Aim: To determine an objective and clinically-feasible method to predict dystonia in cerebral palsy (CP) using magnetic resonance imaging (MRI) following neonatal hypoxic-ischemic encephalopathy (HIE). Methods: In this retrospective case-control study, we examined brain MRIs in neonates at age 4-5 days who underwent therapeutic hypothermia for HIE at a single tertiary care center. The lower average apparent diffusion coefficient (ADC) values between the left and right striatum and thalamus were determined using clinically-integrated software (IBM iConnect Access). Neonatal neurology, movement disorder, and cerebral palsy specialist notes were screened through age 5 years for motor abnormality documentation. Results: In 50 subjects, ADC values significantly predicted dystonia in CP with receiver operator characteristic areas under the curve of 0.862 (p=0.0004) in the striatum and 0.838 (p=0.001) in the thalamus. Striatal ADC values less than 1.014x10-3 mm2/s provided 100% specificity and 70% sensitivity for dystonia. Thalamic ADC values less than 0.973x10-3 mm2/s provided 100% specificity and 80% sensitivity for dystonia. Interpretation: In this small retrospective study, analysis of clinically-acquired MRIs predicted dystonia with high specificity following neonatal HIE. This could be a useful prognostication adjunct guiding when to establish appropriate vigilance for dystonia in CP.

中文翻译：

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新生儿缺氧缺血性脑病的MRI客观张力障碍预测

目的：确定新生儿缺氧缺血性脑病（HIE）后使用磁共振成像（MRI）预测脑瘫（CP）肌张力障碍的客观和临床可行的方法。方法：在这项回顾性病例对照研究中，我们检查了在单个三级护理中心接受过HIE治疗性低温治疗的4-5天新生儿的脑部MRI。使用临床集成软件（IBM iConnect Access）确定左右纹状体和丘脑之间较低的平均表观扩散系数（ADC）值。新生儿神经病学，运动障碍和脑瘫的专家记录在5岁时进行了筛查，以记录运动异常。结果：在50名受试者中，ADC值显着预测了CP的肌张力障碍，其接收者操作者特征区域位于0曲线以下。纹状体为862（p = 0.0004），丘脑为0.838（p = 0.001）。纹状体ADC值小于1.014x10-3 mm2 / s，可为肌张力障碍提供100％的特异性和70％的敏感性。丘脑ADC值小于0.973x10-3 mm2 / s，可为肌张力障碍提供100％的特异性和80％的敏感性。解释：在这项小型回顾性研究中，对临床获得的MRI的分析预测了新生儿HIE后具有高度特异性的肌张力障碍。这对于指导何时为CP的肌张力障碍建立适当的警惕性可能是有用的预后辅助。在这项小型回顾性研究中，对临床获得的MRI的分析预测了新生儿HIE后具有高度特异性的肌张力障碍。这对于指导何时为CP的肌张力障碍建立适当的警惕性可能是有用的预后辅助。在这项小型回顾性研究中，对临床获得的MRI的分析预测了新生儿HIE后具有高度特异性的肌张力障碍。这对于指导何时为CP的肌张力障碍建立适当的警惕性可能是有用的预后辅助。