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Published on: November 20, 2015
Tract integrity predicts neurological outcomes in neonatal hypoxic-ischemic encephalopathy
Pei-Ling Tsai1, Yu-Chun Lo2, Yi-Shan Tsai3
1Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Insights
Diffusion tensor imaging (DTI) of white matter tracts like the corticospinal tract (CST) and optic radiations (OR) can predict neurological outcomes in infants with hypoxic-ischemic encephalopathy (HIE). This method aids early prognostication, regardless of therapeutic hypothermia.
Area of Science:
- Neonatal Neurology
- Neuroimaging
- Developmental Neuroscience
Background:
- Neonatal hypoxic-ischemic encephalopathy (HIE) poses significant risks to infant neurological development.
- Early and accurate prognostication is essential for guiding clinical management and follow-up care for HIE infants.
- Alterations in neural fiber tract integrity may serve as predictive biomarkers for neurological outcomes.
Purpose of the Study:
- To investigate the utility of diffusion tensor imaging (DTI) tractography in predicting neurodevelopmental outcomes in infants with HIE.
- To assess the microstructural integrity of specific neural tracts using fractional anisotropy (FA) and mean diffusivity (MD).
- To determine if DTI findings can provide early prognostication for infants with HIE.
Main Methods:
- Consecutive infants diagnosed with neonatal HIE were enrolled between 2016 and 2020.
- Diffusion tensor imaging (DTI) was performed on infants aged 4-7 days.
- Neurodevelopmental outcomes were evaluated at 24 months using the Bayley Scales of Infant Development, 3rd edition.
Main Results:
- Lower fractional anisotropy (FA) values in key tracts, particularly the corticospinal tract (CST) and optic radiations (OR), correlated with poorer developmental scores at 24 months.
- The prognostic accuracy of FA values in the CST exceeded that of the thalamus/basal ganglia region.
- The correlation between FA and developmental scores was strongest in infants with HIE stage III and was not influenced by therapeutic hypothermia.
Conclusions:
- DTI-assessed tract integrity, specifically in the CST and OR, offers valuable insights for early prognostication in infants with HIE.
- These findings are consistent irrespective of whether therapeutic hypothermia was administered.
- DTI tractography represents a promising tool for predicting neurological outcomes in HIE neonates.
Objective:
Early prognostication in infants with neonatal hypoxic-ischemic encephalopathy (HIE) is crucial for follow-up management. Alternations of microstructural integrity of neural fiber tracts in large-scale neural networks might predict neurological outcomes.
Methods:
All consecutively-admitted patients with neonatal HIE from 2016 to 2020 were enrolled. Diffusion tensor imaging (DTI) tractography was performed at 4-7 days of age. Neurodevelopmental outcomes at 24 months of age were assessed with Bayley Scales of Infant Development, 3rd edition.
Results:
A total of 62 HIE infants were enrolled, and 53 of these underwent DTI. Fractional anisotropy (FA) and mean diffusivity (MD) were measured to indicate the microstructural integrity of tracts, including the arcuate fasciculus, uncinate fasciculus, inferior fronto-occipital fasciculus, corticospinal tract (CST), and optic radiations (OR). Lower FA values of target tracts were associated with lower developmental scores at 24 months of age, particularly in the CST and OR (all P ≤ 0.003). The prognostic accuracy of FA values in CST surpassed that in the region of thalamus/basal ganglia (area under curves 0.839, 95 % CI: 0.728-0.950 vs. 0.755, 95 % CI: 0.583-0.928). Furthermore, the correlation between FA values in target tracts and developmental scores was most significant in infants with HIE stage III and this was not affected by therapeutic hypothermia.
Conclusion:
Tract integrity in the CST and OR detected by DTI provides valuable insights for early prognostication in infants with HIE, regardless of therapeutic hypothermia.
