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Updated: Jun 7, 2026
Non-invasive Optical Measurement of Cerebral Metabolism and Hemodynamics in Infants
Published on: March 14, 2013
Association of Hypoxic-Ischemic Injury of the Brain With MRI-Derived Glymphatic Function Parameters in Neonates
Arum Choi1, Dayeon Bak2, Jimin Kim1
1Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Objective:
To evaluate the association between hypoxic-ischemic injury (HII) of the brain and glymphatic function using MRI-derived parameters in neonates.
Materials And Methods:
This retrospective, single-institution study collected brain MRI scans of 127 neonates between July 2020 and July 2022. The volume and fraction of the basal ganglia perivascular space (BG-PVS) were automatically extracted using three-dimensional T2-weighted image processing. Diffusion-tensor imaging (DTI) along the PVS (DTI-ALPS) index values were derived from the DTI maps. BG-PVS and DTI-ALPS parameters were compared between neonates with and without HII. The correlations between MRI-derived glymphatic parameters and corrected gestational age (CGA), as well as between BG-PVS measurements and the DTI-ALPS index, were analyzed using Spearman coefficients. Multivariable logistic regression adjusted for age, sex, birth weight, and mode of delivery was performed to examine the associations between each glymphatic parameter and HII.
Results:
This study included 97 neonates without HII (median gestational age [GA]: 252 days) and 30 with HII (median GA: 252 days). Neonates with HII had smaller BG-PVS volumes (19 mm³ vs. 33 mm³, P = 0.001) and fractions (0.29% vs. 0.54%, P = 0.003) compared to neonates without HII. The DTI-ALPS index values did not differ significantly between neonates with and without HII (P = 0.54). CGA correlated negatively with BG-PVS measurements (ρ = -0.21 to -0.26, all P < 0.05) and positively with DTI-ALPS index values (ρ = 0.22, P = 0.014). BG-PVS measurements and DTI-ALPS index values were not significantly correlated (ρ = -0.28 to -0.08, all P > 0.05). Multivariable logistic regression revealed a negative association between BG-PVS volume (odds ratio [OR]: 0.96 per mm³ increase, 95% confidence interval [CI]: 0.93-0.99) and fraction (OR: 0.15 per % increase, 95% CI: 0.03-0.79) with HII, while DTI-ALPS index values were not significantly associated with HII (OR: 0.10, 95% CI: 0.00-25.41).
Conclusion:
Neonates with HII demonstrated smaller BG-PVS volume and fraction compared with those without HII, indicating potential alterations in glymphatic function among affected newborns.
Insights
Neonates with brain hypoxic-ischemic injury (HII) show reduced basal ganglia perivascular space (BG-PVS) volume and fraction, suggesting impaired glymphatic function. These MRI findings highlight potential biomarkers for HII in newborns.
Area of Science:
- Neuroimaging
- Neonatal Neurology
- Cerebrovascular Research
Background:
- Hypoxic-ischemic injury (HII) is a significant cause of neonatal brain damage.
- Glymphatic function, responsible for waste clearance in the brain, may be compromised in HII.
- Non-invasive MRI techniques offer potential for assessing glymphatic function in neonates.
Purpose of the Study:
- To investigate the association between brain HII and glymphatic function in neonates.
- To evaluate MRI-derived parameters, specifically basal ganglia perivascular space (BG-PVS) volume and fraction, and diffusion-tensor imaging along the perivascular space (DTI-ALPS) index.
- To correlate these glymphatic parameters with HII status and clinical factors.
Main Methods:
- Retrospective analysis of brain MRI scans from 127 neonates (July 2020-July 2022).
- Automated extraction of BG-PVS volume and fraction using 3D T2-weighted imaging.
- Derivation of DTI-ALPS index values from diffusion-tensor imaging.
- Comparison of glymphatic parameters between neonates with and without HII using multivariable logistic regression.
Main Results:
- Neonates with HII exhibited significantly smaller BG-PVS volume (19 mm³ vs. 33 mm³) and fraction (0.29% vs. 0.54%) compared to controls (P < 0.01).
- DTI-ALPS index values did not significantly differ between groups (P = 0.54).
- Smaller BG-PVS volume and fraction were independently associated with increased odds of HII (OR: 0.96 per mm³ and 0.15 per %, respectively).
Conclusions:
- Reduced BG-PVS volume and fraction in neonates are associated with HII.
- These findings suggest impaired glymphatic function in neonatal HII.
- BG-PVS parameters derived from MRI may serve as potential imaging biomarkers for HII in newborns.
