Early MRI in neonatal hypoxic-ischaemic encephalopathy treated with hypothermia: Prognostic role at 2-year follow-up

Valerie Charon (1) , Maia Proisy (2, 3) , Gilles Bretaudeau (1) , Bertrand Bruneau (3) , Patrick Pladys (4) , Alain Beuchee (1) , Gladys Burnouf-Rose (1) , Jean-Christophe Ferré (1, 2) , Celine Rozel (3, 2)

1 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Ponchaillou]
2 VisAGeS - Vision, Action et Gestion d'informations en Santé
3 Service de radiologie et imagerie médicale [Rennes] = Radiology [Rennes]
4 Service de Pédiatrie

Unlabelled - 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. Conclusion - 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.

Mots clés: infants; metaanalysis; apparent diffusion-coefficients; perinatal asphyxia; brain-injury; therapeutic hypothermia; term newborns; spectroscopy

Domaines: Pédiatrie; Neurobiologie; Ingénierie biomédicale

Valerie Charon, Maia Proisy, Gilles Bretaudeau, Bertrand Bruneau, Patrick Pladys, et al.. Early MRI in neonatal hypoxic-ischaemic encephalopathy treated with hypothermia: Prognostic role at 2-year follow-up. European Journal of Radiology, 2016, 85 (8), pp.1366-1374. ⟨10.1016/j.ejrad.2016.05.005⟩. ⟨hal-01361507⟩