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Prognostic value of diffusion-weighted imaging summation scores or apparent diffusion coefficient maps in newborns with hypoxic-ischemic encephalopathy

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Abstract

Background

The diagnostic and prognostic assessment of newborn infants with hypoxic-ischemic encephalopathy (HIE) comprises, among other tools, diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) maps.

Objective

To compare the ability of DWI and ADC maps in newborns with HIE to predict the neurodevelopmental outcome at 2 years of age.

Materials and methods

Thirty-four term newborns with HIE admitted to the Neonatal Intensive Care Unit of Modena University Hospital from 2004 to 2008 were consecutively enrolled in the study. All newborns received EEG, conventional MRI and DWI within the first week of life. DWI was analyzed by means of summation (S) score and regional ADC measurements. Neurodevelopmental outcome was assessed with a standard 1–4 scale and the Griffiths Mental Developmental Scales - Revised (GMDS-R).

Results

When the outcome was evaluated with a standard 1–4 scale, the DWI S scores showed very high area under the curve (AUC) (0.89) whereas regional ADC measurements in specific subregions had relatively modest predictive value. The lentiform nucleus was the region with the highest AUC (0.78). When GMDS-R were considered, DWI S scores were good to excellent predictors for some GMDS-R subscales. The predictive value of ADC measurements was both region- and subscale-specific. In particular, ADC measurements in some regions (basal ganglia, white matter or rolandic cortex) were excellent predictors for specific GMDS-R with AUCs up to 0.93.

Conclusions

DWI S scores showed the highest prognostic value for the neurological outcome at 2 years of age. Regional ADC measurements in specific subregions proved to be highly prognostic for specific neurodevelopmental outcomes.

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Authors and Affiliations

  1. Neuroradiology Unit, Department of Neuroscience, Nuovo Ospedale Civile S. Agostino Estense di Modena, Azienda Unità Sanitaria Locale di Modena, via Giardini 1355, Modena, 41100, Italy

    Francesca Cavalleri & Alessandra Todeschini

  2. Institute of Pediatrics and Neonatal Medicine and NICU, Modena University Hospital, Modena, Italy

    Licia Lugli, Marisa Pugliese, Elisa Della Casa, Claudio Gallo, Rossella Frassoldati & Fabrizio Ferrari

  3. Department of Clinical and Diagnostic Medicine and Public Health, University of Modena and Reggio Emilia, Modena, Italy

    Roberto D’Amico

Authors
  1. Francesca Cavalleri
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  2. Licia Lugli
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  3. Marisa Pugliese
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  4. Roberto D’Amico
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  5. Alessandra Todeschini
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  6. Elisa Della Casa
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  7. Claudio Gallo
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  8. Rossella Frassoldati
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  9. Fabrizio Ferrari
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Correspondence to Francesca Cavalleri.

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Cavalleri, F., Lugli, L., Pugliese, M. et al. Prognostic value of diffusion-weighted imaging summation scores or apparent diffusion coefficient maps in newborns with hypoxic-ischemic encephalopathy. Pediatr Radiol 44, 1141–1154 (2014). https://doi.org/10.1007/s00247-014-2945-9

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  • DOI: https://doi.org/10.1007/s00247-014-2945-9

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