title: Prognostic utility of magnetic resonance imaging in neonatal hypoxic-ischemic encephalopathy: substudy of a randomized trial.
abstract: OBJECTIVE
  To investigate the effects of hypothermia treatment on magnetic resonance imaging (MRI) patterns of brain injury in newborns with hypoxic-ischemic encephalopathy compared with normothermia, including the prognostic utility of MRI for death and/or disability at a postnatal age of 2 years.
  
  
  METHODS
  Substudy of a randomized controlled trial.
  
  
  METHODS
  Participating centers in the Infant Cooling Evaluation trial.
  
  
  METHODS
  Trial participants (gestational age ≥35 weeks with moderate to severe hypoxic-ischemic encephalopathy, randomized to whole-body hypothermia or normothermia) with available MRIs.
  
  
  METHODS
  We performed qualitative evaluation of T1- and T2-weighted and diffusion MRIs. The posterior limb of the internal capsule was classified as normal or abnormal, whereas the basal ganglia and thalami, white matter, and cortical gray matter were classified as normal or mildly abnormal or moderately/severely abnormal.
  
  
  METHODS
  Death or major disability at 2 years.
  
  
  RESULTS
  We evaluated 127 MRIs (66 patients treated with hypothermia and 61 with normothermia; mean age at scan, 6 postnatal days). The odds of having moderate/severe white matter or cortical gray matter abnormalities on T1- and T2-weighted MRI were reduced by hypothermia (white matter odds ratio, 0.28 [95% CI, 0.09-0.82]; gray matter odds ratio, 0.41 [0.17-1.00]). Abnormal MRI findings predicted adverse outcomes, with T1- and T2-weighted and diffusion MRI abnormalities in the posterior limb of the internal capsule and basal ganglia and thalami demonstrating the greatest predictive value. There was little evidence that prognostic value of the MRI was modified by therapeutic hypothermia (all interactions, P > .05).
  
  
  CONCLUSIONS
  Brain injury on T1- and T2-weighted MRI is reduced in hypothermia-treated newborns. Abnormal MRI findings are prognostic of long-term outcome in moderate to severe hypoxic-ischemic encephalopathy regardless of treatment with hypothermia.
authors: Neonatal Services, Royal Women’s Hospital, Parkville, Victoria, Australia. jeanie.cheong@thewomens.org.au
authors: Jeanie L Y
authors: JL
authors: Cheong
authors: Lee
authors: L
authors: Coleman
authors: Rod W
authors: RW
authors: Hunt
authors: Katherine J
authors: KJ
authors: Lee
authors: Lex W
authors: LW
authors: Doyle
authors: Terrie E
authors: TE
authors: Inder
authors: Susan E
authors: SE
authors: Jacobs
mesh_terms: D001034:Apgar Score; D001921:Brain / Q000473:pathology*; D002423:Cause of Death / Q000639:trends; D002675:Child, Preschool; D003937:Diagnosis, Differential; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods / Q000706:statistics & numerical data*; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods; D020925:Hypoxia-Ischemia, Brain / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011237:Predictive Value of Tests; D011247:Pregnancy; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D014481:United States / Q000453:epidemiology