MRI PARAMETERS AS PREDICTORS OF OUTCOME IN NEONATAL HYPOXIC-ISCHEMIC INJURY

要求支持研究使用磁共振的方法， 近红外光谱（NIRS），将可靠地使临床医生 预测围产期窒息后的神经系统结局。临床和 迄今为止已使用的结果的实验室指标，例如 脐带pH值和阿普加评分都被证明是不可靠的。我们 初步工作表明，标准的磁共振成像可以检测出不同的 出生后第3天的围产期窒息和MR的损害模式 光谱学可以在生命的第二天检测到损伤。磁共振灌注 金脑屏障成像和弥散成像似乎显示 伤害更早。近红外光谱可以检测血红蛋白氧合水平 和线粒体功能的影响。的 该建议假设是反常的T1和T2弛豫时间， 脑灌注异常，脑中质子扩散异常，以及 血脑屏障破坏（通过MRI检测），乳酸盐蓄积 (as MRS检测），以及氧合和线粒体功能异常 (as通过NIRS检测）是将与程度相关的参数 神经发育障碍的症状我们将使用这些数据 在这项研究中获得，以确定足月儿结局的预测因子， 患有围产期缺氧缺血症。这些预测值将被导出 从MR和NIRS参数的相关性（从灌注对比和 扩散磁共振成像，质子磁共振波谱，和近红外光谱进行了在 出生后的头几天）进行复杂的神经发育测试 在3个月、12个月和30个月大时进行。一个复杂 患者跟踪机制将用于维持队列， 婴儿进行长期随访（8-12岁）， 神经、心理和智力的准确评估 结果。此外，MR和NIRS参数将与 项目2中的那些，以帮助解释 病理基质这种方法应该使研究人员能够研究 缺血性损伤的机制，制定合理的治疗方法， 减少这种损害，并更准确地确定那些需要帮助的患者 这些疗法中，有神经发育异常风险的人。

Support is requested to study methods using magnetic resonance (MR) and near infrared spectroscopy (NIRS) that will reliably enable the clinician to predict neurological outcome after perinatal asphyxia. Clinical and laboratory indicators of outcome that have been used to date, such as umbiliCal cord pH and Apgar scores, have proven unreliable. Our preliminary work indicates that standard MR imaging can detect distinctive patterns of damage from perinatal asphyxia by the third day of life and MR spectroscopy can detect injury by the second day of life. Perfusion MR imaging, blond-brain barrier imaging, and diffusion imaging seem to show damage even earlier. NIRS can detect the level of hemoglobin oxygenation and mitochondrial function in the immediate neonatal period. The hypothesis of this proposal are that abnormal T1 and T2 relaxation times, abnormal cerebral perfusion abnormal proton diffusion in the brain, and blood-brain barrier breakdown (as detected by MRI), lactate accumulation (as detected by MRS), and abnormal oxygenation and mitochondrial funCtion (as detected by NIRS) are parameters that will correlate with the degree of neurodevelopmental dysfunction seen later In life. We will use the data obtained in this study to define predictors of outcome in term infants who have suffered perinatal hypoxia-ischemia. These predictors will be derived from a correlation of MR and NIRS parameters (from perfusion contrast and diffusion MR imaging, proton MR spectroscopy, and NIRS performed in the first few days of life) with sophisticated neurodevelopmental testing performed at ages 3 months, 12 months, and 30 months. A sophisticated patient tracking mechanism will be utilized to maintain the cohort of babies for long term follow-up (8-12 years) in order to provide an accurate assessment of neurological, psychological and intellectual outcomes. In addition, the MR and NIRS parameters will be correlated with those in Project 2 in order to aid interpretation with respect to pathologic substrates. This approach should enable investigators to study mechanisms of ischemic damage, develop rational therapies aimed at reducing such damage, and more accurately determine those patients in need of such therapies, those at risk for abnormal neurodevelopmental outcome.