scholarly journals Thermal Index for early non-invasive assessment of brain injury in newborns treated with therapeutic hypothermia: preliminary report

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
W. Walas ◽  
A. Mączko ◽  
Z. Halaba ◽  
M. Bekiesińska-Figatowska ◽  
I. Miechowicz ◽  
...  
Keyword(s):  
Brain Injury ◽  
Therapeutic Hypothermia ◽  
Perinatal Asphyxia ◽  
Brain Mri ◽  
Inversion Recovery ◽  
University Hospital ◽  
Thermal Index ◽  
Fluid Attenuated Inversion Recovery ◽  
Magnetic Resonance Imaging Mri ◽  
Mri Score

AbstractPerinatal asphyxia (PA) is the 3rd most common cause of neonatal death and one of the most common causes of severe neurological impairments in children. Current tools and measurements mainly based on the analysis of clinical evaluation and laboratory and electrophysiological tests do not give consistent data allowing to predict the severity of hypoxic-ischemic encephalopathy (HIE) until a magnetic resonance imaging (MRI) score is performed. The aim of this work is to evaluate the usefulness of the new index, called Thermal Index (TI) in the assessment of the degree of brain damage in newborns in the course of therapeutic hypothermia (TH) due to PA. This was a prospective, observational, pilot study which did not require any changes in the applicable procedures. Analysis has been applied to six newborn babies treated with TH in Neonatal/Paediatric ICU in University Hospital in Opole in 2018 due to PA. They all met criteria for TH according to the current recommendations. Brain MRI was performed after the end of TH when the children were brought back to normal temperature, with the use of a 1.5 T scanner, using T1-, T2-weighted images, fluid-attenuated inversion recovery (FLAIR), inversion recovery (IR), susceptibility-weighted imaging (SWI), and diffusion-weighted imaging (DWI). The images were assessed using MRI score according to the scoring system proposed by Weeke et al. The Thermal Index assessing endogenous heat production was calculated according to the formula proposed in this paper. A high, statistically significant positive correlation was found between MRI scores and TI values (0.98; p = 0.0003) in the 1st hour of therapy. High correlation with MRI assessment, the non-invasiveness of measurements and the availability of results within the first few hours of treatment, allow authors to propose the Thermal Index as a tool for early evaluating of the brain injury in newborns treated with TH. Further research is required to confirm the usefulness of the proposed method.

scholarly journals Thermal Index for Early Non-invasive Assessment of Brain Injury in Newborns Treated With Therapeutic Hypothermia – Preliminary Report of Non-invasive Thermal Measurements

2021 ◽  
Author(s):  
Wojciech Walas ◽  
Anna Mączko ◽  
Zenon Halaba ◽  
Monika Bekiesińska-Figatowska ◽  
Iza Miechowicz ◽  
...  
Keyword(s):  
Brain Injury ◽  
Therapeutic Hypothermia ◽  
Perinatal Asphyxia ◽  
Brain Mri ◽  
Inversion Recovery ◽  
University Hospital ◽  
Thermal Index ◽  
Non Invasive ◽  
Fluid Attenuated Inversion Recovery ◽  
Mri Score

Abstract Perinatal asphyxia (PA) is the 3rd most common cause of neonatal death and one of the most common causes of severe neurological impairments in children. Current tools and measurements mainly based on the analysis of clinical evaluation and laboratory and electrophysiological tests do not give consistent data allowing to predict the severity of hypoxic-ischemic encephalopathy (HIE) until an magnetic resonance imaging (MRI) score is performed. The aim of this work is to evaluate the usefulness of the new index, called Thermal Index (TI) in the assessment of the degree of brain damage in newborns in the course of therapeutic hypothermia (TH) due to PA.This was a prospective, observational, pilot study which did not require any changes in the applicable procedures. Analysis has been applied to six newborn babies treated with TH in Neonatal/Paediatric ICU in University Hospital in Opole in 2018 due to PA. They all met criteria for TH according to the current recommendations. Brain MRI was performed after the end of TH when the children were brought back to normal temperature, with the use of 1.5 T scanner, using T1-, T2-weighted images, fluid-attenuated inversion recovery (FLAIR), inversion recovery (IR), susceptibility-weighted imaging (SWI), and diffusion-weighted imaging (DWI). The images were assessed using MRI score according to the scoring system proposed by Weeke et al. The Thermal Index assessing endogenous heat production was calculated according to the formula proposed in this paper. High, statistically significant positive correlation were found between MRI scores and TI values (0.98; p = 0.0003) in the 1st hour of therapy. High correlation with MRI assessment, the non-invasiveness of measurements and the availability of results within the first few hours of treatment, allow authors to propose the Thermal Index as a tool for early evaluating of the brain injury in newborns treated with TH. Further research is required to confirm the usefulness of the proposed method.

