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Diffusion-Weighted Imaging and Proton Magnetic Resonance Spectroscopy in Perinatal Hypoxic-Ischemic Encephalopathy: Association With Neuromotor Outcome at 18 Months of Age

Department of Diagnostic Radiology, Queen Mary Hospital, The University of Hong Kong, plkhong{at}hkucc.hku.hk

Catherine Tse, MRCP

Department of Paediatrics, Queen Mary Hospital, The University of Hong Kong

Ivan Y. C. Wong, FRCR

Department of Radiology, Tuen Mun Hospital, Hong Kong

Barbara C. C. Lam, FRCP

Department of Paediatrics, Queen Mary Hospital, The University of Hong Kong

Pik-To Cheung, FRCP

Department of Paediatrics, Queen Mary Hospital, The University of Hong Kong

Winnie H. S. Goh, FRCP

Department of Paediatrics, Queen Mary Hospital, The University of Hong Kong

Ngai Shan Kwong, FRCP

Department of Paediatrics, Tuen Mun Hospital, Hong Kong

Gaik-Cheng Ooi, FRCR

Department of Diagnostic Radiology, Queen Mary Hospital, The University of Hong Kong

We evaluated early diffusion-weighted imaging findings, the quantitative apparent diffusion coefficient, and magnetic resonance spectroscopy (the presence of lactate and ratios of N-acetylaspartate to total creatine and choline to total creatine) in the prediction of the 18-month neuromotor outcome of term newborns with hypoxic-ischemic encephalopathy. Conventional T₁- and T₂-weighted and diffusion-weighted imaging was performed in 20 asphyxiated term newborns, with additional basal ganglia magnetic resonance spectroscopy in 15 newborns between 2 and 18 days of life (mean 7.3 days). Neuromotor outcome was dichotomized into normal and abnormal for statistical analysis. Statistically significant differences in the ratios of N-acetylaspartate to total creatine, but not apparent diffusion coefficient values and ratios of choline to total creatine, were found between infants with a normal and an abnormal outcome (Mann-Whitney U-test, P = .010). There was a significant association between the presence of a lactate peak and an abnormal outcome (chi-square test, P = .017). The presence of a lactate peak for predicting an abnormal outcome had a sensitivity of 100% and a specificity of 80%, and the odds ratio was 37.4. Ischemic lesions were more conspicuous and/or extensive on diffusion-weighted imaging in all except one neonate. The presence of normal findings on both diffusion-weighted imaging and conventional magnetic resonance imaging is predictive of a normal neuromotor outcome, whereas lactate and a reduced ratio of N-acetylaspartate to total creatine in the basal ganglia, but not an apparent diffusion coefficient, are associated with an abnormal outcome at 18 months of age. (J Child Neurol 2004;19:872—881).

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