Bao Rina,  Grant Ellen,  Ou Yangming

Final Pr. ID: Poster #: SCI-030

Hypoxic Ischemic Encephalopathy (HIE) is a brain injury caused by a lack of blood and oxygen supply to the brain. HIE affects 4,000,000 term-born neonates per year worldwide, with an estimated 2 billion/year cost in the US, let alone family burdens. Therefore, reducing mortality and morbidity for HIE patients remains an important public health concern. Therapeutic hypothermia (TH) was established in 2005 as a standard therapy by cooling patients to 33-34°C in the first six postnatal hours for 72 hours. However, 35–50% of the patients still experience adverse outcomes, defined as death or cognitive Bayley Scales of Infant Development by age two years. Ongoing HIE-related trials worldwide are testing whether new therapies can supplement TH and further reduce adverse outcomes. However, therapeutic innovation is slow and inconclusive, for 1) before therapy, patients at high risk of developing adverse outcomes cannot be identified; 2) after therapy, outcomes cannot be measured until age two years. Besides, public MRI data exists for hundreds of patients with brain tumors, Alzheimer’s Disease, and other diseases, fueling AI’s success in MRI-based diagnosis and prognosis of brain tumor, Alzheimer’s Disease, and other disorders. In contrast, annotated MRIs with linked clinical and bio-marker data do not exist publicly for HIE. Our previous work has collected multi-site HIE MRI data. Therefore, to fill the gap in HIE diagnosis with MRI data, target high-risk patients, increase efficiency, evaluate therapeutic effects early, and expedite therapeutic innovations, in this work, we propose to predict 2-year neurocognitive outcomes in neonates using brain MRIs by deep learning methods. Read More

Authors:  Bao Rina , Grant Ellen , Ou Yangming

Keywords:  Brain MRIs, Brain injury, Hypoxic Ischemic Encephalopathy

Chacko Anith,  Andronikou Savvas,  Shearn Andrew,  Thai Ngoc Jade

Final Pr. ID: Paper #: 131

3D printed models from MRI scans can effectively demonstrate the surface structure of the brain. Previous workflows focus on adult brains as a basis for prints. Our database of pediatric MRI brains who had perinatal hypoxic ischemic injury and presented late for imaging, with pathology causing cortical surface irregularities and parenchymal cysts. Difficulties arise in accurate depiction of the cortex on 3D print models in these pathologic brains. We aim to demonstrate effective workflows to accurately and efficiently print 3D models of especially pathologic pediatric MRI brains. Also, to critically and empirically test and refine the various steps involved in producing 3D print models which include segmentation of the MRI volume into tissue classes, generation of a surface model from this volume, preparation and final print of a 3D model. Read More

Authors:  Chacko Anith , Andronikou Savvas , Shearn Andrew , Thai Ngoc Jade

Keywords:  3D Printing, Hypoxic Ischaemic Injury, 3D Models

Venkatakrishna Shyam Sunder,  Chacko Anith,  Schoeman Sean,  Andronikou Savvas

Final Pr. ID: Poster #: SCI-029

Effective text-based communication, through radiologist reports, of imaging findings in term Hypoxic Ischemic Injury (HII) to family members, non-radiologist colleagues and members of the legal profession can be extremely challenging. Utilization of 3D printed models, where the actual findings of the brain can be communicated via tactile perception and rotating/grasping the models is a potential solution which has not been tested in practice. We aimed to determine the sensitivity and specificity of different groups, comprising trained radiologists, non-radiologist physicians and non-physicians, in the detection of gross disease of the cerebral cortex from 3D printed brain models derived from MRI scans of children. Read More

Authors:  Venkatakrishna Shyam Sunder , Chacko Anith , Schoeman Sean , Andronikou Savvas

Keywords:  Magnetic Resonance Imaging, 3D Printing, Hypoxic Ischemic Injury

Aviado Randy,  Clark Keaira,  Mahdi Eman,  Nada Ayman,  Mishra Chakradhar,  Jones Kathryn,  Urbine Jacqueline,  Vorona Gregory

Final Pr. ID: Poster #: EDU-090

Brain hypoxic-ischemic injury (HII) is a devastating injury that results in death or profound long-term neurologic disability in both children and adults. Treatment is mostly supportive, including hypothermia and administration of excitatory amino acid antagonists, with a limited window of effectiveness (as little as 6 hours), making early detection of injury critically important. Neuroimaging with Ultrasound, CT, and MRI has become increasingly valuable in the work-up of patients with HII.

