Abstract
Hypoxic-ischemic encephalopathy carries an uncertain prognosis. We sought to retrospectively assess the prognostic value of arterial spin-labeling MR imaging in 22 adult patients diagnosed with hypoxic-ischemic encephalopathy. Quantitative CBF maps were generated from the M0 map, and arterial spin-labeling data on a per-voxel basis were regionally interrogated via visual inspection and ROI placement. Hyperperfusion was defined as regional increases in CBF of >20% (relative to global CBF) and/or >100 mL/100 g/min. Eleven of 22 patients had prominent bilateral medial occipital lobe hyperperfusion, all of whom died before hospital discharge. One patient who had nondistinct arterial spin-labeling hyperperfusion and restricted diffusion survived. Medial occipital lobe hyperperfusion is a distinctive pattern that merits prospective investigation in a cohort of patients with moderate hypoxic-ischemic encephalopathy to determine its predictive ability in patients with a higher likelihood of survival.
Highlights
arterial spin-labeling (ASL) is a noninvasive MR imaging technique that produces perfusion maps that are comparable with contrastbased methods such as dynamic susceptibility contrast MR imaging
Because the brain and kidneys are both very sensitive to hypotension and lack of oxygen, Hypoxic-ischemic encephalopathy (HIE) is often accompanied by transient acute renal injury, which can be a contraindication to gadolinium-based contrast agent administration in MR imaging
In patients with medial occipital lobe hyperperfusion (MOLH), the absent SWI blood oxygen level– dependent venous signal was identified in the occipital lobes in 4/4
Summary
Hyperperfusion after HIE has been observed with arterial spin-labeling (ASL) MR imaging in both pediatric and adult patients, but in nonspecific patterns that have often corresponded with regions of restricted diffusion.6,7 ASL is a noninvasive MR imaging technique that produces perfusion maps that are comparable with contrastbased methods such as dynamic susceptibility contrast MR imaging.8 Because the brain and kidneys are both very sensitive to hypotension and lack of oxygen, HIE is often accompanied by transient acute renal injury, which can be a contraindication to gadolinium-based contrast agent administration in MR imaging.9,10 In light of this limitation, we sought to further clarify whether the presence of hyperperfusion, as previously reported in patients with HIE6 and detected with ASL, could be used as a marker of survival prognosis and to examine its relationship to standard prognostic tests. Eleven of 22 patients had MOLH: prominent or isolated hyperperfusion on ASL involving the bilateral medial occipital lobes (Fig 1).
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