnormalities clinically and on the conventional MRI. In conclusion, diffusion tensor imaging can play a significant role in detecting infants with early indications of hypoxic-ischemic brain injury.
