Correlation of MRSI with Long Term Neurodevelopmental Outcomes in Term Neonates with HIE
Poster No:
1955
Submission Type:
Abstract Submission
Authors:
Kevin Yang1, Amy Kuang1, Yi Li1, Gano Dawn1, Hannah Glass1, Donna Ferriero1, Duan Xu1, Yan Li1
Institutions:
1University of California San Francisco, San Francisco, CA
First Author:
Co-Author(s):
Introduction:
Hypoxic-ischemic encephalopathy (HIE) is one of the most common causes of neonatal injury and is often associated with poor neurodevelopmental outcomes. Single voxel proton (1H) Magnetic Resonance Spectroscopy (MRS) correlates with the severity of brain injury, which can be used for guiding treatment decisions (Barkovich, 1997). In this study, we investigated whole brain MRS to predict potential neurological long-term outcomes in infants with HIE. We evaluated the correlations of the long-term neurodevelopment outcomes at 2 and 4 years in term neonates with HIE who had metabolic assessment at the age of 4 days and 6 months using 1H MRSI.
Methods:
A total of 33 in-term neonates with HIE had MRI exams at post-natal day 4, with 16 of them having a follow-up MR exam at 6 months. The 1H 3D lactate-edited MRSI data were acquired (TE/TR=144/1000ms, nominal voxel size = 1cm3) and processed to provide the voxel-wise estimates of in vivo metabolic parameters, including: Choline (Cho), Creatine (Cr), N-acetylaspartate (NAA), Lipid (Lip), Lactate (Lac). The ratios Cho/Cr, NAA/Cr, Lac/Cr, NAA/Cho, and Lac/NAA were computed for the analysis. Regions of interest (ROIs) were draw bilaterally on T2 images of Basal ganglia (BG), Thalamus, calcarine gray matter (CGM), corticospinal tract (CST), parietal white matter (pWM), frontal white matter (fWM), and visual association tract (VA) (Xu, 2011). Locations of these regions are shown in Figure 1 (top row).
All 33 patients performed the outcome assessment at the age of two-year and four years old using the Bayley Scales of Infant and Toddler Development, III edition (Bayley-III) and Wechsler Preschool and Primary Scale of Intelligence (WPPSI) tests.
Outcome assessment (including mean and standard deviation of the test scores were summarized for each visit. The metabolite ratios between two scans were compared using t-test. The correlations of the neurodevelopmental outcomes and the MRSI measurements in the ROIs were calculated. The significant ones were defined at the level of p < 0.05.
All 33 patients performed the outcome assessment at the age of two-year and four years old using the Bayley Scales of Infant and Toddler Development, III edition (Bayley-III) and Wechsler Preschool and Primary Scale of Intelligence (WPPSI) tests.
Outcome assessment (including mean and standard deviation of the test scores were summarized for each visit. The metabolite ratios between two scans were compared using t-test. The correlations of the neurodevelopmental outcomes and the MRSI measurements in the ROIs were calculated. The significant ones were defined at the level of p < 0.05.
Results:
At age of two (2.6±0.2 y/o), the cognitive composite, language Bayley-III, and motor composite scores were reported as 105.2±17.9, 100.3±15.4, and 99.2±12.1, respectively. Four participants were evaluated as abnormal; four participants were identified to be below average with the cognitive classification; six below average according to language classification; and four below average with motor classification. At age of four (4.2±0.2 y/o), the Full Intelligence Quotient (IQ), Performance IQ, and Verbal IQ scores were reported as 105.0±16.6, 103.4±17.0, 99.2±27.5 respectively. One patient was evaluated as abnormal.
MRSI measurements between the two scans (16 patients) had significant changes in multiple regions. We identified two brain regions (L-Thalamus and R-CST) that had significant changes across all MRS parameters (p<0.05), as shown in Figure 1.
As shown in Figure 2a), several MRSI measurements in CGM, Thalamus and CST at 4-Day baseline had significant correlations with 2-year and 4-year neurodevelopment. Particularly, NAA/Cr was shown to a strong predictor for 4-year outcomes. MRSI at 6-month scan had multiple strong correlations (>0.7), especially in fWM.
MRSI measurements between the two scans (16 patients) had significant changes in multiple regions. We identified two brain regions (L-Thalamus and R-CST) that had significant changes across all MRS parameters (p<0.05), as shown in Figure 1.
As shown in Figure 2a), several MRSI measurements in CGM, Thalamus and CST at 4-Day baseline had significant correlations with 2-year and 4-year neurodevelopment. Particularly, NAA/Cr was shown to a strong predictor for 4-year outcomes. MRSI at 6-month scan had multiple strong correlations (>0.7), especially in fWM.
·Figure 1. An example of an automatically prescribed MRS is in the left amygdala. Top row: voxel location; middle row: tissue segmentation; bottom: processed and quantified spectra.
·Figure 2. Multiple significant correlations (p<0.05) between the MRSI parameters and each of the test scores at age of 4 days (a) and at age of 6 months (b).
Conclusions:
In this study, we used the MRSI data at the age of 4 days and 6 months to predict long-term outcomes. NAA is a neuronal function biomarker. Higher NAA/Cr in several brain areas at the age of 4 days or 6 months is associated with higher IQ at 2 years or 4 years old. Our findings indicate that MRSI performed near birth could be beneficial for predicting brain development and neurodevelopmental outcomes.
Disorders of the Nervous System:
Neurodevelopmental/ Early Life (eg. ADHD, autism)
Lifespan Development:
Early life, Adolescence, Aging 2
Normal Brain Development: Fetus to Adolescence
Neuroanatomy, Physiology, Metabolism and Neurotransmission:
Normal Development
Novel Imaging Acquisition Methods:
MR Spectroscopy 1
Keywords:
Data analysis
Development
Magnetic Resonance Spectroscopy (MRS)
MR SPECTROSCOPY
PEDIATRIC
Pediatric Disorders
1|2Indicates the priority used for review
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Provide references using APA citation style.
Xu D, et al. (2011). MR spectroscopy of normative premature newborns. J Magn Reson Imaging. 33(2), 306-311.