Pia Wintermark
Hypoxic-ischemic encephalopathy (HIE) is a serious brain injury due to birth asphyxia that causes significant mortality and long-term morbidity, including cerebral palsy, mental retardation, learning difficulties, and blindness. Therapeutic hypothermia is currently the only available treatment that may prevent brain injury, but a significant proportion of treated newborns still develop neurological sequelae.
Our data in this article showed for the first time that brain perfusion measured by pulsed arterial spin-labeling (PASL) MRI sequence may be useful in the first days of life for identifying asphyxiated neonates at risk of developing brain injury, whether or not hypothermia is administered. Because hypothermia for 72 hours may not prevent brain injury when hyperperfusion is found early in the course of neonatal HIE, such newborns may be candidates for adjustments in their hypothermia therapy or for adjunctive neuroprotective/neurorestorative therapies.
We are currently expending this research in order to understand better how the more conventional MRI sequences, such as T1/T2-weighted imaging, diffusion-weighted imaging, and diffusion-tensor imaging, are modified by hypothermia in this population of newborns. In addition, we are trying to investigate in more detail the temporal evolution of brain perfusion over the first weeks of life in these newborns and understand better the ongoing mechanisms explaining the persistence of increased perfusion after the first few days of life.
This will bring new information about using MRI as a biomarker of brain injury in these newborns, properly utilizing it to elucidate what is happening in their brains, and influencing this disease course with novel treatments.