title: Early MRI in term infants with perinatal hypoxic-ischaemic brain injury: interobserver agreement and MRI predictors of outcome at 2 years.
abstract: OBJECTIVE
  To compare diffusion-weighted imaging (DWI) and non-DWI magnetic resonance imaging (MRI), proton MR spectroscopy (1H-MRS), and clinical biomarkers for prediction of 2 year developmental outcome in term infants with perinatal hypoxic-ischaemic encephalopathy (HIE).
  
  
  METHODS
  Nineteen infants ≥36 weeks gestation with HIE were recruited and MRI performed day 3-7 (mean = 5). MRI was scored independently by three radiologists using a standardized scoring system. Lactate-to-N-acetylaspartate ratio (Lac:NAA) in the lentiform nucleus was calculated. Developmental assessment was performed at 2 years using the Bayley Scales of Infant and Toddler Development (BSID-III). Interobserver agreement about abnormality in 10 brain regions was measured. Univariate analysis was performed to determine variables associated with adverse outcome (i.e., death or Bayley score for any domain <70).
  
  
  RESULTS
  Good interobserver agreement (kappa = 0.61-0.69) on scores for DWI was obtained for the cortex, putamen, and brainstem, but not for any region on non-DWI. A significant association was found between outcome and Lac:NAA (p < 0.003) and DWI scores for lentiform nucleus, thalamus, cortex, posterior limb of the internal capsule (PLIC), and paracentral white matter (p = 0.001-0.013), but for non-DWI score only in the vermis or brainstem. A combination of Lac:NAA ≥0.25 or DWI/apparent diffusion coefficient (ADC) signal abnormality in the PLIC had 100% specificity and sensitivity for poor outcome.
  
  
  CONCLUSIONS
  Interobserver agreement for non-DWI performed during the first week is poor. Agreement by three radiologists about the presence of abnormal signal within the PLIC on ADC/DWI images or elevation of Lac:NAA above 0.25 improved sensitivity without reducing the prognostic specificity of MRS in the 19 patients, but this requires validation in a larger group of infants with HIE who have been treated with hypothermia.
authors.affiliation: Department of Diagnostic Imaging, Monash Health, Clayton, Victoria, Australia; Southern Clinical School, Monash University, Clayton, Victoria, Australia. Electronic address: Stacy.Goergen@southernhealth.org.au.
authors.forename: S K
authors.initials: SK
authors.lastname: Goergen
authors.affiliation: Monash Children's and Monash Newborn, Clayton, Victoria, Australia; Department of Pediatrics, Chinese General Hospital and Medical Center, Manila, Phillipines.
authors.forename: H
authors.initials: H
authors.lastname: Ang
authors.affiliation: Monash Children's and Monash Newborn, Clayton, Victoria, Australia; Department of Paediatrics, Monash University, Clayton, Victoria, Australia.
authors.forename: F
authors.initials: F
authors.lastname: Wong
authors.affiliation: Monash Children's and Monash Newborn, Clayton, Victoria, Australia.
authors.forename: E A
authors.initials: EA
authors.lastname: Carse
authors.affiliation: Monash Children's and Monash Newborn, Clayton, Victoria, Australia; Department of Paediatrics, Monash University, Clayton, Victoria, Australia; Department of Developmental Medicine, Royal Children's Hospital, Parkville, Victoria, Australia.
authors.forename: M
authors.initials: M
authors.lastname: Charlton
authors.affiliation: Department of Diagnostic Imaging, Monash Health, Clayton, Victoria, Australia.
authors.forename: R
authors.initials: R
authors.lastname: Evans
authors.affiliation: Department of Diagnostic Imaging, Monash Health, Clayton, Victoria, Australia.
authors.forename: G
authors.initials: G
authors.lastname: Whiteley
authors.affiliation: Department of Diagnostic Imaging, Monash Health, Clayton, Victoria, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Clark
authors.affiliation: Department of Diagnostic Imaging, Monash Health, Clayton, Victoria, Australia.
authors.forename: D
authors.initials: D
authors.lastname: Shipp
authors.affiliation: School of Public Health and Preventative Medicine, Monash University, Prahran, Victoria, Australia.
authors.forename: D
authors.initials: D
authors.lastname: Jolley
authors.affiliation: School of Public Health and Preventative Medicine, Monash University, Prahran, Victoria, Australia.
authors.forename: E
authors.initials: E
authors.lastname: Paul
authors.affiliation: Neonatal Services, Royal Women's Hospital, Parkville, Victoria, Australia; Victorian Infant Brain Studies, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Obstetrics & Gynaecology, University of Melbourne, Parkville, Victoria, Australia.
authors.forename: J L Y
authors.initials: JL
authors.lastname: Cheong
mesh_terms: D001224:Aspartic Acid / Q000031:analogs & derivatives / Q000378:metabolism; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D020925:Hypoxia-Ischemia, Brain / Q000175:diagnosis* / Q000378:metabolism; D007231:Infant, Newborn; D007773:Lactates / Q000378:metabolism; D008279:Magnetic Resonance Imaging / Q000379:methods*; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D015588:Observer Variation; D011237:Predictive Value of Tests; D011379:Prognosis; D012680:Sensitivity and Specificity
chemical_list: D007773:Lactates; D001224:Aspartic Acid; C000179:N-acetylaspartate