Nuzum Tatiana A, Mally Pradeep, Wachtel Elena V
Division of Neonatology, Department of Pediatrics, Hassenfeld Children's Hospital at NYU Langone, New York, New York.
Division of Neonatology, Department of Pediatrics, NYCH + H Bellevue Hospital, New York, New York.
Am J Perinatol. 2025 Oct;42(13):1786-1792. doi: 10.1055/a-2540-2956. Epub 2025 Mar 27.
This study aimed to evaluate the utility of early and late magnetic resonance imaging (MRI) in infants with neonatal encephalopathy (NE) after therapeutic hypothermia (TH), and to determine the concordance between magnetic resonance spectroscopy (MRS) and early MRI findings.We conducted a retrospective, observational study including encephalopathic neonates born between 2017 and 2023 at two regional perinatal centers. All subjects underwent early diffusion-weighted MRI (DWI) with or without MRS (day: 4-5), and late conventional T1/T2-weighted MRI (day: 12-14). Both MRIs were assigned an injury severity score based on the National Institute of Child Health and Human Development (NICHD) neonatal research network (NRN) pattern of injury, reflecting the injury apparent on the MR modality obtained. MRS injury was defined as the presence of a lactate peak.The majority of the cohort ( = 98) was moderately encephalopathic (78%). Early and late MR imaging was performed at an average of 5.7 and 13.6 days, respectively. Fifteen percent of infants had evidence of hypoxic-ischemic (HI) injury on early imaging only, and 6% on late imaging only. Forty percent of infants exhibited a change in NICHD score severity between early and late MRI. Twenty-three infants (24%) were found to have a milder injury and 16 (16%) were found to have more severe injury on late imaging, when scores were compared with early imaging scores. The concordance of injury between early MRS and MRI was 62.5%. Among the cases of discordant MRI/MRS, MRS detected additional injury in 70% of cases, and MRI detected additional injury in 30% of cases.Both early and late imaging are important to fully define injury and provide accurate neurodevelopmental prognoses in cases of encephalopathic infants following TH. Failure to perform imaging at two intervals would have potentially resulted in missed diagnoses in 6 to 15% of cases and misestimation of injury in up to 40% of cases. · Early and late neuroimaging is important for accurate neurodevelopmental prognostication of encephalopathic neonates.. · The NICHD NRN MRI scoring system is a helpful tool for clinical practice.. · MR spectroscopy shows promise for HI injury but requires more validation..
本研究旨在评估早期和晚期磁共振成像（MRI）在接受治疗性低温（TH）的新生儿脑病（NE）婴儿中的应用价值，并确定磁共振波谱（MRS）与早期MRI结果之间的一致性。我们进行了一项回顾性观察研究，纳入了2017年至2023年在两个地区围产期中心出生的脑病新生儿。所有受试者均接受了早期弥散加权MRI（DWI）检查，部分同时接受了MRS检查（第4 - 5天），以及晚期常规T1/T2加权MRI检查（第12 - 14天）。根据美国国立儿童健康与人类发展研究所（NICHD）新生儿研究网络（NRN）损伤模式，对两种MRI检查结果分别进行损伤严重程度评分，以反映相应MRI模态下明显的损伤情况。MRS损伤定义为存在乳酸峰。队列中的大多数（n = 98）为中度脑病（78%）。早期和晚期MR成像的平均时间分别为5.7天和13.6天。15%的婴儿仅在早期成像时有缺氧缺血性（HI）损伤证据，6%仅在晚期成像时有该证据。40%的婴儿在早期和晚期MRI之间的NICHD评分严重程度发生了变化。当将晚期成像评分与早期成像评分进行比较时，发现23名婴儿（24%）晚期损伤较轻，16名婴儿（16%）晚期损伤更严重。早期MRS与MRI之间损伤的一致性为62.5%。在MRI/MRS不一致的病例中，MRS在70%的病例中检测到了额外损伤，MRI在30%的病例中检测到了额外损伤。早期和晚期成像对于全面定义TH后脑病婴儿的损伤并提供准确的神经发育预后都很重要。若未在两个时间点进行成像，可能会导致6%至15%的病例漏诊，以及高达40%的病例损伤估计错误。· 早期和晚期神经成像对于脑病新生儿准确的神经发育预后评估很重要。· NICHD NRN MRI评分系统是临床实践中的一个有用工具。· MRS对HI损伤显示出一定前景，但需要更多验证。
