Advanced

AJNR - American Journal of Neuroradiology

This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Christophe, C. Articles by Dan, B. Search for Related Content PubMed PubMed Citation Articles by Christophe, C. Articles by Dan, B.

American Journal of Neuroradiology 23:716-723, April 2002
© 2002 American Society of Neuroradiology

PEDIATRICS

Value of MR Imaging of the Brain in Children with Hypoxic Coma

Catherine Christophe^a, Christine Fonteyne^b, France Ziereisen^a, Florence Christiaens^b, Paul Deltenre^c, Viviane De Maertelaer^d and Bernard Dan^b

^a Department of Imaging, Hôpital Universitaire des Enfants Reine Fabiola
^b Department of Pediatrics, Hôpital Universitaire des Enfants Reine Fabiola
^c Department of Neurology, Centre Hospitalier Universitaire Brugmann
^d IRIBHN, Statistical Unit, Free University of Brussels, Belgium

Address reprint requests to Catherine Christophe, Hôpital Universitaire des Enfants Reine Fabiola, 15 av. J. J. Crocq, B-1020 Brussels, Belgium

BACKGROUND AND PURPOSE: The contribution of MR imaging to identify hypoxic-ischemic injuries has been studied mostly in neonates or adults. The purpose of this study was to describe the MR imaging findings of toddlers and older children with hypoxic coma and to analyze the prognostic value of an MR imaging scoring system.

METHODS: The conditions of 40 children with hypoxic coma (age range, 6 weeks to 18 years) were clinically graded according to the pediatric risk of mortality score, and MR imaging studies were performed. Sixty-four MR imaging studies were distributed in five categories according to their timing relative to the hypoxic event: days 1 through 3, 4–7, 8–15, 16–50, and after day 50. These were evaluated retrospectively by using an eight-point scoring system based on two lesion categories assessing watershed areas and basal ganglia involvement, including signal intensity and morphologic features with respect to maturation-related norms. Two age groups (1 year and >1 year) were considered. The surviving children were grouped according to neurologic outcome.

RESULTS: The occurrence of watershed areas or basal ganglia involvement was not significantly different in association with age. Sixteen children died. Twelve children had moderate to severe sequelae resulting from neurodevelopmental disabilities, and 12 had good neurologic outcomes. There was no correlation between pediatric risk of mortality score and neurologic evolution. There was a strong correlation between first MR imaging score (P < .001) and neurologic outcome. The sensitivity of the first MR imaging score was high (96%), even when obtained during the first 3 days, with a specificity of 50% and a positive predictive value of 82%. Six patients with definite abnormal MR imaging findings experienced good neurologic outcomes.

CONCLUSION: The MR imaging scoring system proposed in this study can be used to establish an early prognosis in a significant proportion of children with hypoxic coma. It is helpful, even during the first 3 days after the event. However, some patients with definite abnormal MR imaging findings may experience good neurologic evolution.

This article has been cited by other articles:

				B. Y. Huang and M. Castillo Hypoxic-Ischemic Brain Injury: Imaging Findings from Birth to Adulthood RadioGraphics, March 1, 2008; 28(2): 417 - 439. [Abstract] [Full Text] [PDF]

				D.J.A. Connolly, E. Widjaja, and P.D. Griffiths Involvement of the Anterior Lobe of the Cerebellar Vermis in Perinatal Profound Hypoxia AJNR Am. J. Neuroradiol., January 1, 2007; 28(1): 16 - 19. [Abstract] [Full Text] [PDF]