scholarly journals Detection of Low-Signal Pulvinar Areas Using Diffusion-Weighted Imaging in Patients with Dementia Experiencing Visual Hallucinations

2016 ◽  
Vol 6 (3) ◽  
pp. 458-464 ◽  
Author(s):  
Mayuko Sugiura ◽  
Masayuki Satoh ◽  
Ken-ichi Tabei ◽  
Tomoki Saito ◽  
Mutsuki Mori ◽  
...  
Keyword(s):  
Sex Education ◽  
Diffusion Weighted Imaging ◽  
University Hospital ◽  
Visual Hallucinations ◽  
Diffusion Weighted ◽  
Evans Index ◽  
Fluid Attenuated Inversion Recovery ◽  
Magnetic Resonance Imaging Mri ◽  
State Examination

Background: Little research has been conducted regarding the role of pulvinar nuclei in the pathogenesis of visual hallucinations due to the difficulty of assessing abnormalities in this region using conventional magnetic resonance imaging (MRI). The present study aimed to retrospectively investigate the relative abilities of diffusion-weighted imaging (DWI), fluid-attenuated inversion recovery (FLAIR), and susceptibility-weighted imaging (SWI) to visualize the pulvinar and to ascertain the relationship between pulvinar visualization and visual hallucinations. Methods: A retrospective analysis of 3T MRIs from 73 patients (31 males, 42 females; mean age 73.5 ± 12.7 years) of the Memory Clinic of Mie University Hospital was conducted. Correlations between pulvinar visualization and the following were analyzed: age, sex, education, hypertension, hyperlipidemia, diabetes mellitus, Mini-Mental State Examination score, Evans index, and visual hallucinations. Results: DWI detected low-signal pulvinar areas in approximately half of the patients (52.1%). Participants with pulvinar visualization were significantly older, and the pulvinar was more frequently visualized in patients who had experienced visual hallucinations compared to those who had not. No significant association was observed between whole brain atrophy and pulvinar visualization. Conclusions: The results of the present study indicate that diffusion-weighted 3T MRI is the most suitable method for the detection of pulvinar nuclei in patients with dementia experiencing visual hallucinations.

scholarly journals Is Erythropoietin Combining with Therapeutic Hypothermia an Efficient and Safe Therapy in Neonatal Hypoxic Ischemic Encephalopathy: A Prospective and Randomized Clinical Trial

2020 ◽  
Author(s):  
Liang-yan Zou ◽  
Bing-xue Huang ◽  
Peng Zhang ◽  
Guo-qiang Cheng ◽  
Chun-mei Lu ◽  
...  
Keyword(s):  
Brain Injury ◽  
Adverse Events ◽  
Therapeutic Hypothermia ◽  
Brain Mri ◽  
Adverse Outcomes ◽  
Hypoxic Ischemic Encephalopathy ◽  
Control Group ◽  
Term Infants ◽  
Basal Nuclei ◽  
Ischemic Encephalopathy

