title: Prognostic value of brain proton MR spectroscopy and diffusion tensor imaging in newborns with hypoxic-ischemic encephalopathy treated by brain cooling.
abstract: BACKGROUND
  MRI, proton magnetic resonance spectroscopy (¹H-MRS), and diffusion tensor imaging (DTI) have been shown to be of great prognostic value in term newborns with moderate-severe hypoxic-ischemic encephalopathy (HIE). Currently, no data are available on ¹H-MRS and DTI performed in the subacute phase after hypothermic treatment. The aim of the present study was to assess their prognostic value in newborns affected by moderate-severe HIE and treated with selective brain cooling (BC).
  
  
  METHODS
  Twenty infants treated with BC underwent conventional MRI and (1)H-MRS at a mean (SD) age of 8.3 (2.8) days; 15 also underwent DTI. Peak area ratios of metabolites and DTI variables, namely mean diffusivity (MD), axial and radial diffusivity, and fractional anisotropy (FA), were calculated. Clinical outcome was monitored until 2 years of age.
  
  
  RESULTS
  Adverse outcome was observed in 6/20 newborns. Both ¹H-MRS and DTI variables showed higher prognostic accuracy than conventional MRI. N-acetylaspartate/creatine at a basal ganglia localisation showed 100% PPV and 93% NPV for outcome. MD showed significantly decreased values in many regions of white and gray matter, axial diffusivity showed the best predictive value (PPV and NPV) in the genu of corpus callosum (100 and 91%, respectively), and radial diffusivity was significantly decreased in fronto white matter (FWM) and fronto parietal (FP) WM. The decrement of FA showed the best AUC (0.94) in the FPWM.
  
  
  CONCLUSIONS
  Selective BC in HIE neonates does not affect the early and accurate prognostic value of ¹H-MRS and DTI, which outperform conventional MRI.
authors.affiliation: Neonatal Intensive Care Unit, Department of Mother and Infant Infermi Hospital of Rimini, Rimini, Italy. gina.ancora@auslrn.net.
authors.forename: G
authors.initials: G
authors.lastname: Ancora
authors.affiliation: MR Functional Unit, Department of Biomedical and Neuromotor Sciences University of Bologna, Bologna, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Testa
authors.affiliation: Neonatology Unit, Department of Woman, Child and Adolescent Health, University of Bologna, Bologna, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Grandi
authors.affiliation: MR Functional Unit, Department of Biomedical and Neuromotor Sciences University of Bologna, Bologna, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Tonon
authors.affiliation: Neonatology Unit, Department of Woman, Child and Adolescent Health, University of Bologna, Bologna, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Sbravati
authors.affiliation: Neonatology Unit, Department of Woman, Child and Adolescent Health, University of Bologna, Bologna, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Savini
authors.affiliation: MR Functional Unit, Department of Biomedical and Neuromotor Sciences University of Bologna, Bologna, Italy.
authors.forename: D N
authors.initials: DN
authors.lastname: Manners
authors.affiliation: MR Functional Unit, Department of Biomedical and Neuromotor Sciences University of Bologna, Bologna, Italy.
authors.forename: L L
authors.initials: LL
authors.lastname: Gramegna
authors.affiliation: Radiology Unit, Department of Woman, Child and Adolescent Health, University of Bologna, Bologna, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Tani
authors.affiliation: Department of Pharmacy and Biotechnologies, University of Bologna, Bologna, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Malucelli
authors.affiliation: Neonatology Unit, Department of Woman, Child and Adolescent Health, University of Bologna, Bologna, Italy.
authors.forename: L T
authors.initials: LT
authors.lastname: Corvaglia
authors.affiliation: Neonatology Unit, Department of Woman, Child and Adolescent Health, University of Bologna, Bologna, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Faldella
authors.affiliation: MR Functional Unit, Department of Biomedical and Neuromotor Sciences University of Bologna, Bologna, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Lodi
mesh_terms: D015415:Biomarkers / Q000032:analysis; D001921:Brain / Q000378:metabolism* / Q000473:pathology*; D017679:Cryotherapy / Q000379:methods*; D056324:Diffusion Tensor Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D020925:Hypoxia-Ischemia, Brain / Q000175:diagnosis* / Q000378:metabolism / Q000628:therapy*; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D011379:Prognosis; D011522:Protons; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D011522:Protons