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Updated: Jul 16, 2025
Non-invasive Optical Measurement of Cerebral Metabolism and Hemodynamics in Infants
Published on: March 14, 2013
Correlating Quantitative MRI-based Apparent Diffusion Coefficient Metrics with 24-month Neurodevelopmental Outcomes
Evan Calabrese1, Yvonne Wu1, Aaron Wolfe Scheffler1
1From the Department of Radiology, Duke University Medical Center, Durham, NC (E.C.); Department of Neurology and Weill Institute for Neuroscience (Y.W., H.C.G.), Department of Pediatrics, UCSF Benioff Children's Hospital (Y.W., H.C.G.), Department of Epidemiology and Biostatistics (A.W.S.), School of Medicine (S.G.), and Neuroradiology Section, Department of Radiology and Biomedical Imaging (C.P.H., Y.L.), University of California, San Francisco, 505 Parnassus Ave, M-391, San Francisco, CA 94143-0628; Department of Radiology, Children's Hospital of Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, Calif (J.L.W.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (R.C.M.); Department of Pediatrics, St Louis University, St Louis, Mo (A.M.); and Departments of Statistics (B.A.C., P.J.H.) and Pediatrics (S.E.J.), University of Washington, Seattle, Wash.
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Background Multiple qualitative scoring systems have been created to capture the imaging severity of hypoxic ischemic brain injury. Purpose To evaluate quantitative volumes of acute brain injury at MRI in neonates with hypoxic ischemic brain injury and correlate these findings with 24-month neurodevelopmental outcomes and qualitative brain injury scoring by radiologists. Materials and Methods In this secondary analysis, brain diffusion-weighted MRI data from neonates in the High-dose Erythropoietin for Asphyxia and Encephalopathy trial, which recruited participants between January 2017 and October 2019, were analyzed. Volume of acute brain injury, defined as brain with apparent diffusion coefficient (ADC) less than 800 × 10-6 mm2/sec, was automatically computed across the whole brain and within the thalami and white matter. Outcomes of death and neurodevelopmental impairment (NDI) were recorded at 24-month follow-up. Associations between the presence and volume (in milliliters) of acute brain injury with 24-month outcomes were evaluated using multiple logistic regression. The correlation between quantitative acute brain injury volume and qualitative MRI scores was assessed using the Kendall tau-b test. Results A total of 416 neonates had available MRI data (mean gestational age, 39.1 weeks ± 1.4 [SD]; 235 male) and 113 (27%) showed evidence of acute brain injury at MRI. Of the 387 participants with 24-month follow-up data, 185 (48%) died or had any NDI. Volume of acute injury greater than 1 mL (odds ratio [OR], 13.9 [95% CI: 5.93, 32.45]; P < .001) and presence of any acute injury in the brain (OR, 4.5 [95% CI: 2.6, 7.8]; P < .001) were associated with increased odds of death or any NDI. Quantitative whole-brain acute injury volume was strongly associated with radiologists' qualitative scoring of diffusion-weighted images (Kendall tau-b = 0.56; P < .001). Conclusion Automated quantitative volume of brain injury is associated with death, moderate to severe NDI, and cerebral palsy in neonates with hypoxic ischemic encephalopathy and correlated well with qualitative MRI scoring of acute brain injury. Clinical trial registration no. NCT02811263 © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Huisman in this issue.
