Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht Brain Center, University Utrecht, Utrecht, The Netherlands.
Department of Developmental Origins of Disease, University Medical Center Utrecht Brain Centre, University Utrecht, Utrecht, The Netherlands.
Pediatr Res. 2021 Apr;89(5):1171-1178. doi: 10.1038/s41390-020-01173-z. Epub 2020 Sep 23.
Postmortem examinations frequently show cerebellar injury in infants with severe hypoxic-ischemic encephalopathy (HIE), while it is less well visible on MRI. The primary aim was to investigate the correlation between cerebellar apparent diffusion coefficient (ADC) values and histopathology in infants with HIE. The secondary aim was to compare ADC values in the cerebellum of infants with HIE and infants without brain injury.
ADC values in the cerebellar vermis, hemispheres and dentate nucleus (DN) of (near-)term infants with HIE (n = 33) within the first week after birth were compared with neonates with congenital non-cardiac anomalies, normal postoperative MRIs and normal outcome (n = 22). Microglia/macrophage activation was assessed using CD68 and/or HLA-DR staining and Purkinje cell (PC) injury using H&E-stained slices. The correlation between ADC values and the histopathological measures was analyzed.
ADC values in the vermis (p = 0.021) and DN (p < 0.001) were significantly lower in infants with HIE compared to controls. ADC values in the cerebellar hemispheres were comparable. ADC values in the vermis were correlated with the number and percentage of normal PCs; otherwise ADC values and histology were not correlated.
Histopathological injury in the cerebellum is common in infants with HIE. ADC values underestimate histopathological injury.
ADC values might underestimate cerebellar injury in neonates with HIE. ADC values in the vermis and dentate nucleus of infants with HIE are lower compared to controls, but not in the cerebellar hemispheres. Abnormal ADC values are only found when cytotoxic edema is very severe. ADC values in the vermis are correlated with Purkinje cell injury in the vermis; furthermore, there were no correlations between ADC values and histopathological measures.
在患有严重缺氧缺血性脑病（HIE）的婴儿中，尸检经常显示小脑损伤，而 MRI 则不太明显。主要目的是研究 HIE 婴儿小脑表观扩散系数（ADC）值与组织病理学之间的相关性。次要目的是比较 HIE 婴儿和无脑损伤婴儿小脑 ADC 值。
比较出生后第一周内（近）足月 HIE 婴儿（n=33）小脑蚓部、半球和齿状核（DN）的 ADC 值与先天性非心脏畸形、正常术后 MRI 和正常结果的新生儿（n=22）。使用 CD68 和/或 HLA-DR 染色评估小胶质细胞/巨噬细胞活化，使用 H&E 染色切片评估浦肯野细胞（PC）损伤。分析 ADC 值与组织病理学测量值之间的相关性。
与对照组相比，HIE 婴儿小脑蚓部（p=0.021）和 DN（p<0.001）的 ADC 值显著降低。小脑半球的 ADC 值无差异。小脑蚓部的 ADC 值与正常 PC 的数量和百分比呈正相关；否则，ADC 值与组织学之间无相关性。
HIE 婴儿的小脑组织病理学损伤很常见。ADC 值低估了组织病理学损伤。
ADC 值可能低估了患有 HIE 的新生儿的小脑损伤。与对照组相比，HIE 婴儿的小脑蚓部和齿状核的 ADC 值较低，但小脑半球的 ADC 值没有差异。只有当细胞毒性水肿非常严重时，才会出现异常的 ADC 值。小脑蚓部的 ADC 值与小脑蚓部的浦肯野细胞损伤呈正相关；此外，ADC 值与组织病理学测量值之间无相关性。
