Reddy Ravikanth
Department of Radiology, St. John's Hospital, Bengaluru, Karnataka, India.
J Neurosci Rural Pract. 2022 Jan 11;13(1):87-94. doi: 10.1055/s-0041-1742157. eCollection 2022 Jan.
Hypoxic-ischemic encephalopathy (HIE) is the most commonly diagnosed neurological abnormality affecting children leading to severe neurological deficits and a cause of neonatal mortality. HIE constitutes a diagnostic challenge in the prematurely born and full-term neonates. HIE causes severe neurological deficit in children and many a times goes unnoticed in early stages. The various patterns of central nervous system (CNS) involvement in HIE are dependent on factors, such as severity and duration of hypoxia, and brain maturity in preterm and full-term patients. Magnetic resonance imaging (MRI) has prognostic significance in detecting patterns of HIE secondary to mild-to-moderate and severe hypoxias and the imaging findings are highly dependent on the time at which imaging is done. MRI helps determine the prognosis of brain development in patients with HIE. This retrospective study elucidates the spectrum of MRI findings in preterm and full-term patients with HIE on MRI. This retrospective descriptive study was conducted at a tertiary care center between April 2017 and May 2019 on 50 patients with a clinical diagnosis of HIE using a General Electric (GE) 1.5-Tesla MRI scanner. Various patterns of HIE were evaluated on MRI in preterm and full-term patients. This retrospective study evaluated MRI findings in 50 infants diagnosed with HIE. Eighteen (36%) were preterm and 32 (64%) were full-term patients. Thirty-five (70%) were male and 15 (30%) were female patients. In the current study, developmental delay was the most commonly associated clinical entity in both preterm and full-term patients. In preterm patients, periventricular leukomalacia was the most prevalent MRI finding, and in full-term patients, subcortical and periventricular white matter hyperintensities on T2-weighted and fluid-attenuated inversion recovery (FLAIR) sequences were most commonly encountered. MRI is the primary imaging modality of choice in preterm and full-term patients with HIE, as it helps determine the severity of hypoxic-ischemic injury by understanding the pattern of brain involvement. In the current study, distinguishable patterns of MRI findings secondary to birth asphyxia and ischemic insult were elucidated in both preterm and full-term patients who are highly dependent on the level of brain maturity at the time of imaging. Regular MRI follow-up has a prognostic significance in HIE with accurate prediction of neurodevelopmental outcome on follow-up studies.
缺氧缺血性脑病（HIE）是影响儿童最常见的神经异常疾病，可导致严重的神经功能缺陷，也是新生儿死亡的原因之一。HIE对早产儿和足月儿的诊断构成挑战。HIE会导致儿童严重的神经功能缺陷，且在早期阶段常常未被察觉。HIE中中枢神经系统（CNS）受累的各种模式取决于多种因素，如缺氧的严重程度和持续时间，以及早产儿和足月儿的脑成熟度。磁共振成像（MRI）在检测轻至中度和重度缺氧继发的HIE模式方面具有预后意义，且成像结果高度依赖于成像时间。MRI有助于确定HIE患者脑发育的预后。 这项回顾性研究阐明了早产儿和足月儿HIE患者的MRI表现谱。 这项回顾性描述性研究于2017年4月至2019年5月在一家三级医疗中心进行，对50例临床诊断为HIE的患者使用通用电气（GE）1.5特斯拉MRI扫描仪进行检查。评估了早产儿和足月儿HIE的各种模式。 这项回顾性研究评估了50例诊断为HIE的婴儿的MRI表现。其中18例（36%）为早产儿，32例（64%）为足月儿。35例（70%）为男性，15例（30%）为女性。在本研究中，发育迟缓是早产儿和足月儿最常见的相关临床情况。在早产儿中，脑室周围白质软化是最常见的MRI表现，而在足月儿中，T2加权和液体衰减反转恢复（FLAIR）序列上的皮质下和脑室周围白质高信号最为常见。 MRI是早产儿和足月儿HIE的主要首选成像方式，因为它有助于通过了解脑受累模式来确定缺氧缺血性损伤的严重程度。在本研究中，阐明了出生窒息和缺血性损伤继发的MRI表现的可区分模式，这在早产儿和足月儿中高度依赖于成像时的脑成熟度水平。定期MRI随访对HIE具有预后意义，在随访研究中能准确预测神经发育结局。
