Related Experiment Video
Updated: Aug 16, 2025
Non-invasive Optical Measurement of Cerebral Metabolism and Hemodynamics in Infants
Published on: March 14, 2013
Utility of Cerebral Microvascular Imaging in Infants Undergoing ECMO
Luis Octavio Tierradentro-Garcia1, Joseph A Stern1, Rebecca Dennis1,2
1Department of Pediatric Radiology, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
Purpose:
Infants who require extracorporeal membrane oxygenation (ECMO) therapy have an increased risk of neurological complications and mortality. Microvascular imaging (MVI) is an advanced Doppler technique that allows high-resolution visualization of microvasculature in the brain. We describe the feasibility and utility of MVI for the evaluation of cerebral microvascular perfusion in patients undergoing ECMO.
Methods:
We retrospectively analyzed brain MVI scans of neonates undergoing ECMO. Two pediatric radiologists qualitatively assessed MVI scans to determine the presence or absence of tortuosity, symmetry, heterogeneity, engorgement, and hypoperfusion of the basal ganglia-thalamus (BGT) region, as well as the presence or absence of white matter vascular engorgement and increased peri-gyral flow in the cortex. We tested the association between the presence of the aforementioned brain MVI features and clinical outcomes.
Results:
We included 30 patients, 14 of which were male (46.7%). The time of ECMO duration was 11.8 ± 6.9 days. The most prevalent microvascular finding in BGT was lenticulostriate vessel tortuosity (26/30, 86.7%), and the most common microvascular finding in the cortex was increased peri-gyral flow (10/24, 41.7%). Cortical white matter vascular engorgement was significantly associated with the presence of any poor outcome as defined by death, seizure, and/or cerebrovascular events on magnetic resonance imaging (p = 0.03).
Conclusion:
MVI is a feasible modality to evaluate cerebral perfusion in infants undergoing ECMO. Additionally, evidence of white matter vascular engorgement after ECMO cannulation could serve as a predictor of poor outcomes in this population.
Insights
Microvascular imaging (MVI) can assess brain blood flow in infants on extracorporeal membrane oxygenation (ECMO). White matter vascular engorgement on MVI may predict poor outcomes in these high-risk infants.
Area of Science:
- Neonatal neurology
- Pediatric radiology
- Cardiovascular imaging
Background:
- Infants requiring extracorporeal membrane oxygenation (ECMO) face significant risks of neurological complications and mortality.
- Advanced Doppler techniques like Microvascular Imaging (MVI) offer high-resolution visualization of cerebral microvasculature.
Purpose of the Study:
- To evaluate the feasibility and utility of MVI for assessing cerebral microvascular perfusion in infants undergoing ECMO.
- To explore the association between MVI findings and clinical outcomes in this vulnerable population.
Main Methods:
- Retrospective analysis of brain MVI scans in neonates undergoing ECMO.
- Qualitative assessment of MVI features including tortuosity, symmetry, heterogeneity, engorgement, and hypoperfusion in the basal ganglia-thalamus (BGT) region and cortex.
- Correlation of MVI findings with clinical outcomes such as death, seizures, and cerebrovascular events.
Main Results:
- Lenticulostriate vessel tortuosity was the most prevalent finding in the BGT region (86.7%).
- Increased peri-gyral flow was the most common cortical finding (41.7%).
- Cortical white matter vascular engorgement was significantly associated with poor outcomes (death, seizure, or cerebrovascular events; p = 0.03).
Conclusions:
- Microvascular imaging (MVI) is a feasible method for evaluating cerebral perfusion in infants on ECMO.
- White matter vascular engorgement identified by MVI may serve as a predictive marker for adverse outcomes in neonates undergoing ECMO therapy.
Related Concept Videos
01:21Imaging Studies for Cardiovascular System IV: CMRI
01:20Imaging Studies for Cardiovascular System II:Types of Echocardiography
Types of Echocardiography
Transthoracic Echocardiography (TTE)
TTE is the most common type of echocardiogram which involves placing a transducer on the patient's chest, emitting sound waves to create heart images. TTE is invaluable for evaluating the heart's size, structure, and motion, making it particularly useful for...