Abstract BackgroundTo evaluate the efficacy and safety of erythropoietin (Epo) combined with therapeutic hypothermia (TH) in neonatal hypoxic-ischemic encephalopathy (HIE).MethodsA total of 78 term infants with HIE were assigned randomly to receive Epo (n = 40) or placebo (n = 38). All infants received TH. Blood samples before TH, after TH and after Epo/placebo were collected for measuring TH associated adverse events, Epo associated factors and potential neural biomarkers. Basal ganglia/ watershed (BG/W) scoring system was used to assess brain injury in MRI. Neurodevelopmental evaluations were performed at 18 months by using BayleyScales of Infant Development II (Bayley II).ResultsEpo-treated group tend to have lower serum creatine kinase (CK) concentration (114 vs 202, P = .04) and higher serum K+, Mg2+ concentration (5.0 vs 4.5, P = .03; 1.0 vs 0.9, P = .02) than control group after intervention. Brain MRI was performed in 65 (83%) neonatal. Totally brain injury score was in even distribution between two groups (median, 0 vs 0, P = .61), but injury region in cortex plus basal nuclei comparing with in basal nuclei solely was less common in the Epo than in the control group (21% vs 31%, P = .046). Only forty patients (40/78, 51%) succeeded in achieving 18-month follow up data. The totally adverse outcomes were trend to decline in the Epo group (35% vs 60%, P = .21). No adverse events were ascribed to Epo treatment.ConclusionsThe combination of Epo and TH is proved to be feasible, safe and potential effective.Trial registration: ChiCTR-TRC-14004532, date of registration: April 18th, 2014.

scholarly journals Fluid-Attenuated Inversion Recovery Signal Intensity as a Predictor of Gadolinium Enhancement in Relapsing-Remitting Multiple Sclerosis

2018 ◽  
Vol 20 (2) ◽  
pp. 62-66 ◽  
Author(s):  
Mihail Guranda ◽  
Marco Essig ◽  
Ariane Poulin ◽  
Reza Vosoughi
Keyword(s):  
Multiple Sclerosis ◽  
Area Under The Curve ◽  
Quantitative Model ◽  
Inversion Recovery ◽  
Gadolinium Enhancement ◽  
Relapsing Remitting ◽  
Fluid Attenuated Inversion Recovery ◽  
Remitting Multiple Sclerosis ◽  
Magnetic Resonance Imaging Mri ◽  
Relapsing Remitting Multiple Sclerosis

Background: Magnetic resonance imaging (MRI) is used to diagnose and monitor disease activity in relapsing-remitting multiple sclerosis (RRMS). The objective of this study was to explore the association of “ultrabright” axial fluid-attenuated inversion recovery (FLAIR) lesions with gadolinium enhancement in patients with RRMS using qualitative and quantitative approaches. Methods: MRIs from patients with RRMS from 2010 to 2015 were reviewed. Two radiologists independently identified ultrabright lesions on axial FLAIR sequences. The contrast-to-noise ratio (CNR) was measured for ultrabright and control lesions. Results: Of 301 lesions included in the study, 77 (26%) were identified by both radiologists as ultrabright. Interrater agreement was moderate (κ = 0.77, P < .001). Lesions identified by both radiologists as ultrabright demonstrated an association with gadolinium enhancement (χ21 = 30.8, P < .001) but were not associated with MRI magnet strength (χ21 = 0.24, P = .65). Higher CNR values were associated with gadolinium enhancement for 1.5-T studies (OR, 1.05; 95% CI, 1.02–1.07; P = .001) and 3-T studies (OR, 1.02; 95% CI, 1.02–1.03; P < .001). Diagnostic accuracy of the quantitative model was good for 1.5-T studies (area under the curve, 0.79; 95% CI, 0.68–0.9; P < .001) and 3-T studies (area under the curve, 0.78; 95% CI, 0.73–0.84; P < .001). Positive predictive value of 100% was obtained for CNR values of 92 for 1.5-T and 184 for 3-T studies. Conclusions: Qualitatively and quantitatively identified ultrabright axial FLAIR lesions are significantly associated with gadolinium enhancement.

Cardiac Dysfunction in Neonatal HIE Is Associated with Increased Mortality and Brain Injury by MRI

2021 ◽  
Author(s):  
Gabriel Altit ◽  
Sonia L. Bonifacio ◽  
Carolina V. Guimaraes ◽  
Shazia Bhombal ◽  
Ganesh Sivakumar ◽  
...  
Keyword(s):  
Brain Injury ◽  
Therapeutic Hypothermia ◽  
Cardiac Dysfunction ◽  
Systolic Function ◽  
Brain Magnetic Resonance Imaging ◽  
Lv Function ◽  
Severe Brain Injury ◽  
Key Points ◽  
Magnetic Resonance Imaging Mri ◽  
Ischemic Encephalopathy

