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Objective and Clinically Feasible Analysis of Diffusion MRI Data can Help Predict Dystonia After Neonatal Brain Injury
Pediatric Neurology ( IF 3.8 ) Pub Date : 2020-11-22 , DOI: 10.1016/j.pediatrneurol.2020.11.011
Keerthana Chintalapati 1 , Hanyang Miao 1 , Amit Mathur 2 , Jeff Neil 1 , Bhooma R Aravamuthan 1
Affiliation  

Background

Dystonia in cerebral palsy is debilitating but underdiagnosed precluding targeted treatment that is most effective if instituted early. Deep gray matter injury is associated with dystonic cerebral palsy but is difficult to quantify. Objective and clinically feasible identification of injury preceding dystonia could help determine the children at the highest risk for developing dystonia and thus facilitate early dystonia detection.

Methods

We examined brain magnetic resonance images from four- to five-day-old neonates after therapeutic hypothermia for hypoxic-ischemic encephalopathy at a tertiary care center. Apparent diffusion coefficient values in the striatum and thalamus were determined using a web-based viewer integrated with the electronic medical record (IBM iConnect Access). The notes of specialists in neonatal neurology, pediatric movement disorders, and pediatric cerebral palsy (physicians most familiar with motor phenotyping after neonatal brain injury) were screened for all subjects through age of five years for motor phenotype documentation.

Results

Striatal and thalamic apparent diffusion coefficient values significantly predicted dystonia with receiver operator characteristic areas under the curve of 0.862 (P = 0.0004) and 0.838 (P = 0.001), respectively (n = 50 subjects). Striatal apparent diffusion coefficient values less than 1.014 × 10−3 mm2/s provided 100% specificity and 70% sensitivity for dystonia. Thalamic apparent diffusion coefficient values less than 0.973 × 10−3 mm2/s provided 100% specificity and 80% sensitivity for dystonia.

Conclusions

Lower striatal and thalamic apparent diffusion coefficient values predicted dystonia in four- to five-day-old neonates who underwent therapeutic hypothermia for hypoxic ischemic encephalopathy. Objective and clinically feasible neonatal brain imaging assessment could help increase vigilance for dystonia in cerebral palsy.



中文翻译:

扩散 MRI 数据的客观和临床可行性分析有助于预测新生儿脑损伤后的肌张力障碍

背景

脑瘫中的肌张力障碍使人衰弱,但诊断不足,排除了早期开始最有效的靶向治疗。深灰质损伤与肌张力障碍性脑瘫有关,但难以量化。客观和临床上可行地识别肌张力障碍前的损伤有助于确定发生肌张力障碍风险最高的儿童,从而促进肌张力障碍的早期检测。

方法

我们在三级护理中心检查了 4 至 5 天大的新生儿在低氧缺血性脑病治疗后的脑磁共振图像。使用与电子病历(IBM iConnect Access)集成的基于网络的查看器确定纹状体和丘脑中的表观扩散系数值。对所有 5 岁以下的受试者进行了新生儿神经病学、小儿运动障碍和小儿脑瘫(最熟悉新生儿脑损伤后运动表型分析的医生)专家的笔记,以获取运动表型文件。

结果

纹状体和丘脑表观扩散系数值显着预测肌张力障碍,受试者操作员特征曲线下面积分别为 0.862(P  = 0.0004)和 0.838(P  = 0.001)(n = 50 名受试者)。纹状体表观扩散系数值小于 1.014 × 10 -3  mm 2 /s 为肌张力障碍提供了 100% 的特异性和 70% 的敏感性。小于 0.973 × 10 -3  mm 2 /s 的丘脑表观扩散系数值对肌张力障碍提供了 100% 的特异性和 80% 的敏感性。

结论

较低的纹状体和丘脑表观弥散系数值可预测因缺氧缺血性脑病接受低温治疗的 4 至 5 日龄新生儿的肌张力障碍。客观和临床可行的新生儿脑成像评估有助于提高对脑瘫肌张力障碍的警惕性。

更新日期:2020-11-22
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