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Semi-quantitative assessment of brain maturation by conventional magnetic resonance imaging in neonates with clinically mild hypoxic-ischemic encephalopathy.

Gao J, Sun QL, Zhang YM, Li YY, Li H, Hou X, Yu BL, Zhou XH, Yang J - Chin. Med. J. (2015)

Bottom Line: In four parameters of TMS scores, the M and C scores were significantly lower in mild HIE group.Of the three patterns of mild HIE, Pattern I (10 cases) showed no significant difference of TMS compared with control neonates, while Pattern II (22 cases), III (13 cases) all had significantly decreased TMS than control neonates (mean ± SD 10.56 ± 0.93 vs. 11.48 ± 0.55, P < 0.05; 12.59 ± 1.28 vs. 13.25 ± 1.29, P < 0.05).It was M, C, and GM scores that significantly decreased in Pattern II, while for Pattern III, only C score significantly decreased.

View Article: PubMed Central - PubMed

Affiliation: Department of Diagnostic Radiology, The First Hospital of Xi'an Jiaotong University, Xi'an, Shannxi 710061, China.

ABSTRACT

Background: Mild hypoxic-ischemic encephalopathy (HIE) injury is becoming the major type in neonatal brain diseases. The aim of this study was to assess brain maturation in mild HIE neonatal brains using total maturation score (TMS) based on conventional magnetic resonance imaging (MRI).

Methods: Totally, 45 neonates with clinically mild HIE and 45 matched control neonates were enrolled. Gestated age, birth weight, age after birth and postmenstrual age at magnetic resonance (MR) scan were homogenous in the two groups. According to MR findings, mild HIE neonates were divided into three subgroups: Pattern I, neonates with normal MR appearance; Pattern II, preterm neonates with abnormal MR appearance; Pattern III, full-term neonates with abnormal MR appearance. TMS and its parameters, progressive myelination (M), cortical infolding (C), involution of germinal matrix tissue (G), and glial cell migration bands (B), were employed to assess brain maturation and compare difference between HIE and control groups.

Results: The mean of TMS was significantly lower in mild HIE group than it in the control group (mean ± standard deviation [SD] 11.62 ± 1.53 vs. 12.36 ± 1.26, P < 0.001). In four parameters of TMS scores, the M and C scores were significantly lower in mild HIE group. Of the three patterns of mild HIE, Pattern I (10 cases) showed no significant difference of TMS compared with control neonates, while Pattern II (22 cases), III (13 cases) all had significantly decreased TMS than control neonates (mean ± SD 10.56 ± 0.93 vs. 11.48 ± 0.55, P < 0.05; 12.59 ± 1.28 vs. 13.25 ± 1.29, P < 0.05). It was M, C, and GM scores that significantly decreased in Pattern II, while for Pattern III, only C score significantly decreased.

Conclusions: The TMS system, based on conventional MRI, is an effective method to detect delayed brain maturation in clinically mild HIE. The conventional MRI can reveal the different retardations in subtle structures and development processes among the different patterns of mild HIE.

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Axial T1- and T2-weighted images (T1WIs and T2WIs) showing; (a and b) Pattern I of mild hypoxic-ischemic encephalopathy (HIE) group: A girl (gestational age 40 + 1-week, postmenstrual age 41 + 2 weeks) presented as normal magnetic resonance appearance with total maturation score (TMS) = 14 (M4, C5, G3, B2); (c and d) Pattern II of mild HIE group: A girl (gestational age 34 + 2 weeks, postmenstrual age 35 + 3 weeks) presented as multiple punctate white matter lesions (high T1WI and low T2WI signal intensity) around bilateral lateral ventricles and low T1WI and high T2WI signal intensity in widespread white matters, and the TMS = 10 (M3, C3, G2, B2); (e and f) Pattern III of mild HIE group: A boy (gestational age 40 + 0 weeks, postmenstrual age 41 + 1-week) exhibited as low T1WI and high T2WI signal intensity in diffuse white matters with TMS = 11 (M3, C4, G3, B1).
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Figure 2: Axial T1- and T2-weighted images (T1WIs and T2WIs) showing; (a and b) Pattern I of mild hypoxic-ischemic encephalopathy (HIE) group: A girl (gestational age 40 + 1-week, postmenstrual age 41 + 2 weeks) presented as normal magnetic resonance appearance with total maturation score (TMS) = 14 (M4, C5, G3, B2); (c and d) Pattern II of mild HIE group: A girl (gestational age 34 + 2 weeks, postmenstrual age 35 + 3 weeks) presented as multiple punctate white matter lesions (high T1WI and low T2WI signal intensity) around bilateral lateral ventricles and low T1WI and high T2WI signal intensity in widespread white matters, and the TMS = 10 (M3, C3, G2, B2); (e and f) Pattern III of mild HIE group: A boy (gestational age 40 + 0 weeks, postmenstrual age 41 + 1-week) exhibited as low T1WI and high T2WI signal intensity in diffuse white matters with TMS = 11 (M3, C4, G3, B1).

Mentions: Figure 2 exhibits the representative T1WIs and T2WIs of three patterns of mild HIE group. For mild HIE neonates with overt brain injuries (Pattern II and III group), except WM injuries, no abnormities in basal-ganglia/thalamus, cortex, PLIC, and brainstem or hemorrhage was found. According to the WM grading,[78] there were 13 and 9 cases in Pattern II group, 11 and 2 cases in Pattern III group presented moderate and severe WM injuries, respectively. For control group, no MRI abnormities were found in any neonates.


