From the Department of Radiology, Duke University Medical Center, Durham, NC (E.C.); Department of Neurology and Weill Institute for Neuroscience (Y.W., H.C.G.), Department of Pediatrics, UCSF Benioff Children's Hospital (Y.W., H.C.G.), Department of Epidemiology and Biostatistics (A.W.S.), School of Medicine (S.G.), and Neuroradiology Section, Department of Radiology and Biomedical Imaging (C.P.H., Y.L.), University of California, San Francisco, 505 Parnassus Ave, M-391, San Francisco, CA 94143-0628; Department of Radiology, Children's Hospital of Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, Calif (J.L.W.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (R.C.M.); Department of Pediatrics, St Louis University, St Louis, Mo (A.M.); and Departments of Statistics (B.A.C., P.J.H.) and Pediatrics (S.E.J.), University of Washington, Seattle, Wash.
Radiology. 2023 Sep;308(3):e223262. doi: 10.1148/radiol.223262.
Background Multiple qualitative scoring systems have been created to capture the imaging severity of hypoxic ischemic brain injury. Purpose To evaluate quantitative volumes of acute brain injury at MRI in neonates with hypoxic ischemic brain injury and correlate these findings with 24-month neurodevelopmental outcomes and qualitative brain injury scoring by radiologists. Materials and Methods In this secondary analysis, brain diffusion-weighted MRI data from neonates in the High-dose Erythropoietin for Asphyxia and Encephalopathy trial, which recruited participants between January 2017 and October 2019, were analyzed. Volume of acute brain injury, defined as brain with apparent diffusion coefficient (ADC) less than 800 × 10 mm/sec, was automatically computed across the whole brain and within the thalami and white matter. Outcomes of death and neurodevelopmental impairment (NDI) were recorded at 24-month follow-up. Associations between the presence and volume (in milliliters) of acute brain injury with 24-month outcomes were evaluated using multiple logistic regression. The correlation between quantitative acute brain injury volume and qualitative MRI scores was assessed using the Kendall tau-b test. Results A total of 416 neonates had available MRI data (mean gestational age, 39.1 weeks ± 1.4 [SD]; 235 male) and 113 (27%) showed evidence of acute brain injury at MRI. Of the 387 participants with 24-month follow-up data, 185 (48%) died or had any NDI. Volume of acute injury greater than 1 mL (odds ratio [OR], 13.9 [95% CI: 5.93, 32.45]; < .001) and presence of any acute injury in the brain (OR, 4.5 [95% CI: 2.6, 7.8]; < .001) were associated with increased odds of death or any NDI. Quantitative whole-brain acute injury volume was strongly associated with radiologists' qualitative scoring of diffusion-weighted images (Kendall tau-b = 0.56; < .001). Conclusion Automated quantitative volume of brain injury is associated with death, moderate to severe NDI, and cerebral palsy in neonates with hypoxic ischemic encephalopathy and correlated well with qualitative MRI scoring of acute brain injury. Clinical trial registration no. NCT02811263 © RSNA, 2023 See also the editorial by Huisman in this issue.
背景 已经创建了多个用于捕捉缺氧缺血性脑损伤影像学严重程度的定性评分系统。目的 评估患有缺氧缺血性脑损伤的新生儿在 MRI 上急性脑损伤的定量体积，并将这些发现与 24 个月的神经发育结果和放射科医生的定性脑损伤评分进行相关性分析。材料与方法 在这项二次分析中，分析了 2017 年 1 月至 2019 年 10 月期间参加高剂量促红细胞生成素治疗窒息和脑病试验的新生儿的脑弥散加权 MRI 数据。全脑及丘脑和脑白质内表观弥散系数（ADC）小于 800×10 mm/sec 的急性脑损伤体积通过自动计算得出。在 24 个月的随访中记录死亡和神经发育损伤（NDI）的结果。使用多变量逻辑回归评估急性脑损伤的存在和体积（以毫升为单位）与 24 个月结果之间的相关性。使用 Kendall tau-b 检验评估定量急性脑损伤体积与定性 MRI 评分之间的相关性。结果 共有 416 名新生儿有 MRI 数据（平均胎龄，39.1 周±1.4[标准差]；235 名男性），113 名（27%）MRI 显示急性脑损伤证据。在 387 名有 24 个月随访数据的参与者中，185 名（48%）死亡或有任何 NDI。损伤体积大于 1 毫升（比值比[OR]，13.9[95%置信区间：5.93，32.45]；<0.001）和脑内存在任何急性损伤（OR，4.5[95%置信区间：2.6，7.8]；<0.001）与死亡或任何 NDI 的几率增加相关。定量全脑急性损伤体积与放射科医生对弥散加权图像的定性评分密切相关（Kendall tau-b=0.56；<0.001）。结论 患有缺氧缺血性脑病的新生儿脑损伤的自动定量体积与死亡、中重度 NDI 和脑瘫有关，并且与急性脑损伤的定性 MRI 评分相关性良好。临床试验注册号 NCT02811263©RSNA，2023 也可参见本期杂志上 Huisman 的社论。
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