Early Diffusion Weighted Imaging versus T1 and T2 Imaging to Predict Medium-Term Outcome after Moderate Hypothermia for Neonatal Hypoxic-Ischemic Encephalopathy

Abstract

Objective: To compare the value of early Diffusion Weighted Imaging (DWI) (with or without measurement of Apparent Diffusion Coefficient [ADC]) and early T1 and T2 weighted imaging and to predict medium-term neurodevelopmental outcome of neonates treated by moderate hypothermia for hypoxic-ischemic encephalopathy (HIE).

Materials and Methods: Prospective medium-term follow-up of 27 term neonates after moderate hypothermia for neonatal HIE; and confrontation of 9–15 months neurodevelopmental outcome with neonatal cerebral magnetic resonance imaging (qualitative analysis of conventional image and DWI by cumulative scores and quantitative measurements of Apparent Diffusion Coefficient [ADC] of 17 brain regions).

Results: Infants with adverse outcome had higher cumulative scores on conventional and DW images. Cumulative scores on DWI were not significantly better than cumulative scores on conventional images to predict adverse outcome (area under the ROC [Receiver Operating Characteristic] curve: 0.83 for DWI versus 0.82 and 0.89 for conventional images). ADC were significantly lower for infants with adverse outcome; ADC of caudate and lentiform nuclei had the highest areas under the curve (0.96 and 0.99, respectively), but these areas were not significantly higher than those of conventional images.

Conclusion: After neonatal HIE treated by moderate hypothermia, cumulative scores were predictive of neurodevelopmental medium-term adverse outcome for conventional and DW images, and DWI alone (without measures of ADC) was not better than conventional images. ADC of the most brain regions were predictive of neurodevelopmental medium-term adverse outcome, but were not significantly better than conventional images.