Diffusion Tensor Imaging Detects Occult Cerebellar Injury in Severe Neonatal Hypoxic-Ischemic Encephalopathy.
Diffusion Tensor Imaging Detects Occult Cerebellar Injury in Severe Neonatal Hypoxic-Ischemic Encephalopathy.
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DOI：
10.1159/000454856
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发表时间：
2017
影响因子：
2.9
通讯作者：
Poretti A
中科院分区：
文献类型：
--
作者：
Lemmon ME;Wagner MW;Bosemani T;Carson KA;Northington FJ;Huisman TAGM;Poretti A
尽管全身低温治疗的好处，许多新生儿缺氧缺血性脑病（HIE）死亡或有显着的长期神经发育障碍。预防性识别有不良结局风险的新生儿是必要的，但并不简单。小脑并不被经典地认为是一个大脑区域容易受到缺氧缺血性损伤，但最近的文献表明，小脑可能参与新生儿缺氧缺血性脑病。在这项研究中，我们的目的是评估与神经健康新生儿对照组相比，新生儿缺氧缺血性脑病小脑和相连的幕上结构的显微结构的完整性。在这项前瞻性队列研究中，我们进行了定量扩散张量成像（DTI）分析的结构通路的连接，这可能是影响新生儿小脑损伤的测量分数各向异性（FA）和平均扩散率（MD）内的上级，中，下小脑脚，齿状核，丘脑。根据常规和高级MRI序列的定性评价，将所有磁共振成像（MRI）研究分为4类严重程度。对患者和对照组的小脑标量进行多变量线性回归分析，控制胎龄、MRI检查时的年龄和HIE严重程度。采用斯皮尔曼等级相关法对小脑和丘脑的DTI标量进行相关分析。纳入57例（23例女性，40%）新生儿HIE和12例（6例女性，50%）新生儿对照。HIE严重程度组3和4（基底节/丘脑和/或皮质损伤）中有8例患者（14%）。基于常规和DTI图像的定性分析，没有患者有小脑损伤的证据。在FA和MD标量中，患者和对照组之间没有显著差异。然而，与对照组相比，在MRI上有中度或重度损伤证据的患者（3类和4类）中，小脑中脚的FA值（0.294 vs. 0.380，p < 0.001）和上级小脑脚的MD值（0.920 vs. 1.007 × 10−3 mm/s2，p = 0.001）显著降低。在患者中，小脑DTI标量与丘脑内的DTI标量呈正相关。我们的研究结果表明，中度至重度缺氧缺血性脑病的婴儿可能有小脑白质束的隐匿性损伤，这是不能单独通过神经影像学数据的定性分析检测。小脑DTI标量与丘脑测量相关，强调小脑损伤不太可能单独发生，并可能反映HIE的严重程度。新生儿缺氧缺血性脑病合并小脑损伤对远期神经发育的影响值得进一步研究。
Despite the benefits of whole-body hypothermia therapy, many infants with hypoxic-ischemic encephalopathy (HIE) die or have significant long-term neurodevelopmental impairment. Prospectively identifying neonates at risk of poor outcome is essential but not straightforward. The cerebellum is not classically considered to be a brain region vulnerable to hypoxic-ischemic insults; recent literature suggests, however, that the cerebellum may be involved in neonatal HIE. In this study, we aimed to assess the microstructural integrity of cerebellar and linked supratentorial structures in neonates with HIE compared to neurologically healthy neonatal controls. In this prospective cohort study, we performed a quantitative diffusion tensor imaging (DTI) analysis of the structural pathways of connectivity, which may be affected in neonatal cerebellar injury by measuring fractional anisotropy (FA) and mean diffusivity (MD) within the superior, middle, and inferior cerebellar peduncles, dentate nuclei, and thalami. All magnetic resonance imaging (MRI) studies were grouped into 4 categories of severity based on a qualitative evaluation of conventional and advanced MRI sequences. Multivariable linear regression analysis of cerebellar scalars of patients and controls was performed, controlling for gestational age, age at the time of MRI, and HIE severity. Spearman rank correlation was performed to correlate DTI scalars of the cerebellum and thalami. Fifty-seven (23 females, 40%) neonates with HIE and 12 (6 females, 50%) neonatal controls were included. There were 8 patients (14%) in HIE severity groups 3 and 4 (injury of the basal ganglia/thalamus and/or cortex). Based on a qualitative analysis of conventional and DTI images, no patients had evidence of cerebellar injury. No significant differences between patients and controls were found in the FA and MD scalars. However, FA values of the middle cerebellar peduncles (0.294 vs. 0.380, p < 0.001) and MD values of the superior cerebellar peduncles (0.920 vs. 1.007 × 10−3 mm/s2, p = 0.001) were significantly lower in patients with evidence of moderate or severe injury on MRI (categories 3 and 4) than in controls. In patients, cerebellar DTI scalars correlated positively with DTI scalars within the thalami. Our results suggest that infants with moderate-to-severe HIE may have occult injury of cerebellar white-matter tracts, which is not detectable by the qualitative analysis of neuroimaging data alone. Cerebellar DTI scalars correlate with thalamic measures, highlighting that cerebellar injury is unlikely to occur in isolation and may reflect the severity of HIE. The impact of concomitant cerebellar injury in HIE on long-term neurodevelopmental outcome warrants further study.
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DOI：
10.1016/j.ijdevneu.2013.06.004
发表时间：
2013-11
期刊：
International journal of developmental neuroscience : the official journal of the International Society for Developmental Neuroscience
影响因子：
--
作者：
Oishi K;Faria AV;Yoshida S;Chang L;Mori S
通讯作者：
Mori S
影响因子：
8
作者：
Thayyil, Sudhin;Chandrasekaran, Manigandan;Robertson, Nicola J.
通讯作者：
Robertson, Nicola J.
影响因子：
19.7
作者：
Alderliesten, Thomas;de Vries, Linda S.;Groenendaal, Floris
通讯作者：
Groenendaal, Floris
影响因子：
2.9
作者：
Foster, KA;Colditz, PB;Roberts, MS
通讯作者：
Roberts, MS
DOI：
10.1159/000067958
发表时间：
2003-01-01
期刊：
BIOLOGY OF THE NEONATE
影响因子：
--
作者：
Satas, S;Loberg, E;Thoresen, M
通讯作者：
Thoresen, M