High-risk and preterm infants are likely to develop germinal matrix hemorrhage (GMH), intraventricular hemorrhage (IVH), cystic periventricular leukomalacia (PVL) and diffuse white matter injury. The aim of this study is to compare the usefulness of ultrasonography (USG), diffusion-weighted MR imaging (DWMRI) and electroencephalography (EEG) for the early diagnosis of ischemic brain injury and their prognostic value. Among the total of 89 infants who were diagnosed as suffering from perinatal asphyxia, hypoxic ischemic encephalopathy (HIE) or seizure, admitted to NICU in Seoul National University Bundang hospital between May 2003 and August 2004, 28 infants were examined using conventional and DWMRI during the early period of injury. Four infants were excluded based on exclusion criteria before analysis. The study population included 45.8% (11/24) male and 54.2% (13/24) female infants. Their gestational age was 38¡3/4 3 weeks and birth weight was 3.09¡3/4 0.82kg (range: 1.52∼4.86kg). The 5-min APGAR score ranged from 1 to 10 (median 7). Forty-five% (11/24) infants were delivered by cesarean section and 54.2% (13/24) infants were delivered vaginally. The first examinations were performed at 3.17¡3/4 1.64 days (1∼7 days) for USG, 5.74¡3/4 3.44 days (2∼13 days) for MRI and 4.19¡3/4 2.71 days (1∼13 days) for EEG. The rate of abnormal findings on their first examinations was 30.4% (7/23) on USG, 50.0% (12/24) on DWMRI and 90.4% (19/21) on EEG. Based on follow-up medical records especially in view of neurologic sequelae and treatment, EEG showed the highest sensitivity, specificity and negative predictive value. While DWMRI was more sensitive but less specific than USG. In conclusion, DWMRI showed higher correlation with subsequent neurologic sequelae than conventional MRI and USG. In addition, both EEG and DWMRI, when performed in the acute phase of the disease in high-risk newborn infants, are expected to be useful for treatment planning and for the earlier prediction of the neurologic prognosis.
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Shin, Y., Shin, Y., Kim, B. et al. 344 The Value of Diffusion-Weighted Magnetic Resonance Imaging, Ultrasonography and Electroencepahlography for Early Diagnosis of Neonatal Encephalopathy. Pediatr Res 58, 413 (2005) doi:10.1203/00006450-200508000-00373