In this educational exhibit we will: a) review the pathophysiologic features and factors that influence the pattern of injury, b) discuss the specific imaging patterns in preterm and term neonates, c) review the imaging approach and highlight the role of advanced MRI techniques such as MR spectroscopy, DWI/ADC, and ASL perfusion in the evaluation process. Finally, we will briefly elaborate on the therapeutic hypothermia in HII, and the influence on imaging findings. Read More

Authors:  Aviado Randy , Clark Keaira , Mahdi Eman , Nada Ayman , Mishra Chakradhar , Jones Kathryn , Urbine Jacqueline , Vorona Gregory

Keywords:  Hypoxic, Brain, Neonate

Haddad Sophie,  Foran Ann,  Tierradentro-garcia Luis,  Ho Fung Victor M,  Hwang Misun

Final Pr. ID: Poster #: CR-025

Hypoxic ischemic encephalopathy (HIE) is a significant cause of severe long term neurological impairment and mortality in the newborn. It develops in two stages; the ischemic phase caused by hypoxia leading to cytotoxic edema, followed by the reperfusion phase with the release of reactive oxygen species leading to oxidative damage and vasogenic edema. Imaging plays a key role in diagnosis, management, and treatment of HIE. It also offers important prognostic information. MRI remains the preferred imaging modality.
Microvascular imaging (MVI) is a novel advanced Doppler ultrasound (US) technique that permits visualization of the microvasculature without the administration of contrast agents. It enhances the visualization of flow signal in the microvessels and helps reveal functional insights into the brain at high resolution.

A female newborn of 32 weeks of gestation was delivered by urgent C-section following absent fetal movements and suspected placental abruption. She was born to a mother with a reported exposure to cocaine with a last use the week prior to delivery. At birth, no pulse was detected, and CPR was initiated immediately. O2 saturation remained low during resuscitation despite intubation and a FiO2 of 100%. Return of spontaneous circulation was noted 50 minutes after birth. Following birth, the patient was diagnosed with severe HIE and had multiple seizures. Her physical exam revealed fixed and cloudy pupils with a diameter of 4 mm and no brainstem reflexes. At one day of life, a brain US was done and displayed diffusely increased echogenicity of the parenchyma and crowding of the cortical gyri concerning for cerebral edema. MVI revealed markedly increased microvascular perfusion in the basal ganglia, thalami, and periventricular region consistent with post-ischemic reperfusion in the setting of HIE. MRI showed diffusion restriction throughout the brain including the medial temporal lobes, hippocampi, thalami, basal ganglia, and frontoparietal cortex. Also noted was extensive hyperintense signal abnormality on T2-weighted sequences within both the gray and white matter with loss of the gray-white matter differentiation and moderate sulcal effacement. These findings confirmed the diagnosis of severe HIE.

In our case, MVI demonstrated marked hyperperfusion in the basal ganglia, thalami and periventricular region. Whether this MVI flow signature can prognosticate poor clinical outcomes, it warrants further investigation. Read More

Authors:  Haddad Sophie , Foran Ann , Tierradentro-garcia Luis , Ho Fung Victor M , Hwang Misun

Keywords:  Microvascular Imaging, Hypoxic ischemic encephalopathy

Cort Kayla,  Piskunowicz Maciej,  Hwang Misun

Final Pr. ID: Poster #: EDU-008

Contrast-enhanced ultrasound (CEUS) for the evaluation of the neonatal brain provides additional diagnostic information when compared to conventional gray scale ultrasound through the detection of perfusion abnormalities associated with injury. When compared to cross-sectional imaging, CEUS has many advantages given its relative low cost and ability to be performed at the bedside, without the need for sedation or exposure to ionizing radiation. Diagnostic information is yielded through the qualitative evaluation of parenchymal enhancement patterns as well as quantification of microbubble perfusion kinetics from which time intensity curves are derived and additional perfusion parameters can be extrapolated. Given the 2-dimensional nature of the modality, a strategically designed scanning protocol is necessary to obtain the aforementioned quantitative values. The purpose of this exhibit is to demonstrate the current understanding of brain CEUS and educate on the brain CEUS protocol used for the diagnosis of neonatal brain pathology. Read More

Authors:  Cort Kayla , Piskunowicz Maciej , Hwang Misun

Keywords:  hypoxic ischemic injury

Chacko Anith,  Andronikou Savvas,  Goncalves Fabricio,  Mian Ali,  Vedajallam Schadie,  Thai Ngoc Jade

Final Pr. ID: Poster #: EDU-048

The inter-arterial watershed zone in neonates is a geographic area without discernible anatomic boundaries, is difficult to demarcate and usually not featured in atlases. Schematics currently used to depict the areas are not based on any prior anatomic mapping, as compared to adults. Magnetic resonance imaging (MRI) of neonates in the acute to subacute phase with suspected hypoxic ischaemic injury can demonstrate signal abnormality and restricted diffusion in the cortical and subcortical parenchyma of the watershed regions, although this can often be subtle.

