Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Harvard Medical School, Boston, MA, USA.
Pediatr Res. 2023 Sep;94(3):1011-1017. doi: 10.1038/s41390-023-02580-8. Epub 2023 Apr 6.
MRI is the gold standard test to define brain injury in infants with neonatal encephalopathy(NE). As imaging findings evolve considerably over the first week, early imaging may not fully reflect the final nature of the injury. This study aimed to compare day 4 versus second week MRI in infants with NE.
Retrospective cohort study including infants who received therapeutic hypothermia(TH) for NE and had two MRIs: early (≤7days) and late (>7days). MRIs were clinically reported and also reviewed by study investigators.
94infants with NE were included (40mild,49moderate,5severe). Twenty-four infants(26%) had a normal early scan of which 3/24(13%) had injury noted on repeat MRI. Seventy infants(74%) had abnormal findings noted on early MRI, of which 4/70(6%) had further evolution of injury while 11/70(16%) had complete resolution of findings. Applying a grading system resulted in a change of grade in 7 infants.
In infants who received TH for NE, 19% had changes noted between their early and late MRIs. While the impact on predicting neurodevelopmental outcome was not studied, relying solely on early MRI may overestimate injury in a proportion of infants and miss injury in others. Combining early and late MRI allows for better characterization of injury.
MRI is the gold standard tool to define brain injury in infants with NE, however, imaging findings evolve considerably over the first week of life. Most centers perform a single MRI on day 4 after rewarming. In our cohort, 19% of infants had a notable change in their MRI findings between early (within the first week) and late (beyond the first week) scans. Relying solely on early MRI may overestimate injury in a proportion of infants and miss injury in others. Combining early and late MRI following hypothermia allows for better characterization of brain injury.
MRI 是诊断患有新生儿脑病（NE）的婴儿脑损伤的金标准测试。由于成像结果在第一周内发生了很大变化，早期成像可能无法完全反映损伤的最终性质。本研究旨在比较 NE 婴儿的第 4 天与第 2 周 MRI。
这是一项回顾性队列研究，纳入了接受 NE 治疗并接受了两次 MRI 的婴儿：早期（≤7 天）和晚期（>7 天）。MRI 由临床报告，也由研究调查人员进行了审查。
共有 94 例 NE 婴儿入组（轻度 40 例，中度 49 例，重度 5 例）。24 例（26%）婴儿早期 MRI 正常，其中 3/24（13%）在重复 MRI 中发现损伤。70 例（74%）婴儿在早期 MRI 中发现异常，其中 4/70（6%）损伤进一步演变，11/70（16%）发现病变完全消退。应用分级系统导致 7 例婴儿的分级发生变化。
在接受 NE 治疗并接受 TH 的婴儿中，19%的婴儿在其早期和晚期 MRI 之间发现了变化。虽然未研究其对预测神经发育结局的影响，但仅依靠早期 MRI 可能会高估一部分婴儿的损伤，而错过其他婴儿的损伤。结合早期和晚期 MRI 可以更好地对损伤进行特征描述。
MRI 是诊断患有 NE 的婴儿脑损伤的金标准工具，但是，成像结果在生命的第一周内发生了很大变化。大多数中心在复温后第 4 天进行单次 MRI。在我们的队列中，19%的婴儿在早期（第一周内）和晚期（第一周后）扫描之间的 MRI 发现有明显变化。仅依靠早期 MRI 可能会高估一部分婴儿的损伤，而错过其他婴儿的损伤。在低温治疗后结合早期和晚期 MRI 可以更好地对脑损伤进行特征描述。
