Please use this identifier to cite or link to this item: https://doi.org/10.3174/ajnr.A1318
Title: Do apparent diffusion coefficient measurements predict outcome in children with neonatal hypoxic-ischemic encephalopathy?
Authors: Liauw, L 
Van Wezel-Meijler, G
Veen, S
Van Buchem, M.A
Van Der Grond, J
Keywords: article
asphyxia
basal ganglion
brain ischemia
brain stem
capsula interna
clinical article
controlled study
diffusion coefficient
diffusion weighted imaging
female
human
infant
male
newborn hypoxia
nuclear magnetic resonance imaging
outcome assessment
rank sum test
Asphyxia Neonatorum
Basal Ganglia
Brain Stem
Diffusion Magnetic Resonance Imaging
Female
Humans
Hypoxia-Ischemia, Brain
Infant, Newborn
Magnetic Resonance Imaging
Male
Predictive Value of Tests
Retrospective Studies
ROC Curve
Sensitivity and Specificity
Issue Date: 2009
Publisher: American Society of Neuroradiology
Citation: Liauw, L, Van Wezel-Meijler, G, Veen, S, Van Buchem, M.A, Van Der Grond, J (2009). Do apparent diffusion coefficient measurements predict outcome in children with neonatal hypoxic-ischemic encephalopathy?. American Journal of Neuroradiology 30 (2) : 264-270. ScholarBank@NUS Repository. https://doi.org/10.3174/ajnr.A1318
Rights: Attribution 4.0 International
Abstract: Background and Purpose: Diffusion-weighted imaging (DWI) permits early detection and quantification of hypoxic-ischemic (HI) brain lesions. Our aim was to assess the predictive value of DWI and apparent diffusion coefficient (ADC) measurements for outcome in children with perinatal asphyxia. Materials and Methods: Term neonates underwent MR imaging within 10 days after birth because of asphyxia. MR imaging examinations were retrospectively evaluated for HI brain damage. ADC was measured in 30 standardized brain regions and in visibly abnormal areas on DWI. In survivors, developmental outcome until early school age was graded into the following categories: 1) normal, 2) mildly abnormal, and 3) definitely abnormal. For analysis, category 3 and death (category 4) were labeled "adverse," 1 and 2 were "favorable," and 2-3 and death were "abnormal" outcome. Differences in outcome between infants with and without DWI abnormalities were analyzed by using x2 tests. The nonparametric Mann-Whitney U test analyzed whether ADC values in visible DWI abnormalities correlated with age at imaging. Logistic regression analysis tested the predictive value for outcome of the ADC in each standardized brain region. Receiver operating characteristic analysis was used to find optimal ADC cutoff values for each region for the various outcome scores. Results: Twenty-four infants (13 male) were included. Mean age at MR imaging was 4.3 days (range, 1-9 days). Seven infants died. There was no difference in outcome between infants with and without visible DWI abnormalities. Only ADC of the posterior limb of the internal capsule correlated with age. ADC in visibly abnormal DWI regions did not have a predictive value for outcome. Of all measurements performed, only the ADC in the normal-appearing basal ganglia and brain stem correlated significantly with outcome; low ADC values were associated with abnormal/adverse outcome, and higher ADC values, with normal/favorable outcome (basal ganglia: P = .03 for abnormal, P = .01 for adverse outcome; brain stem: P = .006 for abnormal, P = .03 for adverse outcome). Conclusions: ADC values in normal-appearing basal ganglia and brain stem correlated with outcome, independently of all MR imaging findings including those of DWI. ADC values in visibly abnormal brain tissue on DWI did not show a predictive value for outcome.
Source Title: American Journal of Neuroradiology
URI: https://scholarbank.nus.edu.sg/handle/10635/183923
ISSN: 0195-6108
DOI: 10.3174/ajnr.A1318
Rights: Attribution 4.0 International
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