Semi-quantitative assessment of brain maturation by conventional magnetic resonance imaging in neonates with clinically mild hypoxic-ischemic encephalopathy.

Gao J, Sun QL, Zhang YM, Li YY, Li H, Hou X, Yu BL, Zhou XH, Yang J - Chin. Med. J. (2015)

Axial T1- and T2-weighted images (T1WIs and T2WIs) showing; (a and b) Pattern I of mild hypoxic-ischemic encephalopathy (HIE) group: A girl (gestational age 40 + 1-week, postmenstrual age 41 + 2 weeks) presented as normal magnetic resonance appearance with total maturation score (TMS) = 14 (M4, C5, G3, B2); (c and d) Pattern II of mild HIE group: A girl (gestational age 34 + 2 weeks, postmenstrual age 35 + 3 weeks) presented as multiple punctate white matter lesions (high T1WI and low T2WI signal intensity) around bilateral lateral ventricles and low T1WI and high T2WI signal intensity in widespread white matters, and the TMS = 10 (M3, C3, G2, B2); (e and f) Pattern III of mild HIE group: A boy (gestational age 40 + 0 weeks, postmenstrual age 41 + 1-week) exhibited as low T1WI and high T2WI signal intensity in diffuse white matters with TMS = 11 (M3, C4, G3, B1).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4834765&req=5

Figure 2: Axial T1- and T2-weighted images (T1WIs and T2WIs) showing; (a and b) Pattern I of mild hypoxic-ischemic encephalopathy (HIE) group: A girl (gestational age 40 + 1-week, postmenstrual age 41 + 2 weeks) presented as normal magnetic resonance appearance with total maturation score (TMS) = 14 (M4, C5, G3, B2); (c and d) Pattern II of mild HIE group: A girl (gestational age 34 + 2 weeks, postmenstrual age 35 + 3 weeks) presented as multiple punctate white matter lesions (high T1WI and low T2WI signal intensity) around bilateral lateral ventricles and low T1WI and high T2WI signal intensity in widespread white matters, and the TMS = 10 (M3, C3, G2, B2); (e and f) Pattern III of mild HIE group: A boy (gestational age 40 + 0 weeks, postmenstrual age 41 + 1-week) exhibited as low T1WI and high T2WI signal intensity in diffuse white matters with TMS = 11 (M3, C4, G3, B1).
Mentions: Figure 2 exhibits the representative T1WIs and T2WIs of three patterns of mild HIE group. For mild HIE neonates with overt brain injuries (Pattern II and III group), except WM injuries, no abnormities in basal-ganglia/thalamus, cortex, PLIC, and brainstem or hemorrhage was found. According to the WM grading,[78] there were 13 and 9 cases in Pattern II group, 11 and 2 cases in Pattern III group presented moderate and severe WM injuries, respectively. For control group, no MRI abnormities were found in any neonates.

Bottom Line: In four parameters of TMS scores, the M and C scores were significantly lower in mild HIE group.Of the three patterns of mild HIE, Pattern I (10 cases) showed no significant difference of TMS compared with control neonates, while Pattern II (22 cases), III (13 cases) all had significantly decreased TMS than control neonates (mean ± SD 10.56 ± 0.93 vs. 11.48 ± 0.55, P < 0.05; 12.59 ± 1.28 vs. 13.25 ± 1.29, P < 0.05).It was M, C, and GM scores that significantly decreased in Pattern II, while for Pattern III, only C score significantly decreased.

View Article: PubMed Central - PubMed

Affiliation: Department of Diagnostic Radiology, The First Hospital of Xi'an Jiaotong University, Xi'an, Shannxi 710061, China.

ABSTRACT

Background: Mild hypoxic-ischemic encephalopathy (HIE) injury is becoming the major type in neonatal brain diseases. The aim of this study was to assess brain maturation in mild HIE neonatal brains using total maturation score (TMS) based on conventional magnetic resonance imaging (MRI).

Methods: Totally, 45 neonates with clinically mild HIE and 45 matched control neonates were enrolled. Gestated age, birth weight, age after birth and postmenstrual age at magnetic resonance (MR) scan were homogenous in the two groups. According to MR findings, mild HIE neonates were divided into three subgroups: Pattern I, neonates with normal MR appearance; Pattern II, preterm neonates with abnormal MR appearance; Pattern III, full-term neonates with abnormal MR appearance. TMS and its parameters, progressive myelination (M), cortical infolding (C), involution of germinal matrix tissue (G), and glial cell migration bands (B), were employed to assess brain maturation and compare difference between HIE and control groups.

Results: The mean of TMS was significantly lower in mild HIE group than it in the control group (mean ± standard deviation [SD] 11.62 ± 1.53 vs. 12.36 ± 1.26, P < 0.001). In four parameters of TMS scores, the M and C scores were significantly lower in mild HIE group. Of the three patterns of mild HIE, Pattern I (10 cases) showed no significant difference of TMS compared with control neonates, while Pattern II (22 cases), III (13 cases) all had significantly decreased TMS than control neonates (mean ± SD 10.56 ± 0.93 vs. 11.48 ± 0.55, P < 0.05; 12.59 ± 1.28 vs. 13.25 ± 1.29, P < 0.05). It was M, C, and GM scores that significantly decreased in Pattern II, while for Pattern III, only C score significantly decreased.

Conclusions: The TMS system, based on conventional MRI, is an effective method to detect delayed brain maturation in clinically mild HIE. The conventional MRI can reveal the different retardations in subtle structures and development processes among the different patterns of mild HIE.

Show MeSH
Related in: MedlinePlus