Cerebral oxygen metabolism during and after therapeutic hypothermia in neonatal hypoxic–ischemic encephalopathy: a feasibility study using magnetic resonance imaging

Anil N. Shetty, Ashley M. Lucke, Peiying Liu, Magdalena Sanz Cortes, Joseph L. Hagan, Zili D. Chu, Jill V. Hunter, Hanzhang Lu, Wesley Lee, Jeffrey R. Kaiser

Research output: Contribution to journalArticle

Abstract

Background: Therapeutic hypothermia is the standard-of-care treatment for infants diagnosed with moderate-to-severe hypoxic–ischemic encephalopathy (HIE). MRI for assessing brain injury is usually performed after hypothermia because of logistical challenges in bringing acutely sick infants receiving hypothermia from the neonatal intensive care unit (NICU) to the MRI suite. Perhaps examining and comparing early cerebral oxygen metabolism disturbances to those after rewarming will lead to a better understanding of the mechanisms of brain injury in HIE and the effects of therapeutic hypothermia. Objective: The objectives were to assess the feasibility of performing a novel T2-relaxation under spin tagging (TRUST) MRI technique to measure venous oxygen saturation very early in the time course of treatment, 18–24 h after the initiation of therapeutic hypothermia, to provide a framework to measure neonatal cerebral oxygen metabolism noninvasively, and to compare parameters between early and post-hypothermia MRIs. Materials and methods: Early (18–24 h after initiating hypothermia) MRIs were performed during hypothermia treatment in nine infants with HIE (six with moderate and three with severe HIE). Six infants subsequently had an MRI after hypothermia. Mean values of cerebral blood flow, oxygen extraction fraction, and cerebral metabolic rate of oxygen from MRIs during hypothermia were compared between infants with moderate and severe HIE; and in those with moderate HIE, we compared cerebral oxygen metabolism parameters between MRIs performed during and after hypothermia. Results: During the initial hypothermia MRI at 23.5±5.2 h after birth, infants with severe HIE had lower oxygen extraction fraction (P=0.04) and cerebral metabolic rate of oxygen (P=0.03) and a trend toward lower cerebral blood flow (P=0.33) compared to infants with moderate HIE. In infants with moderate HIE, cerebral blood flow decreased and oxygen extraction fraction increased between MRIs during and after hypothermia (although not significantly); cerebral metabolic rate of oxygen (P=0.93) was not different. Conclusion: Early MRIs were technically feasible while maintaining hypothermic goal temperatures in infants with HIE. Cerebral oxygen metabolism early during hypothermia is more disturbed in severe HIE. In infants with moderate HIE, cerebral blood flow decreased and oxygen extraction fraction increased between early and post-hypothermia scans. A comparison of cerebral oxygen metabolism parameters between early and post-hypothermia MRIs might improve our understanding of the evolution of HIE and the benefits of hypothermia. This approach could guide the use of adjunctive neuroprotective strategies in affected infants.

Original languageEnglish (US)
JournalPediatric Radiology
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Induced Hypothermia
Feasibility Studies
Brain Diseases
Hypothermia
Magnetic Resonance Imaging
Oxygen
Cerebrovascular Circulation
Brain Injuries
Rewarming
Neonatal Intensive Care Units
Standard of Care

Keywords

  • Brain
  • Cerebral metabolism
  • Hypoxic–ischemic encephalopathy
  • Infants
  • Magnetic resonance imaging
  • T2-relaxation under spin tagging
  • Therapeutic hypothermia

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Radiology Nuclear Medicine and imaging

Cite this

Cerebral oxygen metabolism during and after therapeutic hypothermia in neonatal hypoxic–ischemic encephalopathy : a feasibility study using magnetic resonance imaging. / Shetty, Anil N.; Lucke, Ashley M.; Liu, Peiying; Sanz Cortes, Magdalena; Hagan, Joseph L.; Chu, Zili D.; Hunter, Jill V.; Lu, Hanzhang; Lee, Wesley; Kaiser, Jeffrey R.

In: Pediatric Radiology, 01.01.2018.

