Published online October 2, 2006
PEDIATRICS Vol. 118 No. 4 October 2006, pp. 1467-1477 (doi:10.1542/peds.2005-2976)
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ARTICLE

Comparative Prognostic Utilities of Early Quantitative Magnetic Resonance Imaging Spin-Spin Relaxometry and Proton Magnetic Resonance Spectroscopy in Neonatal Encephalopathy

Shanthi Shanmugalingam, MRCPCHa, John S. Thornton, PhDb,c, Osuke Iwata, MDa, Alan Bainbridge, PhDd, Frances E. O'Brien, MRCPCHa, Andrew N. Priest, DPhild, Roger J. Ordidge, PhDb, Ernest B. Cady, BScb,d, John S. Wyatt, FRCPCHa and Nicola J. Robertson, FRCPCH, PhDa

a Centre for Perinatal Brain Research, Institute for Women's Health
b Department of Medical Physics and Bioengineering, University College London, London, United Kingdom
c Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery
d Department of Medical Physics and Bioengineering, University College London Hospitals National Health Service Foundation Trust, London, United Kingdom

OBJECTIVE. We sought to compare the prognostic utilities of early MRI spin-spin relaxometry and proton magnetic resonance spectroscopy in neonatal encephalopathy.

METHODS. Twenty-one term infants with neonatal encephalopathy were studied at a mean age of 3.1 days (range: 1–5). Basal ganglia, thalamic and frontal, parietal, and occipital white matter spin-spin relaxation times were determined from images with echo times of 25 and 200 milliseconds. Metabolite ratios were determined from an 8-mL thalamic-region magnetic resonance spectroscopy voxel (1H point-resolved spectroscopy; echo time 270 milliseconds). Outcomes were assigned at age 1 year as follows: (1) normal, (2) moderate (neuromotor signs or Griffiths developmental quotient of 75–84), (3) severe (functional neuromotor deficit or developmental quotient <75 or died). Predictive efficacies for differentiation between normal and adverse (combined moderate and severe) outcomes were compared by receiver operating characteristic curve analysis and logistic regression.

RESULTS. Thalamic and basal ganglia spin-spin relaxation times correlated positively with outcome and predicted adversity. Although thalamic and basal ganglia spin-spin relaxation times were prognostic of adversity, magnetic resonance spectroscopy metabolite ratios were better predictors, and, of these, lactate/N-acetylaspartate was most accurate.

CONCLUSIONS. Deep gray matter spin-spin relaxation time was increased in the first few days after birth in infants with an adverse outcome. Proton magnetic resonance spectroscopy was more prognostic than spin-spin relaxation time, with lactate/N-acetylaspartate the best measure. Nevertheless, both techniques were useful for early prognosis, and the potential superior spatial resolution of spin-spin relaxometry may define better the precise anatomic pattern of injury in the early days after birth.

Key Words: neonatal • encephalopathy • MRI • T2 relaxometry • magnetic resonance spectroscopy

Abbreviations: NE—neonatal encephalopathy • HI—hypoxia-ischemia • T2—spin-spin relaxation time • DWI—diffusion-weighted imaging • 1H MRS—proton magnetic resonance spectroscopy • Cr—creatine plus phosphocreatine • NAA—N-acetylaspartate • TE—echo time • TR—recovery time • ROI—region of interest • DQ—developmental quotient

Accepted Jun 1, 2006.




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