title: Early MRI in neonatal hypoxic-ischaemic encephalopathy treated with hypothermia: Prognostic role at 2-year follow-up.
abstract: The prognostic role of early MRI (≤ 6 days of life) is still uncertain in hypoxic-ischaemic encephalopathy (HIE) treated with hypothermia.
  
  
  OBJECTIVE
  To compare the prognostic value of early (≤ 6 days) and late MRIs (≥ 7 days) in predicting adverse outcome at 2 years old in asphyxiated term neonates treated with hypothermia.
  
  
  METHODS
  This retrospective study included all asphyxiated neonates eligible for hypothermia treatment between November 2009 and July 2012. Two MRI scans were performed at a median age of day 4 (early MRI) and day 11 (late MRI). Two radiologists analysed independently each MRI. Imaging was classified as normal/subnormal or abnormal, using a visual analysis. Apparent diffusion coefficient (ADC) values were measured within predefined areas and posterior limb of internal capsule (PLIC) signal intensity was analysed. Neurodevelopmental outcome was assessed at 18-41 months (median age 24 months) as favourable or adverse.
  
  
  RESULTS
  Of the 38 neonates followed up, 8 had an adverse outcome, all related to abnormal MRIs. Twenty-nine neonates had both MRIs sequentially. Both early and late MRIs yielded 100% sensitivity for adverse outcome by using the visual analysis. Early MRI had a higher specificity than late MRI (96.3% versus 89.3%). ADC measurements did not provide further information than visual analysis. PLIC signal abnormalities were a good predictor of adverse outcome on both MRIs.
  
  
  CONCLUSIONS
  Early MRI (≤ 6 days) was a good predictor of neurodevelopmental outcome at 2 years old. It could reliably guide intensive care decisions after the end of hypothermia treatment.
authors.affiliation: CHU Rennes, Department of Paediatric Radiology, Hôpital Sud, 16 Boulevard de Bulgarie, 35200 Rennes, France. Electronic address: va.charon@gmail.com.
authors.forename: Valérie
authors.initials: V
authors.lastname: Charon
authors.affiliation: CHU Rennes, Department of Paediatric Radiology, Hôpital Sud, 16 Boulevard de Bulgarie, 35200 Rennes, France.
authors.forename: Maïa
authors.initials: M
authors.lastname: Proisy
authors.affiliation: CHU Rennes, Paediatrics department, Centre d'Action Médico-Sociale Précoce, Hôpital Pontchaillou, 2 rue Henri le Guilloux, 35000 Rennes, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Bretaudeau
authors.affiliation: CHU Rennes, Department of Paediatric Radiology, Hôpital Sud, 16 Boulevard de Bulgarie, 35200 Rennes, France.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Bruneau
authors.affiliation: CHU Rennes, Paediatrics department, Neonatology and CIC 1414, Hôpital Sud, 16 Boulevard de Bulgarie, 35200 Rennes, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Pladys
authors.affiliation: CHU Rennes, Paediatrics department, Neonatology and CIC 1414, Hôpital Sud, 16 Boulevard de Bulgarie, 35200 Rennes, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Beuchée
authors.affiliation: CHU Rennes, Paediatrics department, Centre Hospitalier Public du Cotentin, 2 Rue Aristide Briand, 50130 Cherbourg-Octeville, France.
authors.forename: Gladys
authors.initials: G
authors.lastname: Burnouf-Rose
authors.affiliation: CHU Rennes, Department of Neuroradiology, Hôpital Pontchaillou, 2 rue Henri le Guilloux, 35000 Rennes, France.
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Ferré
authors.affiliation: CHU Rennes, Department of Paediatric Radiology, Hôpital Sud, 16 Boulevard de Bulgarie, 35200 Rennes, France.
authors.forename: Céline
authors.initials: C
authors.lastname: Rozel
mesh_terms: D001238:Asphyxia Neonatorum / Q000000981:diagnostic imaging / Q000628:therapy; D001921:Brain / Q000254:growth & development; D002657:Child Development / Q000502:physiology; D038524:Diffusion Magnetic Resonance Imaging / Q000706:statistics & numerical data; D017352:Echo-Planar Imaging / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D020925:Hypoxia-Ischemia, Brain / Q000000981:diagnostic imaging* / Q000628:therapy; D021621:Imaging, Three-Dimensional / Q000379:methods; D007231:Infant, Newborn; D020772:Internal Capsule / Q000000981:diagnostic imaging; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data*; D008297:Male; D063868:Patient Outcome Assessment; D011379:Prognosis; D011597:Psychomotor Performance / Q000502:physiology; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013997:Time Factors; D016896:Treatment Outcome
keywords: Brain-; Hypothermia; Induced-; Neonates-; diffusion magnetic resonance imaging-; hypoxia-Ischaemia; patient outcome assessment