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01-10-2017 | Original Article

A validated clinical MRI injury scoring system in neonatal hypoxic-ischemic encephalopathy

Authors: Shamik B. Trivedi, Zachary A. Vesoulis, Rakesh Rao, Steve M. Liao, Joshua S. Shimony, Robert C. McKinstry, Amit M. Mathur

Published in: Pediatric Radiology | Issue 11/2017

Abstract

Background

Deep nuclear gray matter injury in neonatal hypoxic-ischemic encephalopathy (HIE) is associated with worse neurodevelopmental outcomes. We previously published a qualitative MRI injury scoring system utilizing serial T1-weighted, T2-weighted and diffusion-weighted imaging (DWI), weighted for deep nuclear gray matter injury.

Objectives

To establish the validity of the MRI scoring system with neurodevelopmental outcome at 18-24 months.

Materials and methods

MRI scans from neonates with moderate to severe HIE treated with therapeutic hypothermia were evaluated. Signal abnormality was scored on T1-weighted, T2-weighted and DWI sequences and assessed using an established system in five regions: (a) subcortical: caudate nucleus, globus pallidus and putamen, thalamus and the posterior limb of the internal capsule; (b) white matter; (c) cortex, (d) cerebellum and (e) brainstem. MRI injury was graded as none, mild, moderate or severe. Inter-rater reliability was tested on a subset of scans by two independent and blinded neuroradiologists. Surviving infants underwent the Bayley Scales of Infant and Toddler Development-III (Bayley-III) at 18-24 months. Data were analyzed using univariate and multivariate linear and logistic regression.

Results

Fifty-seven eligible neonates underwent at least one MRI scan in the first 2 weeks of life. Mean postnatal age at scan 1 was 4±2 days in 50/57 (88%) neonates and 48/54 (89%) surviving infants underwent scan 2 at 10±2 days. In 54/57 (95%) survivors, higher MRI injury grades were significantly associated with worse outcomes in the cognitive, motor and language domains of the Bayley-III.

Conclusion

A qualitative MRI injury scoring system weighted for deep nuclear gray matter injury is a significant predictor of neurodevelopmental outcome at 18–24 months in neonates with HIE.

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Title: A validated clinical MRI injury scoring system in neonatal hypoxic-ischemic encephalopathy
Authors: Shamik B. Trivedi
Zachary A. Vesoulis
Rakesh Rao
Steve M. Liao
Joshua S. Shimony
Robert C. McKinstry
Amit M. Mathur
Publication date: 01-10-2017
Publisher: Springer Berlin Heidelberg
Published in: Pediatric Radiology / Issue 11/2017
Print ISSN: 0301-0449
Electronic ISSN: 1432-1998
DOI: https://doi.org/10.1007/s00247-017-3893-y

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

A validated clinical MRI injury scoring system in neonatal hypoxic-ischemic encephalopathy

Abstract

Background

Objectives

Materials and methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Objectives

Materials and methods

Results

Conclusion

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