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Making MR Imaging Child's Play - Pediatric Neuroimaging Protocol, Guidelines and Procedure
Published on: July 30, 2009
Neuroimaging and Neuropathologic Findings in Pediatric Patients with ECMO: An Imaging-Pathology Comparison
Margherita Tabet1, Bill Zhang2, Chasity Custer3
1Department of Anesthesiology and Pain Management, UT Southwestern Medical Center, Dallas, TX, USA. margherita.tabet@utsouthwestern.edu.
Neurocritical Care
|May 26, 2026
Summary
Neurologic injury scoring on neuroimaging strongly correlates with actual brain pathology in children on extracorporeal membrane oxygenation (ECMO). This supports imaging as a surrogate for monitoring, but highlights the need for advanced methods.
Area of Science:
- Pediatric Neurology
- Critical Care Medicine
- Neuropathology
Background:
- Neurologic complications significantly impact morbidity and mortality in pediatric patients requiring extracorporeal membrane oxygenation (ECMO).
- Assessing these complications is challenging due to limited antemortem neuroimaging and the infrequent availability of postmortem neuropathology.
Purpose of the Study:
- To correlate antemortem neuroimaging findings with postmortem neuropathology in pediatric ECMO patients.
- To evaluate the utility of the Neurologic Injury Severity (NIS) framework in assessing brain injury severity.
Main Methods:
- A retrospective cohort study of pediatric ECMO patients (0-18 years) who underwent cerebral autopsy between 2009-2024.
- Standardized neuropathologic sampling and grading of injuries across six brain regions.
- Antemortem CT or head ultrasound within 7 days of death were reviewed and scored using the NIS framework by a blinded neuroradiologist.
Main Results:
- Neuropathology revealed frequent ischemic and hemorrhagic injuries, predominantly in frontal, deep grey, and temporal lobes.
- NIS scores showed a strong correlation with global and regional histopathologic severity, particularly in the frontal, temporal, and deep grey matter regions.
- Immunohistochemistry identified subtle injuries missed by H&E staining, indicating limitations in standard histologic assessment.
Conclusions:
- Structured neuroimaging severity scoring, especially CT, correlates well with neuropathology in pediatric ECMO decedents.
- The NIS framework shows promise as a surrogate for underlying neuropathology.
- Refined histologic methods and adjunctive neuromonitoring are crucial for optimizing neurologic surveillance in this population.
