Do Apparent Diffusion Coefficient Measurements Predict Outcome in Children with Neonatal Hypoxic-Ischemic Encephalopathy?
Do Apparent Diffusion Coefficient Measurements Predict Outcome in Children with Neonatal Hypoxic-Ischemic Encephalopathy?
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DOI：
10.3174/ajnr.a1318
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发表时间：
2009-02-01
影响因子：
3.5
通讯作者：
van der Grond, J.
中科院分区：
文献类型：
--
作者：
Liauw, L.;van Wezel-Meijler, G.;van der Grond, J.
背景和目的：弥散加权成像（DWI）可以早期检测和定量缺氧缺血性（HI）脑病变。我们的目的是评估DWI和表观扩散系数（ADC）测量结果的预测价值在围产期asphyxia.MATERIALS和METHODS：足月新生儿出生后10天内进行MR成像，因为窒息。回顾性评价MRI检查HI脑损伤。测量30个标准化脑区和DWI上明显异常区域的ADC值。在幸存者中，将学龄前的发育结果分为以下类别：1）正常，2）轻度异常，3）明确异常。对于分析，类别3和死亡（类别4）标记为“不良”，1和2为“有利”，2-3和死亡为“异常”结局。采用X（2）检验分析有和无DWI异常的婴儿之间的结局差异。非参数Mann-Whitney U检验分析可见DWI异常的ADC值是否与成像时的年龄相关。Logistic回归分析测试了每个标准化脑区ADC结果的预测值。采用受试者工作特征分析，以找到最佳的ADC截止值为每个区域的各种结果scores.RESULTS：24名婴儿（13名男性）。MR成像时的平均年龄为4.3天（范围，1-9天），7名婴儿死亡。有和没有明显DWI异常的婴儿之间的结果没有差异。只有内囊后肢的ADC值与年龄相关。DWI明显异常区域的ADC值对预后无预测价值。在所有测量中，只有基底节和脑干的ADC值与结果显著相关;低ADC值与异常/不良结果相关，高ADC值与正常/良好结果相关（基底神经节：异常P = .03，不良结局P = .01;脑干：异常P = .006，不良结局P = .03）。基底节和脑干ADC值与预后相关，与所有MR成像结果（包括DWI）无关。DWI上不可见的异常脑组织ADC值对预后无预测价值。
BACKGROUND AND PURPOSE: Diffusion-weighted imaging (DWI) permits early detection and quantification of hypoxic-ischemic (HI) brain lesions. Our aim was to assess the predictive value of DWI and apparent diffusion coefficient (ADC) measurements for outcome in children with perinatal asphyxia.MATERIALS AND METHODS: Term neonates underwent MR imaging within 10 days after birth because of asphyxia. MR imaging examinations were retrospectively evaluated for HI brain damage. ADC was measured in 30 standardized brain regions and in visibly abnormal areas on DWI. In survivors, developmental outcome until early school age was graded into the following categories: 1) normal, 2) mildly abnormal, and 3) definitely abnormal. For analysis, category 3 and death (category 4) were labeled "adverse," 1 and 2 were "favorable," and 2-3 and death were "abnormal" outcome. Differences in outcome between infants with and without DWI abnormalities were analyzed by using X(2) tests. The nonparametric Mann-Whitney U test analyzed whether ADC values in visible DWI abnormalities correlated with age at imaging. Logistic regression analysis tested the predictive value for outcome of the ADC in each standardized brain region. Receiver operating characteristic analysis was used to find optimal ADC cutoff values for each region for the various outcome scores.RESULTS: Twenty-four infants (13 male) were included. Mean age at MR imaging was 4.3 days (range, 1-9 days), Seven infants died. There was no difference in outcome between infants with and without visible DWI abnormalities. Only ADC of the posterior limb of the internal capsule correlated with age. ADC in visibly abnormal DWI regions did not have a predictive value for outcome. Of all measurements performed, only the ADC in the normal-appearing basal ganglia and brain stem correlated significantly with outcome; low ADC values were associated with abnormal/adverse outcome, and higher ADC values, with normal/favorable outcome (basal ganglia: P = .03 for abnormal, P = .01 for adverse outcome; brain stem: P = .006 for abnormal, P = .03 for adverse outcome).CONCLUSIONS: ADC values in normal-appearing basal ganglia and brain stem correlated with outcome, independently of all MR imaging findings including those of DWI. ADC values invisibly abnormal brain tissue on DWI did not show a predictive value for outcome.