title: Distribution and severity of hypoxic-ischaemic lesions on brain MRI following therapeutic cooling: selective head versus whole body cooling.
abstract: BACKGROUND
  Whole body cooling (WBC) cools different parts of the brain uniformly, and selective head cooling (SHC) cools the superficial brain more than the deeper brain structures. In this study, the authors hypothesised that the hypoxic-ischaemic lesions on brain MRI following cooling would differ between modalities of cooling.
  
  
  OBJECTIVE
  To compare the frequency, distribution and severity of hypoxic-ischaemic lesions on brain MRI between SHC or WBC.
  
  
  METHODS
  In a single centre retrospective study, 83 infants consecutively cooled using either SHC (n=34) or WBC (n=49) underwent brain MRI. MRI images were evaluated by a neuroradiologist, who was masked to clinical parameters and outcomes, using a basal ganglia/watershed (BG/W) scoring system. Higher scores (on a scale of 0 to 4) were given for more extensive injury. The score has been reported to be predictive of neuromotor and cognitive outcome at 12 months.
  
  
  RESULTS
  The two groups were similar for severity of depression as assessed by a history of an intrapartum sentinel event, Apgar scores, initial blood pH and base deficit and early neurological examination. However, abnormal MRI was more frequent in the SHC group (SHC 25 of 34, 74% vs WBC 22 of 49, 45%; p=0.0132, OR 3.4, 95% CI 1.3 to 8.8). Infants from the SHC group also had more severe hypoxic-ischaemic lesions (median BG/W score: SHC 2 vs WBC 0, p=0.0014).
  
  
  CONCLUSIONS
  Hypoxic-ischaemic lesions on brain MRI following therapeutic cooling were more frequent and more severe with SHC compared with WBC.
authors.affiliation: University of Michigan, Pediatrics and Communicable Disease, University of Michigan Health System, C S Mott Children's Hospital, 1500 E Medical center Drive, Ann Arbor, MI 48109-0254, USA. subratas@med.umich.edu
authors.forename: Subrata
authors.initials: S
authors.lastname: Sarkar
authors.forename: Steven M
authors.initials: SM
authors.lastname: Donn
authors.forename: Jayapalli R
authors.initials: JR
authors.lastname: Bapuraj
authors.forename: Indira
authors.initials: I
authors.lastname: Bhagat
authors.forename: John D
authors.initials: JD
authors.lastname: Barks
mesh_terms: D001034:Apgar Score; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D020925:Hypoxia-Ischemia, Brain / Q000473:pathology / Q000628:therapy*; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D008297:Male; D012189:Retrospective Studies