A prospective, longitudinal diffusion tensor imaging study of brain injury in newborns

Objective To establish the magnitude and time course of the changes in water diffusion coefficient (Dav) following newborn infant brain injury. Methods Ten newborn infants at high risk for perinatal brain injury were recruited from the neonatal intensive care unit. Conventional and diffusion tensor MRI was performed on three occasions during the first week of life. Regions of injury were determined by evaluating conventional MR images (T1, T2, fluid-attenuated inversion recovery) at 1 week after injury. Dav values were determined for these regions for all three scans. Results Dav values were decreased in most infants 1 day after injury, but injury was not evident or underestimated in 4 of 10 infants despite the presence of injury on conventional imaging at 1 week. By the third day, Dav values were decreased in injured areas in all infants, reaching a nadir of approximately 35% less than normal values. By the seventh day after injury, Dav values were returning to normal (pseudonormalization). Conclusions MR diffusion images (for which contrast is determined by changes in Dav) obtained on the first day after injury do not necessarily show the full extent of ultimate injury in newborn infants. Images obtained between the second and fourth days of life reliably indicate the extent of injury. By the seventh day, diffusion MR is less sensitive to perinatal brain injury than conventional MR because of transient pseudonormalization of Dav. Overall, diffusion MR may not be suitable as a gold standard for detection of brain injury during the first day after injury in newborn infants.

[1]  D. Vigneron,et al.  Proton spectroscopy and diffusion imaging on the first day of life after perinatal asphyxia: preliminary report. , 2001, AJNR. American journal of neuroradiology.

[2]  A. Elster,et al.  Acute cerebral infarction: quantification of spin-density and T2 shine-through phenomena on diffusion-weighted MR images. , 1999, Radiology.

[3]  S. Maier,et al.  MR line-scan diffusion-weighted imaging of term neonates with perinatal brain ischemia. , 1999, AJNR. American journal of neuroradiology.

[4]  F. Cowan,et al.  Early Detection of Cerebral Infarction and Hypoxic Ischemic Encephalopathy in Neonates Using Diffusion-Weighted Magnetic Resonance Imaging , 1994, Neuropediatrics.

[5]  A. Snyder,et al.  Quantitative diffusion-tensor anisotropy brain MR imaging: normative human data and anatomic analysis. , 1999, Radiology.

[6]  M E Moseley,et al.  Comparison of diffusion‐ and T2‐weighted MRI for the early detection of cerebral ischemia and reperfusion in rats , 1991, Magnetic resonance in medicine.

[7]  Benjamin C. P. Lee,et al.  Echoplanar diffusion-weighted imaging in neonates and infants with suspected hypoxic-ischemic injury: correlation with patient outcome. , 1999, AJR. American journal of roentgenology.

[8]  J. Pipe,et al.  Neonatal hypoxic-ischemic encephalopathy: detection with diffusion-weighted MR imaging. , 2000, AJNR. American journal of neuroradiology.

[9]  R. Dijkhuizen,et al.  Dynamics of cerebral tissue injury and perfusion after temporary hypoxia-ischemia in the rat: evidence for region-specific sensitivity and delayed damage. , 1998, Stroke.

[10]  F A Jolesz,et al.  Early detection of periventricular leukomalacia by diffusion-weighted magnetic resonance imaging techniques. , 1999, The Journal of pediatrics.

[11]  R A Zimmerman,et al.  Quantitative apparent diffusion coefficient measurements in term neonates for early detection of hypoxic-ischemic brain injury: initial experience. , 2001, Radiology.

[12]  Y. Samson,et al.  False-negative diffusion-weighted MR findings in acute ischemic stroke. , 2000, AJNR. American journal of neuroradiology.

[13]  J. Petrella,et al.  Use of MR exponential diffusion-weighted images to eradicate T2 "shine-through" effect. , 1999, AJR. American journal of roentgenology.

[14]  R N Bryan,et al.  Diagnosis of Acute Cerebral Infarction : Comparison of CT and MR Imaging 611 , 2013 .

[15]  K. Nelson,et al.  Potentially asphyxiating conditions and spastic cerebral palsy in infants of normal birth weight. , 1998, American journal of obstetrics and gynecology.

[16]  P. Davis,et al.  Nonaccidental Pediatric Head Injury: Diffusion-weighted Imaging Findings , 2001, Neurosurgery.

[17]  K. Nelson,et al.  Birth asphyxia and the neonatal brain: what do we know and when do we know it? , 1993, Clinics in perinatology.

[18]  Gary Duckwiler,et al.  Thrombolytic reversal of acute human cerebral ischemic injury shown by diffusion/perfusion magnetic resonance imaging , 2000, Annals of neurology.

[19]  R. Kikinis,et al.  Quantitative magnetic resonance imaging of brain development in premature and mature newborns , 1998, Annals of neurology.

[20]  M. Kraut,et al.  Diffusion tensor MR imaging of the brain and white matter tractography. , 2002, AJR. American journal of roentgenology.

[21]  J. Shimony,et al.  Normal brain maturation during childhood: developmental trends characterized with diffusion-tensor MR imaging. , 2001, Radiology.

[22]  J. Volpe.  Neurology of the Newborn , 1959, Major problems in clinical pediatrics.

[23]  T. L. Davis,et al.  Hyperacute stroke: evaluation with combined multisection diffusion-weighted and hemodynamically weighted echo-planar MR imaging. , 1996, Radiology.

[24]  A. Marmarou,et al.  Characterization of edema by diffusion-weighted imaging in experimental traumatic brain injury. , 1996, Journal of neurosurgery.

[25]  A. Snyder,et al.  Normal brain in human newborns: apparent diffusion coefficient and diffusion anisotropy measured by using diffusion tensor MR imaging. , 1998, Radiology.

[26]  L H Schwamm,et al.  Ischemic stroke: effects of etiology and patient age on the time course of the core apparent diffusion coefficient. , 2001, Radiology.

[27]  P. Booker,et al.  A model to predict the histopathology of human stroke using diffusion and T2-weighted magnetic resonance imaging. , 1995, Stroke.

[28]  J. Miller,et al.  Transient Focal Cerebral Ischemia , 2001 .

[29]  R R Edelman,et al.  Time course of the apparent diffusion coefficient (ADC) abnormality in human stroke , 1997, Neurology.

[30]  J. Kucharczyk,et al.  Early detection of regional cerebral ischemia in cats: Comparison of diffusion‐ and T2‐weighted MRI and spectroscopy , 1990, Magnetic resonance in medicine.

[31]  T E Conturo,et al.  Differences between gray matter and white matter water diffusion in stroke: diffusion-tensor MR imaging in 12 patients. , 2000, Radiology.

[32]  J D Fenstermacher,et al.  Secondary decline in apparent diffusion coefficient and neurological outcomes after a short period of focal brain ischemia in rats , 2000, Annals of neurology.

[33]  W. T. Dixon,et al.  Measuring diffusion in inhomogeneous systems in imaging mode using antisymmetric sensitizing gradients , 1992 .

[34]  Wei Li,et al.  Fast magnetic resonance diffusion‐weighted imaging of acute human stroke , 1992, Neurology.