Research output: Contribution to journalArticle

Shetty, Anil N. ; Lucke, Ashley M. ; Liu, Peiying ; Sanz Cortes, Magdalena ; Hagan, Joseph L. ; Chu, Zili D. ; Hunter, Jill V. ; Lu, Hanzhang ; Lee, Wesley ; Kaiser, Jeffrey R. / Cerebral oxygen metabolism during and after therapeutic hypothermia in neonatal hypoxic–ischemic encephalopathy : a feasibility study using magnetic resonance imaging. In: Pediatric Radiology. 2018.
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title = "Cerebral oxygen metabolism during and after therapeutic hypothermia in neonatal hypoxic–ischemic encephalopathy: a feasibility study using magnetic resonance imaging",
abstract = "Background: Therapeutic hypothermia is the standard-of-care treatment for infants diagnosed with moderate-to-severe hypoxic–ischemic encephalopathy (HIE). MRI for assessing brain injury is usually performed after hypothermia because of logistical challenges in bringing acutely sick infants receiving hypothermia from the neonatal intensive care unit (NICU) to the MRI suite. Perhaps examining and comparing early cerebral oxygen metabolism disturbances to those after rewarming will lead to a better understanding of the mechanisms of brain injury in HIE and the effects of therapeutic hypothermia. Objective: The objectives were to assess the feasibility of performing a novel T2-relaxation under spin tagging (TRUST) MRI technique to measure venous oxygen saturation very early in the time course of treatment, 18–24 h after the initiation of therapeutic hypothermia, to provide a framework to measure neonatal cerebral oxygen metabolism noninvasively, and to compare parameters between early and post-hypothermia MRIs. Materials and methods: Early (18–24 h after initiating hypothermia) MRIs were performed during hypothermia treatment in nine infants with HIE (six with moderate and three with severe HIE). Six infants subsequently had an MRI after hypothermia. Mean values of cerebral blood flow, oxygen extraction fraction, and cerebral metabolic rate of oxygen from MRIs during hypothermia were compared between infants with moderate and severe HIE; and in those with moderate HIE, we compared cerebral oxygen metabolism parameters between MRIs performed during and after hypothermia. Results: During the initial hypothermia MRI at 23.5±5.2 h after birth, infants with severe HIE had lower oxygen extraction fraction (P=0.04) and cerebral metabolic rate of oxygen (P=0.03) and a trend toward lower cerebral blood flow (P=0.33) compared to infants with moderate HIE. In infants with moderate HIE, cerebral blood flow decreased and oxygen extraction fraction increased between MRIs during and after hypothermia (although not significantly); cerebral metabolic rate of oxygen (P=0.93) was not different. Conclusion: Early MRIs were technically feasible while maintaining hypothermic goal temperatures in infants with HIE. Cerebral oxygen metabolism early during hypothermia is more disturbed in severe HIE. In infants with moderate HIE, cerebral blood flow decreased and oxygen extraction fraction increased between early and post-hypothermia scans. A comparison of cerebral oxygen metabolism parameters between early and post-hypothermia MRIs might improve our understanding of the evolution of HIE and the benefits of hypothermia. This approach could guide the use of adjunctive neuroprotective strategies in affected infants.",
keywords = "Brain, Cerebral metabolism, Hypoxic–ischemic encephalopathy, Infants, Magnetic resonance imaging, T2-relaxation under spin tagging, Therapeutic hypothermia",
author = "Shetty, {Anil N.} and Lucke, {Ashley M.} and Peiying Liu and {Sanz Cortes}, Magdalena and Hagan, {Joseph L.} and Chu, {Zili D.} and Hunter, {Jill V.} and Hanzhang Lu and Wesley Lee and Kaiser, {Jeffrey R.}",
year = "2018",
month = "1",
day = "1",
doi = "10.1007/s00247-018-4283-9",
language = "English (US)",
journal = "Pediatric Radiology",
issn = "0301-0449",
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TY - JOUR

T1 - Cerebral oxygen metabolism during and after therapeutic hypothermia in neonatal hypoxic–ischemic encephalopathy

T2 - a feasibility study using magnetic resonance imaging

AU - Shetty, Anil N.

AU - Lucke, Ashley M.

AU - Liu, Peiying

AU - Sanz Cortes, Magdalena

AU - Hagan, Joseph L.

AU - Chu, Zili D.

AU - Hunter, Jill V.