Objective Describe the association between cardiac dysfunction and death or moderate-to-severe abnormalities on brain magnetic resonance imaging (MRI) in neonates undergoing therapeutic hypothermia for hypoxic ischemic encephalopathy (HIE). Study Design Retrospective study in neonates with moderate or severe HIE undergoing therapeutic hypothermia between 2008 and 2017. Primary outcome was death or moderate-to-severe brain injury using the Barkovich score. Conventional and speckle-tracking echocardiography measures were extracted from available echocardiograms to quantify right (RV) and left (LV) ventricular functions. Results A total of 166 newborns underwent therapeutic hypothermia of which 53 (36.5%) had echocardiography performed. Ten (19%) died prior to hospital discharge, and 11 (26%) had moderate-to-severe brain injury. There was no difference in chronologic age at echocardiography between the normal and adverse outcome groups (22 [±19] vs. 28 [±21] hours, p = 0.35). Cardiac findings in newborns with abnormal outcome included lower systolic and diastolic blood pressure (BP) at echocardiography (p = 0.004) and decreased tricuspid annular plane systolic excursion (a marker of RV systolic function; p = 0.01), while the ratio of systolic pulmonary artery (PA) pressure to systolic BP indicated isosystemic pressures (>2/3 systemic) in both groups. A multilogistic regression analysis, adjusting for weight and seizure status, indicated an association between abnormal outcome and LV function by longitudinal strain, as well as by ejection fraction. Conclusion Newborns who died or had moderate–to-severe brain injury had a higher incidence of cardiac dysfunction but similar PA pressures when compared with those who survived with mild or no MRI abnormalities. Key Points

Abstract P579: Fluid Attenuated Inversion Recovery Correlates With Time of Onset of Arterial Ischemic Stroke in Childhood

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Dennis Shaw ◽  
Dwight Barry ◽  
Michael G Abraham ◽  
Dana D Cummings ◽  
Mark T MacKay ◽  
...  
Keyword(s):  
Tissue Injury ◽  
Brain Mri ◽  
Inversion Recovery ◽  
Stroke Onset ◽  
Childhood Stroke ◽  
Arterial Ischemic Stroke ◽  
Anterior Circulation ◽  
Increased Risk ◽  
Fluid Attenuated Inversion Recovery ◽  
Highest Density Interval

Background: In adults, time since stroke onset correlates with efficacy and risk of recanalization therapies; beyond this temporal window there is increased risk of adverse events in particular hemorrhage with thrombolysis and decreased benefit of recanalization due to irreversible tissue injury. In adults the appearance of fluid attenuated inversion recovery (FLAIR) signal is a proxy for time, and is typically present by 6 hours. The time to FLAIR signal hyperintensity in childhood stroke is unknown but is of interest with potential utility due to the often greater uncertainty as to timing symptom onset. Methods: Time to FLAIR signal hyperintensity on brain MRI performed on children within 24 hours of stroke onset was studied with logistic regression. Results: A total of 68 MRIs with FLAIR imaging were available from 54 children (27 female), age 0.8 to 17.9 years, median 12.0 years. Seventy-four percent (40/54) of children and 72% (49/68) of scans had anterior circulation stroke. Interquartile range for time to FLAIR presence was 7.8 to 19.1 hours. The 90% probability of FLAIR change was reached at 11.2 hours for all strokes (Figure, dotted line; 80% highest density interval (HDI): 1.2-11.2 hours), and 9.3 hours for anterior circulation only strokes (Figure, solid line; 80% HDI: 3.3-9.3 hours), though nearly all had FLAIR change by 6 hours. FLAIR change was absent in 4 children after 6 hours, two with anterior circulation stroke (16 year-old at 6.1 hours, 10 year-old at 7.0 hours) and 2 with posterior circulation stroke (15 year-old at 7.3 hours, 9 month-old at 18.2 hours). Conclusion: Similar to adults, FLAIR hyperintensity can be used to estimate time since stroke ictus in childhood stroke. Children may have somewhat delayed time to FLAIR signal change compared with adults, suggesting that they may have a longer window for effective recanalization therapies.

scholarly journals Contrast-Enhanced FLAIR (Fluid-Attenuated Inversion Recovery) for Evaluating Mild Traumatic Brain Injury

