Correlation Between Neuroimaging and Neuropathologic Findings in Pediatric ECMO Patients.

Area of Science:

• Pediatric Neurology
• Neurocritical Care
• Medical Imaging

Background:

• Neurologic complications are a major cause of death and disability in pediatric patients requiring extracorporeal membrane oxygenation (ECMO).
• Assessing brain injury in these critically ill children is challenging due to limitations of antemortem neuroimaging and the infrequent availability of postmortem neuropathology.
• Correlating imaging findings with actual brain pathology is crucial for improving diagnostic accuracy and patient monitoring.

Purpose of the Study:

• To evaluate the correlation between antemortem neuroimaging scores and postmortem neuropathologic findings in pediatric patients supported with ECMO.
• To determine if a standardized imaging severity score can serve as a reliable surrogate for histopathologic brain injury in this population.

Main Methods:

• A retrospective single-center cohort study included pediatric patients (0-18 years) who underwent cerebral autopsy after ECMO support between 2009 and 2024.
• Standardized neuropathologic sampling assessed injury severity (mild, moderate, severe) across six brain regions.
• Antemortem CT or head ultrasound (HUS) within seven days of death was reviewed by a blinded neuroradiologist and scored using the Neurologic Injury Severity (NIS) framework.

Main Results:

• Of 54 patients with neuropathology, 26 had qualifying neuroimaging. Frequent ischemic and hemorrhagic injuries were noted, predominantly in frontal, deep grey, and temporal regions.
• NIS scores showed a strong correlation with global and regional histopathologic severity, particularly in the frontal, temporal, and deep grey matter regions.
• Discordance in parieto-occipital, pontine, and cerebellar regions highlighted subtle injuries detectable by immunohistochemistry but not standard H&E staining. Severe pathology consistently correlated with NIS ≥10.

Conclusions:

• Structured neuroimaging severity scoring, especially with CT, strongly correlates with neuropathology in pediatric ECMO decedents.
• The NIS framework shows promise as a surrogate for underlying brain pathology in this vulnerable population.
• Refined histologic methods and adjunctive neuromonitoring are needed to optimize neurologic surveillance in pediatric ECMO patients.