Proton Spectroscopy and Diffusion Imaging on the First Day of Life after Perinatal Asphyxia: Preliminary Report
A. James Barkovicha,
Kaye D. Westmarka,
Harvinder S. Bedia,
J. Colin Partridgea,
Donna M. Ferrieroa and
Daniel B. Vignerona
a From the Departments of Neuroradiology (A.J.B., D.B.V.), Neurology (A.J.B., D.M.F.), and Pediatrics (J.C.P., D.M.F., A.J.B.), University of California, San Francisco; and the Departments of Radiology (K.D.W.) and Neonatology (H.S.B.), Clear Lake Regional Medical Center, Webster, TX.
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FIG 1. Patient 5.
A, Diffusion-weighted image (b = 700 s/mm2) at age 16 hours. Small areas of reduced diffusion (arrows) are seen in posterior limbs of internal capsules.
B, Proton MR spectrum (2000/288) at age 16 hours from single voxel in thalamus/lentiform nucleus. Lactate peak (doublet at 1.33 ppm, indicated by solid arrow) is markedly elevated and NAA peak (singlet at 2.01 ppm, indicated by open arrow) is reduced.
C and D, Follow-up SE (517/8) images at age 15 days. Despite some motion degradation, globular T1 shortening (arrows) is seen in lateral putamen and posteromedial lentiform nucleus bilaterally and at the depths of the posterior sylvian cortex. Diffusion images were negative at this study.
E, Follow-up proton spectrum (2000/288) from the thalami/lentiform nuclei at age 15 days shows further diminution in the size of the NAA peak and almost complete disappearance of the lactate peak.
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FIG 2. Patient 7.
A and B, Diffusion-weighted images (b = 700 s/mm2) at age 18 hours shows reduced diffusion, manifest as high signal intensity (arrows), in the lateral thalami and possibly in the posterior limbs of the internal capsules. No significant reduction in diffusion is seen in the centra semiovale (in B).
C and D, Follow-up diffusion-weighted images (b = 700, s/mm2) at age 7 days at the same levels show reduced diffusion (hyperintensity, arrows) within a much larger area, including the lentiform nuclei and thalami (in C) and along the corticospinal tracts (in D).
E, Axial SE (516/8) image through the basal ganglia shows T1 shortening in the lateral thalami (open arrows) and lentiform nuclei (solid arrows), confirming the injury seen in C.
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FIG 3. Patient 2.
A, Diffusion-weighted image (b = 700 s/mm2) at the level of the basal ganglia performed at age 16 hours shows diffusely reduced diffusion in cortex and deep gray nuclei. On initial evaluation, this image was thought to be normal; however, subsequent analysis revealed a reduction in the ADC of about 15% throughout the brain. The distortion and hyperintensity of the back of the head results from chemical blankets used to keep the body temperature at 37°C.
B, Proton MR spectrum (2000/288) from the thalami and basal ganglia at age 16 hours shows marked reduction of NAA (singlet at 2.01 ppm, indicated by open arrow) and marked elevation of lactate (doublet at 1.33 ppm, indicated by solid arrow).
C, Axial SE (3000/120) image at age 18 hours shows some mildly diffuse T2 prolongation.
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