In contrast, in the chronic stage of evolution of partial prolonged hypoxic-ischaemic injury, atrophy and ulegyria can make the watershed zone more conspicuous as a region. Our aim is to use images extracted from a large medicolegal database (approximately 2000 cases), of delayed MRI scans in children with cerebral palsy, to demonstrate the watershed region.

To achieve this, we have selected cases diagnosed on imaging as having sustained a pattern of term, partial-prolonged hypoxic-ischaemic injury affecting the hemispheric cortex, based on the presence of bilateral, symmetric atrophy with ulegyria. From these we have identified those patients demonstrating injury along the entire watershed continuum as well as those demonstrating selective anterior or posterior watershed predominant injury for demonstration.

Recognition of this zone is essential for diagnosing partial-prolonged hypoxic-ischaemic injury sustained in term neonates, which also has implications for potential compensation in litigation. The set of images presented in this pictorial review provides a template for identifying the cortical watershed distribution when there is milder regional (anterior, parasagittal, peri-Sylvian and posterior) watershed injury and for more severe injury where multiple regions are injured in combination or as a continuum. Read More

Authors:  Chacko Anith , Andronikou Savvas , Goncalves Fabricio , Mian Ali , Vedajallam Schadie , Thai Ngoc Jade

Keywords:  Cortical Ischemic Patterns, Watershed Zone, Hypoxic Ischemic Injury

Hill Ann,  Hirsig Leslie,  Yazdani Milad,  Collins Heather,  Jenkins Dorothea

Final Pr. ID: Poster #: SCI-015

MRS is the best prognostic indicator for hypoxic-ischemic encephalopathy (HIE) but is difficult to obtain early after injury. We investigated whether cerebral blood flow measures of resistive indices (RI) and time average maximum velocities (TAMx) shortly after birth would relate to later degree of neural injury by MRI in hypothermic HIE newborns. We predicted that abnormally high/low blood flow would be associated with poor outcomes. Read More

Authors:  Hill Ann , Hirsig Leslie , Yazdani Milad , Collins Heather , Jenkins Dorothea

Keywords:  Cerebral Blood Flow, Hypoxic Ischemic Encephalopathy (HIE), Magnetic Resonance Spectroscopy (MRS)

Bao Rina,  Grant Ellen,  Ou Yangming

Final Pr. ID: Poster #: SCI-027

Hypoxic ischemic encephalopathy (HIE) is a brain injury that occurs in 1 ∼ 5/1000 term-born neonates. HIE lesion detection is a crucial step in clinical care of HIE. It could lead to a more accurate estimation of prognosis, a better understanding of neurological symptoms, and a timely prediction of response to therapy in this population. In addition, the rise of Artificial Intelligence (AI) brings hope to objectively and accurately finding HIE lesions. With public MRI data for brain tumors, Alzheimer’s Disease, and other diseases, AI has achieved significant success in MRI-based diagnosis and prognosis of these diseases. To facilitate the early prognosis and diagnosis of HIE, in this work, we focus on HIE lesion detection with MRI data using deep learning methods. Read More

Authors:  Bao Rina , Grant Ellen , Ou Yangming

Keywords:  Brain MRIs, Brain injury, Hypoxic Ischemic Encephalopathy

Misiura Anne,  Urbine Jaqueline,  Mallon Mea,  Malik Archana,  Kazmi Faaiza,  Poletto Erica

Final Pr. ID: Poster #: EDU-082

Hypoxic-ischemic encephalopathy is a potentially devastating neurological diagnosis for which prompt recognition is crucial for patient management. The appearance of HIE on imaging depends on the duration and severity of the hypoperfusion injury, which can range from global to subtle. As such, the differential diagnosis is wide, including infectious, metabolic, and congenital dysmyelination causes. It is also critical for the pediatric radiologist to be aware of possible confounding cases when presented with imaging features seen in HIE which would significantly change management. Read More

Authors:  Misiura Anne , Urbine Jaqueline , Mallon Mea , Malik Archana , Kazmi Faaiza , Poletto Erica

Keywords:  Hypoxic, Infection, Encephalopathy

A Ebinesh,  Manchanda Alpana,  Dixit Rashmi,  Das Prince,  Kumar Ajay,  Krishna Ganesh

Final Pr. ID: Poster #: EDU-021

Insult to developing neonatal brain can significantly impair motor, cognitive, language and behavioral functions. MR imaging is an indispensable investigation for the evaluation of neonatal encephalopathy due to its high sensitivity, specificity and prognostic utility. MRI with its recent advancements can yield valuable information on morphology, neuronal connectivity, structural and functional architecture of gray and white matter. Read More

Authors:  A Ebinesh , Manchanda Alpana , Dixit Rashmi , Das Prince , Kumar Ajay , Krishna Ganesh

Keywords:  Neonatal encephalopathy, Neonatal brain, Hypoxic ischemic encephalopathy

