Diffusion-weighted images in neonatal cerebral hypoxic-ischemic injury.

Diffusion-weighted images of magnetic resonance imaging, obtained by mapping apparent diffusion coefficients, are more sensitive than other magnetic resonance imaging sequences in the earliest detection of acute cytotoxic injury. The usefulness of diffusion-weighted images in focal ischemic brain injury has been documented in children and adults. We report eight full-term neonates with global cerebral hypoxic-ischemic injury and abnormalities on diffusion-weighted images. Distribution of diffusion-weighted imaging abnormalities in the eight neonates was consistent with global hypoxic-ischemic injury in full-term neonates, with diffuse cortical necrosis, border-zone infarcts, or basal ganglia/thalamic injury. Magnetic resonance imaging scans with diffusion-weighted images were obtained within the first 4 days of age in all eight neonates. In each patient, standard magnetic resonance imaging sequences substantially underestimated the extent of injury when compared with diffusion-weighted images in unmyelinated neonatal brains. Extensive injury bilaterally with basal ganglia and thalamic and widespread multifocal cortical injury correlated with a severe neurologic outcome. Lesser degrees of injury, limited to smaller sectors of cortical or border zone involvement, were associated with better neurologic outcome. The high sensitivity of diffusion-weighted images to map the extent of hypoxic-ischemic injury in neonates makes it a potentially useful tool for assessing future neuroprotective strategies for neonatal hypoxic-ischemic injury.

[1]  P. Schaefer,et al.  Diffusion-Weighted Imaging in Neonatal Cerebral Infarction: Clinical Utility and Follow-Up , 2000, Journal of child neurology.

[2]  S. Williams,et al.  Diffusion‐Weighted Imaging Studies of Cerebral Ischemia in Gerbils: Potential Relevance to Energy Failure , 1992, Stroke.

[3]  R. Vannucci,et al.  HYPOXIC-ISCHEMIC ENCEPHALOPATHY , 2000, American journal of perinatology.

[4]  A. Hill,et al.  Current concepts of hypoxic-ischemic cerebral injury in the term newborn. , 1991, Pediatric neurology.

[5]  P. Langhorne,et al.  Acute Cerebral Infarction , 1995, Emergency Pathophysiology.

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

[7]  M E Moseley,et al.  Diffusion-weighted MR imaging and T2-weighted MR imaging in acute cerebral ischaemia: comparison and correlation with histopathology. , 1990, Acta neurochirurgica. Supplementum.

[8]  T. Hanihara,et al.  Diffusion‐weighted magnetic resonance imaging: Detection of ischemic injury 39 minutes after onset in a stroke patient , 1999, Annals of neurology.

[9]  P van Gelderen,et al.  Water diffusion and acute stroke , 1994, Magnetic resonance in medicine.

[10]  D. Ferriero,et al.  Perinatal asphyxia: MR findings in the first 10 days. , 1995, AJNR. American journal of neuroradiology.

[11]  Joseph J. Volpe,et al.  Hypoxic-ischemic encephalopathy : Biochemical and physiological aspects , 2001 .

[12]  G. Jh.  Ischemic injuries of the brain. Morphologic evolution. , 1983 .

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

[14]  U. Tuor,et al.  Magnetic Resonance Imaging during Cerebral Hypoxia-Ischemia: T2 Increases in 2-Week-Old But Not 4-Week-Old Rats , 1999, Pediatric Research.

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

[16]  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.

[17]  K Minematsu,et al.  Diffusion‐weighted magnetic resonance imaging , 1992, Neurology.

[18]  G. Greisen.  Effect of Cerebral Blood Flow and Cerebrovascular Autoregulation on the Distribution, Type and Extent of Cerebral Injury , 1992, Brain pathology.

[19]  F. Blankenberg,et al.  Apoptotic cell death: its implications for imaging in the next millennium , 2000, European Journal of Nuclear Medicine.

[20]  C. Sotak,et al.  Effects of a novel NMDA antagonist on experimental stroke rapidly and quantitatively assessed by diffusion‐weighted MRI , 1993, Neurology.

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

[22]  R. A. Zimmerman,et al.  Changes in brain water diffusion during childhood , 1999, Neuroradiology.

[23]  U. Tuor,et al.  Metabolite changes in neonatal rat brain during and after cerebral hypoxia‐ischemia: a magnetic resonance spectroscopic imaging study † , 1999, NMR in biomedicine.

[24]  K Minematsu,et al.  Reversible Focal Ischemic Injury Demonstrated by Diffusion‐Weighted Magnetic Resonance Imaging in Rats , 1992, Stroke.