Guarnera Alessia, Lucignani Giulia, Parrillo Chiara, Rossi-Espagnet Maria Camilla, Carducci Chiara, Moltoni Giulia, Savarese Immacolata, Campi Francesca, Dotta Andrea, Milo Francesco, Cappelletti Simona, Capitello Grimaldi Teresa, Gandolfo Carlo, Napolitano Antonio, Longo Daniela
Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital IRCCS, Piazza Sant'Onofrio, 4, 00165 Rome, Italy.
Neuroradiology Unit, NESMOS Department Sant'Andrea Hospital, La Sapienza University, Via di Grottarossa, 1035-1039, 00189 Rome, Italy.
Children (Basel). 2023 Feb 25;10(3):446. doi: 10.3390/children10030446.
Hypoxic-ischemic encephalopathy (HIE) is a severe pathology, and no unique predictive biomarker has been identified. Our aims are to identify associations of perinatal and outcome parameters with morphological anomalies and ADC values from MRI. The secondary aims are to define a predictive ADC threshold value and detect ADC value fluctuations between MRIs acquired within 7 days (MR0) and at 1 year (MR1) of birth in relation to perinatal and outcome parameters.
Fifty-one term children affected by moderate HIE treated with hypothermia and undergoing MRI0 and MRI1 were recruited. Brain MRIs were evaluated through the van Rooij score, while ADC maps were co-registered on a standardized cerebral surface, on which 29 ROIs were drawn. Statistical analysis was performed in Matlab, with the statistical significance value at 0.05.
ADC0 < ADC1 in the left and right thalami, left and right frontal white matter, right visual cortex, and the left dentate nucleus of children showing abnormal perinatal and neurodevelopmental parameters. At ROC analysis, the best prognostic ADC cut-off value was 1.535 mm/s × 10 (sensitivity 80%, specificity 86%) in the right frontal white matter. ADC1 > ADC0 in the right visual cortex and left dentate nucleus, positively correlated with multiple abnormal perinatal and neurodevelopmental parameters. The van Rooij score was significantly higher in children presenting with sleep disorders.
ADC values could be used as prognostic biomarkers to predict children's neurodevelopmental outcomes. Further studies are needed to address these crucial topics and validate our results. Early and multidisciplinary perinatal evaluation and the subsequent re-assessment of children are pivotal to identify physical and neuropsychological disorders to guarantee early and tailored therapy.
缺氧缺血性脑病（HIE）是一种严重的病理状况，尚未发现独特的预测生物标志物。我们的目的是确定围产期和结局参数与MRI形态学异常及ADC值之间的关联。次要目的是确定预测性ADC阈值，并检测出生后7天内（MR0）和1岁时（MR1）获取的MRI之间ADC值的波动与围产期和结局参数的关系。
招募了51名足月、患有中度HIE且接受低温治疗并进行了MRI0和MRI1检查的儿童。通过van Rooij评分评估脑部MRI，同时将ADC图与标准化脑表面进行配准，并在其上绘制29个感兴趣区（ROI）。在Matlab中进行统计分析，统计学显著性值设定为0.05。
围产期和神经发育参数异常的儿童，其左右丘脑、左右额叶白质、右侧视觉皮层和左侧齿状核的ADC0 < ADC1。在ROC分析中，右侧额叶白质中最佳的预后ADC临界值为1.535 mm/s×10（灵敏度80%，特异性86%）。右侧视觉皮层和左侧齿状核的ADC1 > ADC0，与多个围产期和神经发育异常参数呈正相关。睡眠障碍儿童的van Rooij评分显著更高。
ADC值可作为预测儿童神经发育结局的预后生物标志物。需要进一步研究来解决这些关键问题并验证我们的结果。早期多学科围产期评估及随后对儿童的重新评估对于识别身体和神经心理障碍以确保早期和针对性治疗至关重要。
