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
* Corresponding author
1 CHU Pontchaillou [Rennes]
2 VisAGeS - Vision, Action et Gestion d'informations en Santé
INSERM - Institut National de la Santé et de la Recherche Médicale : U746, Inria Rennes – Bretagne Atlantique , IRISA-D5 - SIGNAUX ET IMAGES NUMÉRIQUES, ROBOTIQUE
3 Service de radiologie et imagerie médicale [Rennes]
4 Service de Pédiatrie
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. 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.
Keywords : spectroscopy term newborns therapeutic hypothermia brain-injury infants metaanalysis apparent diffusion-coefficients perinatal asphyxia
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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, Elsevier, 2016, 85 (8), pp.1366-1374. ⟨10.1016/j.ejrad.2016.05.005⟩. ⟨hal-01361507⟩

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