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Society for Pediatric Radiology – Poster Archive

Hypoxic Ischemic Encephalopathy
Showing 8 Abstracts.

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

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

Keywords:  Microvascular Imaging, Hypoxic ischemic encephalopathy

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

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

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

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

Keywords:  Neurosonography, Cerebral Doppler, Hypoxic Ischemic Encephalopathy