AU - Lu, Hanzhang

AU - Lee, Wesley

AU - Kaiser, Jeffrey R.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background: Therapeutic hypothermia is the standard-of-care treatment for infants diagnosed with moderate-to-severe hypoxic–ischemic encephalopathy (HIE). MRI for assessing brain injury is usually performed after hypothermia because of logistical challenges in bringing acutely sick infants receiving hypothermia from the neonatal intensive care unit (NICU) to the MRI suite. Perhaps examining and comparing early cerebral oxygen metabolism disturbances to those after rewarming will lead to a better understanding of the mechanisms of brain injury in HIE and the effects of therapeutic hypothermia. Objective: The objectives were to assess the feasibility of performing a novel T2-relaxation under spin tagging (TRUST) MRI technique to measure venous oxygen saturation very early in the time course of treatment, 18–24 h after the initiation of therapeutic hypothermia, to provide a framework to measure neonatal cerebral oxygen metabolism noninvasively, and to compare parameters between early and post-hypothermia MRIs. Materials and methods: Early (18–24 h after initiating hypothermia) MRIs were performed during hypothermia treatment in nine infants with HIE (six with moderate and three with severe HIE). Six infants subsequently had an MRI after hypothermia. Mean values of cerebral blood flow, oxygen extraction fraction, and cerebral metabolic rate of oxygen from MRIs during hypothermia were compared between infants with moderate and severe HIE; and in those with moderate HIE, we compared cerebral oxygen metabolism parameters between MRIs performed during and after hypothermia. Results: During the initial hypothermia MRI at 23.5±5.2 h after birth, infants with severe HIE had lower oxygen extraction fraction (P=0.04) and cerebral metabolic rate of oxygen (P=0.03) and a trend toward lower cerebral blood flow (P=0.33) compared to infants with moderate HIE. In infants with moderate HIE, cerebral blood flow decreased and oxygen extraction fraction increased between MRIs during and after hypothermia (although not significantly); cerebral metabolic rate of oxygen (P=0.93) was not different. Conclusion: Early MRIs were technically feasible while maintaining hypothermic goal temperatures in infants with HIE. Cerebral oxygen metabolism early during hypothermia is more disturbed in severe HIE. In infants with moderate HIE, cerebral blood flow decreased and oxygen extraction fraction increased between early and post-hypothermia scans. A comparison of cerebral oxygen metabolism parameters between early and post-hypothermia MRIs might improve our understanding of the evolution of HIE and the benefits of hypothermia. This approach could guide the use of adjunctive neuroprotective strategies in affected infants.

AB - Background: Therapeutic hypothermia is the standard-of-care treatment for infants diagnosed with moderate-to-severe hypoxic–ischemic encephalopathy (HIE). MRI for assessing brain injury is usually performed after hypothermia because of logistical challenges in bringing acutely sick infants receiving hypothermia from the neonatal intensive care unit (NICU) to the MRI suite. Perhaps examining and comparing early cerebral oxygen metabolism disturbances to those after rewarming will lead to a better understanding of the mechanisms of brain injury in HIE and the effects of therapeutic hypothermia. Objective: The objectives were to assess the feasibility of performing a novel T2-relaxation under spin tagging (TRUST) MRI technique to measure venous oxygen saturation very early in the time course of treatment, 18–24 h after the initiation of therapeutic hypothermia, to provide a framework to measure neonatal cerebral oxygen metabolism noninvasively, and to compare parameters between early and post-hypothermia MRIs. Materials and methods: Early (18–24 h after initiating hypothermia) MRIs were performed during hypothermia treatment in nine infants with HIE (six with moderate and three with severe HIE). Six infants subsequently had an MRI after hypothermia. Mean values of cerebral blood flow, oxygen extraction fraction, and cerebral metabolic rate of oxygen from MRIs during hypothermia were compared between infants with moderate and severe HIE; and in those with moderate HIE, we compared cerebral oxygen metabolism parameters between MRIs performed during and after hypothermia. Results: During the initial hypothermia MRI at 23.5±5.2 h after birth, infants with severe HIE had lower oxygen extraction fraction (P=0.04) and cerebral metabolic rate of oxygen (P=0.03) and a trend toward lower cerebral blood flow (P=0.33) compared to infants with moderate HIE. In infants with moderate HIE, cerebral blood flow decreased and oxygen extraction fraction increased between MRIs during and after hypothermia (although not significantly); cerebral metabolic rate of oxygen (P=0.93) was not different. Conclusion: Early MRIs were technically feasible while maintaining hypothermic goal temperatures in infants with HIE. Cerebral oxygen metabolism early during hypothermia is more disturbed in severe HIE. In infants with moderate HIE, cerebral blood flow decreased and oxygen extraction fraction increased between early and post-hypothermia scans. A comparison of cerebral oxygen metabolism parameters between early and post-hypothermia MRIs might improve our understanding of the evolution of HIE and the benefits of hypothermia. This approach could guide the use of adjunctive neuroprotective strategies in affected infants.

KW - Brain

KW - Cerebral metabolism

KW - Hypoxic–ischemic encephalopathy

KW - Infants

KW - Magnetic resonance imaging

KW - T2-relaxation under spin tagging

KW - Therapeutic hypothermia

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