Journal of Pediatric Neuroradiology 2016; 05(04): 242-247
DOI: 10.1055/s-0036-1597689
Original Article
Georg Thieme Verlag KG Stuttgart • New York

Can Apparent Diffusion Coefficient Values Predict Time of Onset in Term Neonates with Hypoxic–Ischemic Injury?

Mohamed G. Eissawy
1   Radiology Department, Minia University Faculty of Medicine, Minia, Egypt
Mahmoud M. Higazi
1   Radiology Department, Minia University Faculty of Medicine, Minia, Egypt
Sheren E. Maher
1   Radiology Department, Minia University Faculty of Medicine, Minia, Egypt
2   Pediatric Department, Minia University Faculty of Medicine, Minia, Egypt
› Author Affiliations
Further Information

Publication History

17 July 2016

26 November 2016

Publication Date:
26 December 2016 (online)


Background Hypoxic–ischemic injury (HII) is a significant cause of neonatal morbidity and mortality. It had been postulated that apparent diffusion coefficient (ADC) abnormalities in term neonatal HII generally peak at 3 to 5 days after birth and subsequently “pseudonormalize” by the end of the first week. Thus, ADC values may provide a clue for timing of HII.

Objective In this study, we sought to assess whether ADC values can always predict time of hypoxic ischemic insult.

Methodology We prospectively analyzed 34 full-term neonates with suspected HII by diffusion-weighted (DW) magnetic resonance imaging (MRI) within 14 days after birth. DW images (DWIs) were assessed for areas of restricted diffusion at different locations that could be encountered in HII. ADC maps were generated and ADC values were calculated. Spearman correlation coefficient and receiver operating characteristic (ROC) curve analyses were performed.

Results The mean age of neonates at time of MRI was 8 (±4) days (range: 2–14 days). No significant correlation detected between ADC values and age of neonates at time of imaging (p = 0.183; R2 = 0.06). ROC curve analysis showed that ADC values could not discriminate between neonates who were imaged early (≤7 days) or later (p = 0.391; area under the curve = 0.633).

Conclusion ADC values may not be capable to accurately predict time of onset in term neonates with HII. ADC values should always be interpreted in combination with both conventional and DWIs, and each case should be individualized instead of generalization.

