Characterization of Acute Pediatric Anoxic Brain Injury in Non-fatal Drowning Using MRI

使用 MRI 表征非致命性溺水中的急性小儿缺氧性脑损伤

• 批准号: 9809943
• 负责人: FLORENCE CHIANG
• 金额: $ 7.69万
• 依托单位: UNIVERSITY OF TEXAS HLTH SCIENCE CENTER
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-07-20 至 2021-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9809943
• 关键词: Accidental Injury; Acute; Admission activity; Adult; Affect; Age; Animals; Anisotropy; Anoxic Encephalopathy; Area; Arteries; Asphyxia Neonatorum; Atrophic; Basal Ganglia; Blood Vessels; Brain Injuries; Cause of Death; Child; Childhood; Chronic; Chronic Phase; Clinical; Cognitive; Detection; Diagnostic; Diffuse; Diffusion Magnetic Resonance Imaging; Drowning; Edema; Etiology; Exhibits; Feasibility Studies; Functional disorder; Future; Goals; Hour; Hypoxia; Image; Image Analysis; Immersion Investigative Technique; Incidence; Injury; Internal Capsule; Ischemia; Length; Length of Stay; Lesion; Limb structure; Liquid substance; Literature; Localized Lesion; Magnetic Resonance Imaging; Magnetic Resonance Spectroscopy; Methods; Neuroprotective Agents; Patients; Pattern; Phase; Pilot Projects; Practice Management; Prognostic Marker; Reporting; Secondary to; Severities; Spatial Distribution; Stroke; Structure; Submersion; T2 weighted imaging; Testing; Thalamic structure; Therapeutic; Therapeutic Intervention; Visual; Work; base; cytotoxic; diagnostic biomarker; disability; gray matter; imaging biomarker; imaging modality; imaging study; improved; motor impairment; multiorgan damage; neuroimaging; neuropathology; outcome forecast; prognostic; quantitative imaging; stroke model; therapeutic target; white matter

Project Summary/Abstract This is a pilot study to confirm localized lesions in acute pediatric anoxic brain injury (ABI) secondary to nonfatal drowning using magnetic resonance imaging (MRI). Drowning is the third leading cause of death due to unintentional injury worldwide, with the highest incidence in young children (ages 1-4 years). Although drowning (i.e. submersion/immersion in liquid) results in multi-organ damage, the most devastating disability results from brain injury. Current diagnostic neuroimaging findings (largely via qualitative visual inspection) are nonspecific and offer little value for prognosis or for directing therapeutic interventions in the acute injury phase of pediatric ABI post- drowning. Our preliminary MRI studies show that chronic ABI displays lesions limited to the lenticulostriate distribution, which is an end-arterial watershed zone, similar to focal ischemia seen in stroke. We found that this localized pattern of injury exhibits gray matter atrophy and also white matter microstructural abnormalities on diffusion-tensor images (DTI), by using fully automated quantitative imaging analysis. Interestingly, lesion burden limited to the lenticulostriate distribution has not been reported in adults with nonfatal drowning and may be observed only in children. Acute ABI due to different ischemic neuropathologies can be detected sooner on diffusion-weighted images as compared to other structural MRI modalities (i.e. T1 and T2-weighted images) according to evidence provided in the literature. For example, detection of lesions occurs by 30 minutes after occlusion of vasculature in animal stroke models on diffusion-weighted images. Further, focal microstructural compromise can be detected by 16 hours in perinatal asphyxia on diffusion-weighted images—which demonstrates a similar injury pattern in the lenticulostriate distribution. The overall goal of the proposal is to identify and validate acute-imaging markers for ABI in nonfatal drowning. To this end, we seek to test 3 aims using structural MRI. Based on current literature and results from our preliminary work, we expect an injury pattern that is localized to the lenticulostriate vascular distribution affecting both gray and white matter. In the acute phase of injury, we will seek to demonstrate focal abnormalities on DTI (Aim 1) and T2-weighted images (Aim 2). Additionally, we will correlate abnormalities on DTI with duration of hospital stay (Aim 3), which promises to validate diagnostic and prognostic imaging markers. Future testing of neuroprotective agents in the acute injury phase would leverage conclusions from this feasibility study.

项目总结/摘要 这是一项初步研究，以确认继发于急性缺氧性脑损伤（ABI）的局部病变。 非致命性溺水使用磁共振成像（MRI）。溺水是第三大死因， 在世界范围内，意外伤害的发生率最高的是幼儿（1-4岁）。虽然 溺水（即浸没/浸入液体）导致多器官损伤，这是最具破坏性的残疾 是脑损伤造成的 目前的神经影像学诊断结果（主要通过定性目视检查）是非特异性的， 对预后或指导治疗干预在儿童ABI术后急性损伤阶段的价值不大， 溺水了我们的初步MRI研究表明，慢性ABI显示病变局限于脑纹状体 分布，这是一个动脉末端分水岭区，类似于中风中看到的局灶性缺血。我们发现 这种局部损伤表现为灰质萎缩以及白色物质显微结构异常 扩散张量图像（DTI），通过使用全自动定量成像分析。有趣的是，病变 在非致命性溺水的成人中，尚未报道局限于纹状体分布的负担， 可能仅在儿童中观察到。 由于不同的缺血性神经病变引起的急性ABI可以在弥散加权图像上更快地检测到， 根据提供的证据，与其他结构MRI模式（即T1和T2加权图像）相比 在文献中。例如，病变的检测发生在动物脉管系统闭塞后30分钟。 扩散加权图像上的中风模型。此外，可以通过16检测到局部微观结构受损 在弥散加权成像上，围产期窒息的24小时内， 纹状分布。 该提案的总体目标是识别和验证非致命性溺水中ABI的急性成像标记物。 为此，我们试图使用结构MRI测试3个目标。根据现有文献和我们的研究结果， 初步工作，我们预计损伤模式，是本地化的脑纹血管分布 影响灰色和白色物质。在损伤的急性期，我们将试图证明病灶 DTI（Aim 1）和T2加权图像（Aim 2）异常。此外，我们将把异常与 DTI与住院时间（目标3），这有望验证诊断和预后成像 标记。未来在急性损伤阶段对神经保护剂的测试将利用以下结论： 这个可行性研究。