title: Diffusion-weighted imaging and proton magnetic resonance spectroscopy in perinatal hypoxic-ischemic encephalopathy: association with neuromotor outcome at 18 months of age.
abstract: We evaluated early diffusion-weighted imaging findings, the quantitative apparent diffusion coefficient, and magnetic resonance spectroscopy (the presence of lactate and ratios of N-acetylaspartate to total creatine and choline to total creatine) in the prediction of the 18-month neuromotor outcome of term newborns with hypoxic-ischemic encephalopathy. Conventional T1- and T2-weighted and diffusion-weighted imaging was performed in 20 asphyxiated term newborns, with additional basal ganglia magnetic resonance spectroscopy in 15 newborns between 2 and 18 days of life (mean 7.3 days). Neuromotor outcome was dichotomized into normal and abnormal for statistical analysis. Statistically significant differences in the ratios of N-acetylaspartate to total creatine, but not apparent diffusion coefficient values and ratios of choline to total creatine, were found between infants with a normal and an abnormal outcome (Mann-Whitney U-test, P = .010). There was a significant association between the presence of a lactate peak and an abnormal outcome (chi-square test, P = .017). The presence of a lactate peak for predicting an abnormal outcome had a sensitivity of 100% and a specificity of 80%, and the odds ratio was 37.4. Ischemic lesions were more conspicuous and/or extensive on diffusion-weighted imaging in all except one neonate. The presence of normal findings on both diffusion-weighted imaging and conventional magnetic resonance imaging is predictive of a normal neuromotor outcome, whereas lactate and a reduced ratio of N-acetylaspartate to total creatine in the basal ganglia, but not an apparent diffusion coefficient, are associated with an abnormal outcome at 18 months of age.
authors.affiliation: Queen Mary Hospital and The Duchess of Kent Children's Habilitation Institute, Hong Kong. plkhong@hkucc.hku.hk
authors.forename: Pek-Lan
authors.initials: PL
authors.lastname: Khong
authors.forename: Catherine
authors.initials: C
authors.lastname: Tse
authors.forename: Ivan Y C
authors.initials: IY
authors.lastname: Wong
authors.forename: Barbara C C
authors.initials: BC
authors.lastname: Lam
authors.forename: Pik-To
authors.initials: PT
authors.lastname: Cheung
authors.forename: Winnie H S
authors.initials: WH
authors.lastname: Goh
authors.forename: Ngai Shan
authors.initials: NS
authors.lastname: Kwong
authors.forename: Gaik-Cheng
authors.initials: GC
authors.lastname: Ooi
mesh_terms: D001224:Aspartic Acid / Q000031:analogs & derivatives* / Q000032:analysis; D001238:Asphyxia Neonatorum / Q000175:diagnosis* / Q000503:physiopathology; D001479:Basal Ganglia / Q000473:pathology; D001921:Brain / Q000473:pathology*; D002794:Choline / Q000032:analysis; D003401:Creatine / Q000032:analysis; D038524:Diffusion Magnetic Resonance Imaging; D004734:Energy Metabolism / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002534:Hypoxia, Brain / Q000175:diagnosis* / Q000503:physiopathology; D007223:Infant; D007231:Infant, Newborn; D019344:Lactic Acid / Q000032:analysis; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D009460:Neurologic Examination / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D013223:Statistics as Topic
chemical_list: D001224:Aspartic Acid; D019344:Lactic Acid; C000179:N-acetylaspartate; D003401:Creatine; D002794:Choline