  • References

  • 1 Agut T, León M, Rebollo M, Muchart J, Arca G, Garcia-Alix A. Early identification of brain injury in infants with hypoxic ischemic encephalopathy at high risk for severe impairments: accuracy of MRI performed in the first days of life. BMC Pediatr 2014; 14 (1) 177 DOI: 10.1186/1471-2431-14-177.
  • 2 Cavalleri F, Lugli L, Pugliese M , et al. Prognostic value of diffusion-weighted imaging summation scores or apparent diffusion coefficient maps in newborns with hypoxic-ischemic encephalopathy. Pediatr Radiol 2014; 44 (9) 1141-1154
  • 3 Ghei SK, Zan E, Nathan JE , et al. MR imaging of hypoxic-ischemic injury in term neonates: pearls and pitfalls. Radiographics 2014; 34 (4) 1047-1061
  • 4 Allen KA, Brandon DH. Hypoxic ischemic encephalopathy: pathophysiology and experimental treatments. Newborn Infant Nurs Rev 2011; 11 (3) 125-133
  • 5 van Laerhoven H, de Haan TR, Offringa M, Post B, van der Lee JH. Prognostic tests in term neonates with hypoxic-ischemic encephalopathy: a systematic review. Pediatrics 2013; 131 (1) 88-98
  • 6 Rutherford M, Malamateniou C, McGuinness A, Allsop J, Biarge MM, Counsell S. Magnetic resonance imaging in hypoxic-ischaemic encephalopathy. Early Hum Dev 2010; 86 (6) 351-360
  • 7 Alderliesten T, de Vries LS, Benders MJNL, Koopman C, Groenendaal F. MR imaging and outcome of term neonates with perinatal asphyxia: value of diffusion-weighted MR imaging and 1H MR spectroscopy. Radiology 2011; 261 (1) 235-242
  • 8 Badve CA, Khanna PC, Ishak GE. Neonatal ischemic brain injury: what every radiologist needs to know. Pediatr Radiol 2012; 42 (5) 606-619
  • 9 Goergen SK, Ang H, Wong F , et al. Early MRI in term infants with perinatal hypoxic-ischaemic brain injury: interobserver agreement and MRI predictors of outcome at 2 years. Clin Radiol 2014; 69 (1) 72-81
  • 10 Cauley KA, Filippi CG. Apparent diffusion coefficient histogram analysis of neonatal hypoxic-ischemic encephalopathy. Pediatr Radiol 2014; 44 (6) 738-746
  • 11 Dağ Y, Firat AK, Karakaş HM, Alkan A, Yakinci C, Erdem G. Clinical outcomes of neonatal hypoxic ischemic encephalopathy evaluated with diffusion-weighted magnetic resonance imaging. Diagnostic and Interventional Radiology (Ankara, Turkey). . Published October 2006. Accessed January 30, 2016
  • 12 Soul JS, Robertson RL, Tzika AA, du Plessis AJ, Volpe JJ. Time course of changes in diffusion-weighted magnetic resonance imaging in a case of neonatal encephalopathy with defined onset and duration of hypoxic-ischemic insult. Pediatrics 2001; 108 (5) 1211-1214
  • 13 Pfister RH, Soll RF. Hypothermia for the treatment of infants with hypoxic-ischemic encephalopathy. J Perinatol 2010; 30 (Suppl): S82-S87
  • 14 Lai M-C, Yang S-N. Perinatal hypoxic-ischemic encephalopathy. J Biomed Biotechnol 2011; 2011: 609813 DOI: 10.1155/2011/609813.
  • 15 Forbes KPN, Pipe JG, Bird R. Neonatal hypoxic-ischemic encephalopathy: detection with diffusion-weighted MR imaging. Am J Neuroradiol 2000; 21 (8) 1490-1496
  • 16 Grant PE, Yu D. Acute injury to the immature brain with hypoxia with or without hypoperfusion. Radiol Clin North Am 2006; 44 (1) 63-77 , viii
  • 17 Huang BY, Castillo M. Hypoxic-ischemic brain injury: imaging findings from birth to adulthood. Radiographics 2008; 28 (2) 417-439 , quiz 617
  • 18 Shroff MM, Soares-Fernandes JP, Whyte H, Raybaud C. MR imaging for diagnostic evaluation of encephalopathy in the newborn. Radiographics 2010; 30 (3) 763-780
  • 19 Mader I, Schöning M, Klose U, Küker W. Neonatal cerebral infarction diagnosed by diffusion-weighted MRI: pseudonormalization occurs early. Stroke 2002; 33 (4) 1142-1145
  • 20 Liauw L, van der Grond J, van den Berg-Huysmans AA, Palm-Meinders IH, van Buchem MA, van Wezel-Meijler G. Hypoxic-ischemic encephalopathy: diagnostic value of conventional MR imaging pulse sequences in term-born neonates. Radiology 2008; 247 (1) 204-212
  • 21 Lawrence RK, Inder TE. Anatomic changes and imaging in assessing brain injury in the term infant. Clin Perinatol 2008; 35 (4) 679-693 , vi
  • 22 Cowan F, Rutherford M, Groenendaal F , et al. Origin and timing of brain lesions in term infants with neonatal encephalopathy. Lancet 2003; 361 (9359): 736-742
  • 23 Volpe JJ. Neonatal encephalopathy: an inadequate term for hypoxic-ischemic encephalopathy. Ann Neurol 2012; 72 (2) 156-166
  • 24 Roescher AM, Timmer A, Erwich JJHM, Bos AF. Placental pathology, perinatal death, neonatal outcome, and neurological development: a systematic review. PLoS One 2014; 9 (2) e89419 DOI: 10.1371/journal.pone.0089419.
  • 25 Robertson CM, Perlman M. Follow-up of the term infant after hypoxic-ischemic encephalopathy. Paediatr Child Health 2006; 11 (5) 278-282
  • 26 Rutherford M, Counsell S, Allsop J , et al. Diffusion-weighted magnetic resonance imaging in term perinatal brain injury: a comparison with site of lesion and time from birth. Pediatrics 2004; 114 (4) 1004-1014
  • 27 Winter JD, Lee DS, Hung RM , et al. Apparent diffusion coefficient pseudonormalization time in neonatal hypoxic-ischemic encephalopathy. Pediatr Neurol 2007; 37 (4) 255-262
  • 28 Tanner SF, Ramenghi LA, Ridgway JP , et al. Quantitative comparison of intrabrain diffusion in adults and preterm and term neonates and infants. Am J Roentgenol 2000; 174 (6) 1643-1649
  • 29 Neil JJ, Inder TE. Detection of wallerian degeneration in a newborn by diffusion magnetic resonance imaging (MRI). J Child Neurol 2006; 21 (2) 115-118
  • 30 Li W, Wu B, Batrachenko A , et al. Differential developmental trajectories of magnetic susceptibility in human brain gray and white matter over the lifespan. Hum Brain Mapp 2014; 35 (6) 2698-2713
  • 31 Deoni SCL, Dean III DC, O'Muircheartaigh J, Dirks H, Jerskey BA. Investigating white matter development in infancy and early childhood using myelin water faction and relaxation time mapping. Neuroimage 2012; 63 (3) 1038-1053