Reliability of Early Magnetic Resonance Imaging (MRI) and Necessity of Repeating MRI in Noncooled and Cooled Infants With Neonatal Encephalopathy

Elavazhagan Chakkarapani; Kenneth J Poskitt; Steven P Miller; Jill G Zwicker; Qi Xu; Darren S T Wong; Elke H Roland; Alan Hill; Vann Chau

doi:10.1177/0883073815600865

Reliability of Early Magnetic Resonance Imaging (MRI) and Necessity of Repeating MRI in Noncooled and Cooled Infants With Neonatal Encephalopathy

J Child Neurol. 2016 Apr;31(5):553-9. doi: 10.1177/0883073815600865. Epub 2015 Aug 31.

Authors

Elavazhagan Chakkarapani¹, Kenneth J Poskitt², Steven P Miller³, Jill G Zwicker⁴, Qi Xu⁵, Darren S T Wong⁵, Elke H Roland⁵, Alan Hill⁵, Vann Chau⁶

Affiliations

¹ Department of Pediatrics (Neonatology), University of British Columbia and BC Children's Hospital, Vancouver, British Columbia, Canada Department of Pediatrics (Neurology), University of British Columbia and BC Children's Hospital, Vancouver, British Columbia, Canada School of Clinical Sciences, University of Bristol, St Michael's Hospital, Bristol, United Kingdom.
² Department of Pediatrics (Neurology), University of British Columbia and BC Children's Hospital, Vancouver, British Columbia, Canada Department of Radiology, University of British Columbia and BC Children's Hospital, Vancouver, British Columbia, Canada.
³ Department of Pediatrics (Neonatology), University of British Columbia and BC Children's Hospital, Vancouver, British Columbia, Canada Child and Family Research Institute, Vancouver, British Columbia, Canada Department of Pediatrics (Neurology), University of Toronto and the Hospital for Sick Children, Toronto, Ontario, Canada Neurosciences & Mental Health Research Institute, Toronto, Ontario, Canada.
⁴ Department of Pediatrics (Developmental Pediatrics), University of British Columbia and BC Children's Hospital, Vancouver, British Columbia, Canada Department of Occupational Science and Occupational Therapy, Vancouver, British Columbia, Canada Child and Family Research Institute, Vancouver, British Columbia, Canada Sunny Hill Health Centre for Children, Vancouver, British Columbia, Canada.
⁵ Department of Pediatrics (Neurology), University of British Columbia and BC Children's Hospital, Vancouver, British Columbia, Canada.
⁶ Child and Family Research Institute, Vancouver, British Columbia, Canada Department of Pediatrics (Neurology), University of Toronto and the Hospital for Sick Children, Toronto, Ontario, Canada Neurosciences & Mental Health Research Institute, Toronto, Ontario, Canada vann.chau@sickkids.ca.

PMID: 26323498
DOI: 10.1177/0883073815600865

Abstract

In cooled newborns with encephalopathy, although late magnetic resonance imaging (MRI) scan (10-14 days of age) is reliable in predicting long-term outcome, it is unknown whether early scan (3-6 days of life) is. We compared the predominant pattern and extent of lesion between early and late MRI in 89 term neonates with neonatal encephalopathy. Forty-three neonates (48%) were cooled. The predominant pattern of lesions and the extent of lesion in the watershed region agreed near perfectly in noncooled (kappa = 0.94; k = 0.88) and cooled (k = 0.89; k = 0.87) infants respectively. There was perfect agreement in the extent of lesion in the basal nuclei in noncooled infants (k = 0.83) and excellent agreement in cooled infants (k = 0.67). Changes in extent of lesions on late MRI occurred in 19 of 89 infants, with higher risk in infants with hypoglycemia and moderate-severe lesions in basal nuclei. In most term neonates with neonatal encephalopathy, early MRI (relative to late scan) robustly predicts the predominant pattern and extent of injury.

Keywords: asphyxia; brain injury; hypothermia; magnetic resonance imaging; neonatal encephalopathy; newborn.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Brain / diagnostic imaging
Brain Diseases / diagnostic imaging*
Brain Diseases / therapy*
Female
Humans
Hypothermia, Induced*
Image Processing, Computer-Assisted
Infant, Newborn
Infant, Newborn, Diseases / diagnostic imaging*
Infant, Newborn, Diseases / therapy*
Magnetic Resonance Imaging*
Male
Reproducibility of Results
Retrospective Studies
Statistics, Nonparametric
Time Factors

Grants and funding

XG 07-034/Canadian Institutes of Health Research/Canada