Goncalves Fabricio,  Khrichenko Dmitry,  Zheng Qiang,  Hwang Misun

Final Pr. ID: Paper #: 161

Ultrasound (US) is a powerful imaging tool in the evaluation of neonates with suspected hypoxic-ischemic encephalopathy (HIE). US evaluation of the neonatal brain has been mainly performed qualitatively, comparing intracranial structures with different echotextures. Qualitative US analysis of the neonatal HIE brain may vary according to technical variations, the severity of the injury and the presence of coexistent complications. Quantitative analysis of the neonatal brain echotexture has been seldom attempted. Our aim was to compare the echotextures of specific brain regions between HIE patients and controls. Read More

Authors:  Goncalves Fabricio , Khrichenko Dmitry , Zheng Qiang , Hwang Misun

Keywords:  Ultrasound, Hypoxic-ischemic encephalopathy

Chacko Anith,  Andronikou Savvas,  Goncalves Fabricio,  Vedajallam Schadie,  Thai Ngoc Jade

Final Pr. ID: Paper #: 132

Hypoxic ischemic injury (HII) is a leading cause of neonatal encephalopathy and resultant cerebral palsy. Most studies focus on early magnetic resonance imaging (MRI) findings and patterns of injury, with few studies evaluating patterns in delayed MRI of patients with cerebral palsy.

We aim to categorise the delayed imaging MRI findings and distribution of abnormalities in a large cohort of children with cerebral palsy and obtained for medicolegal purposes to determine the causes of cerebral palsy, and to map the frequency of anatomic involvement in those with hypoxic ischemic injury. Read More

Authors:  Chacko Anith , Andronikou Savvas , Goncalves Fabricio , Vedajallam Schadie , Thai Ngoc Jade

Keywords:  hypoxic ischaemic injury, HII, Patterns of hypoxic ischemic injury

Lakatos Andrea,  Kolossvary Marton,  Szabo Miklos,  Kiss Mate,  Gyebnar Gyula,  Bagyura Zsolt,  Kozak Lajos Rudolf

Final Pr. ID: Poster #: SCI-017

The radiology report is a tool to communicate information to the referring physician and record data for follow-up or research purposes. With structured reporting templates information becomes uniform, comprehensive and easily manageable. In collaboration with neonatologists and information technologists we developed a structured MRI reporting template for neonatal hypoxic-ischemic encephalopathy (HIE). Read More

Authors:  Lakatos Andrea , Kolossvary Marton , Szabo Miklos , Kiss Mate , Gyebnar Gyula , Bagyura Zsolt , Kozak Lajos Rudolf

Keywords:  Hypoxic-ischemic encephalopathy, Neonates, Magnetic resonance, Diffusion-weighted imaging, Structured reporting

Venkatakrishna Shyam Sunder,  Elsingergy Mohamed,  Worede Fikadu,  Andronikou Savvas

Final Pr. ID: Poster #: SCI-012

Perinatal Hypoxic Ischemic Injury (HII) has a higher prevalence in the developing world. One of the primary concepts for suggesting that an imaging pattern reflects a global insult to the brain is when the injury is noted to be bilateral and symmetric in distribution. In the context of HII in term neonates, this is either bilateral symmetric (a) peripheral/watershed injury (WS) or (b) bilateral symmetric Basal-ganglia-thalamus (BGT) pattern, often with the peri-Rolandic and hippocampal injury. Unilateral, asymmetric or unequal distribution of injury may therefore be misdiagnosed as perinatal arterial ischemic stroke. This has been previously reported in the typical distribution patterns, without a clear indication of the prevalence. We aimed to determine the prevalence of unilateral, asymmetric and unequal degree HII and to characterize the distribution on MRI in a large database of patients with Cerebral Palsy (CP) from South Africa. Read More

Authors:  Venkatakrishna Shyam Sunder , Elsingergy Mohamed , Worede Fikadu , Andronikou Savvas

Keywords:  Hypoxic Ischemic Injury (HII), Basal-ganglia-thalamus and Watershed, Unilateral, Asymmetric or Unequal distribution

Cielma Tara,  Bandarkar Anjum,  Demshur Lesley,  Bulas Dorothy

Final Pr. ID: Poster #: EDU-002 (T)

Background: Duplex sonography is a critical portion of intracranial hemodynamics evaluation. Serial Doppler examination allows real-time assessment of disease progression or improvement.

The goals of this exhibit are:
1. Describe the technical approach of performing neonatal/infant transcranial Doppler ultrasound.
2. Review tips, and up to date technology that assist in optimizing studies.
3. Discuss changes in flow patterns with various pathologies, providing examples of clinical indications.
4. Review future potential techniques and applications. Read More

Authors:  Cielma Tara , Bandarkar Anjum , Demshur Lesley , Bulas Dorothy

Keywords:  Neurosonography, Cerebral Doppler, Hypoxic Ischemic Encephalopathy