PEDIATRICS Vol. 118 No. 4 October 2006, pp. 1467-1477 (doi:10.1542/peds.2005-2976)
ARTICLE |
Comparative Prognostic Utilities of Early Quantitative Magnetic Resonance Imaging Spin-Spin Relaxometry and Proton Magnetic Resonance Spectroscopy in Neonatal Encephalopathy
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: 15). 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 7584), (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: NEneonatal encephalopathy HIhypoxia-ischemia T2spin-spin relaxation time DWIdiffusion-weighted imaging 1H MRSproton magnetic resonance spectroscopy Crcreatine plus phosphocreatine NAAN-acetylaspartate TEecho time TRrecovery time ROIregion of interest DQdevelopmental quotient
Accepted Jun 1, 2006.
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