PLoS ONE ◽  
2014 ◽  
Vol 9 (7) ◽  
pp. e102229 ◽  
Author(s):  
Soo Chin Kim ◽  
Sun-Won Park ◽  
Inseon Ryoo ◽  
Seung Chai Jung ◽  
Tae Jin Yun ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury ◽  
Inversion Recovery ◽  
Contrast Enhanced ◽  
Fluid Attenuated Inversion Recovery

Segmentation of Brain MRI Using Wavelet Transform and Grammatical Bee Colony

2018 ◽  
Vol 27 (07) ◽  
pp. 1850108 ◽  
Author(s):  
Tapas Si ◽  
Arunava De ◽  
Anup Kumar Bhattacharjee
Keyword(s):  
Magnetic Resonance ◽  
Brain Mri ◽  
Mr Images ◽  
Bee Colony ◽  
Analysis Task ◽  
Trained Classifier ◽  
Skull Stripping ◽  
Segmented Images ◽  
Fluid Attenuated Inversion Recovery ◽  
Magnetic Resonance Imaging Mri

Multimodal Magnetic Resonance Imaging (MRI) is an imaging technique widely used in the diagnosis and treatment planning of patients. Lesion segmentation of brain MRI is one of the most important image analysis task in medical imaging. In this paper, a new method for the supervised segmentation of the lesion in brain MRI using Grammatical Bee Colony (GBC) is proposed. The segmentation process is adversely affected by the presence of noises and intensity inhomogeneities in the Magnetic Resonance (MR) images. Therefore, noises are removed from the images and intensity inhomogeneities are corrected in the pre-processing steps. A set of stationary wavelet features are extracted from the co-registered [Formula: see text]1-weighted ([Formula: see text]-[Formula: see text]), [Formula: see text]2-weighted ([Formula: see text]-[Formula: see text]) and Fluid–Attenuated Inversion Recovery (FLAIR) images after skull stripping. A classifier is evolved using the GBC to classify the tissues as healthy tissues or lesions. The GBC classifier is trained with extracted features. The trained classifier is used to segment the test Magnetic Resonance (MR) image into healthy tissues or lesion regions. Finally, the connected component labeling algorithm is used to extract the lesions from the segmented images in the post-processing step. Effectiveness of the proposed method is tested by identifying the brain lesions from a set of MR images.

scholarly journals PROVE—Pre-Eclampsia Obstetric Adverse Events: Establishment of a Biobank and Database for Pre-Eclampsia

Cells ◽  
2021 ◽  
Vol 10 (4) ◽  
pp. 959
Author(s):  
Lina Bergman ◽  
Karl Bergman ◽  
Eduard Langenegger ◽  
Ashley Moodley ◽  
Stephanie Griffith-Richards ◽  
...  
Keyword(s):  
South Africa ◽  
Clinical Data ◽  
Drug Evaluation ◽  
Brain Mri ◽  
University Hospital ◽  
Middle Income ◽  
Low Middle Income Countries ◽  
Future Drug ◽  
Magnetic Resonance Imaging Mri ◽  
Organ Complications

Pre-eclampsia is a leading cause of maternal and perinatal morbidity and mortality. The burden of disease lies mainly in low-middle income countries. The aim of this project is to establish a pre-eclampsia biobank in South Africa to facilitate research in the field of pre-eclampsia with a focus on phenotyping severe disease.The approach of our biobank is to collect biological specimens, detailed clinical data, tests, and biophysical examinations, including magnetic resonance imaging (MRI) of the brain, MRI of the heart, transcranial Doppler, echocardiography, and cognitive function tests.Women diagnosed with pre-eclampsia and normotensive controls are enrolled in the biobank at admission to Tygerberg University Hospital (Cape Town, South Africa). Biological samples and clinical data are collected at inclusion/delivery and during the hospital stay. Special investigations as per above are performed in a subset of women. After two months, women are followed up by telephonic interviews. This project aims to establish a biobank and database for severe organ complications of pre-eclampsia in a low-middle income country where the incidence of pre-eclampsia with organ complications is high. The study integrates different methods to investigate pre-eclampsia, focusing on improved understanding of pathophysiology, prediction of organ complications, and potentially future drug evaluation and discovery.

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