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MRI and spectroscopy in (near) term neonates with perinatal asphyxia and therapeutic hypothermia
  1. Thomas Alderliesten,
  2. Linda S de Vries,
  3. Liza Staats,
  4. Ingrid C van Haastert,
  5. Lauren Weeke,
  6. Manon J N L Benders,
  7. Corine Koopman-Esseboom,
  8. Floris Groenendaal
  1. Department of Neonatology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
  1. Correspondence to Dr Floris Groenendaal, Department of Neonatology, Room number KE.04.123.1, Wilhelmina Children's Hospital, University Medical Center Utrecht, Lundlaan 6, 3584 EA Utrecht, The Netherlands; F.Groenendaal{at}


Background Previous studies have demonstrated the association of abnormalities on diffusion-weighted MRI (DW-MRI) and proton magnetic resonance spectroscopy (1H-MRS) in infants with perinatal asphyxia. The use of therapeutic hypothermia might change this association.

Aim To study the association between DW-MRI and 1H-MRS and outcome after perinatal asphyxia and therapeutic hypothermia in infants with a gestational age of ≥36 weeks.

Patients and methods Infants with perinatal asphyxia and therapeutic hypothermia (n=88) were included when an MR examination was performed within 7 days after birth. Apparent diffusion coefficient (ADC) values of the basal ganglia and thalamus were calculated, as were lactate/N-acetylaspartate (LAC/NAA) and N-acetylaspartate/choline (NAA/Cho) ratios. Death or an abnormal neurodevelopment at ≥24 months was considered an adverse outcome. Receiver operating characteristic analysis was performed to determine cut-off levels.

Results Of the 88 infants, 22 died and 7 had an adverse neurodevelopmental outcome. In infants with an adverse outcome, ADC values of the basal ganglia and thalamus were significantly lower, and Lac/NAA ratios were significantly higher than in infants with a normal outcome. Areas under the curve of ADC of the basal ganglia, thalami and Lac/NAA ratio were 0.89, 0.88 and 0.87, respectively. NAA/Cho ratios were in this cohort not associated with outcome.

Conclusions During and after therapeutic hypothermia, low ADC values and high Lac/NAA ratios of the basal ganglia and thalamus are associated with an adverse outcome in infants with perinatal asphyxia.

  • perinatal asphyxia
  • brain
  • MRI
  • MRS
  • Neurodevelopment

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  • Contributors FG has designed the study, analysed the data and written the manuscript. MJNLB, LSdV and FG have performed the MRI studies. TA and LS have collected the MRI and MRS data. ICvH, CK-E and LSdV have performed the follow-up examinations. LW has reviewed the aEEG assessments and clinical and MRI data. TA, LSdV, ICvH, LW and CK-E, have revised the manuscript in detail.

  • Competing interests None declared.

  • Ethics approval Waiver by the Ethical Committee of our institute.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The data on which the results of this study was based could be obtained by contacting the corresponding author.