Abstract
The aim of this article was to review the studies on diagnostic and prognostic value of radiological investigations (cranial sonography, Doppler ultrasonography, and magnetic resonance imaging) in the detection of hypoxic-ischemic brain injuries in full-term newborns. Materials and Methods. A systematic search of studies on the diagnostic and prognostic possibilities of radiological investigations for the detection of hypoxic-ischemic injuries in full-term newborns was performed. Results. A total of 13 prospective and 4 retrospective studies that analyzed the incidence of hypoxic-ischemic cerebral injuries, determined by means of cranial sonography, Doppler sonography, and magnetic resonance imaging, and associations with the stages of hypoxic-ischemic encephalopathy and long-term neurodevelopmental outcomes were included in this systematic review. Conclusions. Magnetic resonance imaging detects lesions in 75%–100% of cases. Magnetic resonance imaging performed at the age of 7–11 days demonstrated a high sensitivity (100%) and negative predictive value (100%) to predict unfavorable outcomes at 4 years of age. In newborns with hypoxic-ischemic encephalopathy, substantial cerebral hemodynamic alterations are detected after birth. The sensitivity and negative predictive value of cerebral blood flow velocities (peak systolic flow velocity, end-diastolic flow velocity) changes at 12±2 hours of age to predict the severity of hypoxic-ischemic encephalopathy and unfavorable outcomes at 18 months of age were found to be high (90% and 94%, respectively). A low resistive index (<0.56) at the age of 1–3 days had a specificity of 95% to predict unfavorable outcomes at 3 years of age. The data on the diagnostic and prognostic potential of cranial sonography are limited scarce and contrary.
Highlights
Perinatal asphyxia (PA) remains one of the main causes of mortality and morbidity among newborns, with an estimated incidence of [1,2,3,4,5,6,7,8] per 1000 live births according to different studies (1)
In newborns with hypoxic-ischemic encephalopathy, substantial cerebral hemodynamic alterations are detected after birth
Forty studies did not meet the inclusion criteria: 11 studies presented the comparison of magnetic resonance imaging (MRI) sequences, 6 analyzed lesions of definite cerebral structures, 5 assessed the correlation of long-term hypoxic-ischemic encephalopathy (HIE) outcomes with MRI findings, 2 reported MRI findings after the application of hypothermia, 4 reported the findings of MRI performed during [1–24] years of life or radiologicalpathological correlation, 4 included preterm newborns, and 8 studies were not associated with the problem at all
Summary
Perinatal asphyxia (PA) remains one of the main causes of mortality and morbidity among newborns, with an estimated incidence of [1,2,3,4,5,6,7,8] per 1000 live births according to different studies (1). In order to identify hypoxic injuries, it is necessary to evaluate the findings suggestive of asphyxia and perform neuroradiological investigations. Neuroradiological investigations should depict cerebral injuries and prompt the initiation of necessary neuroprotective treatment. The main methods of investigation of cerebral injuries in a full-term newborn are cranial sonography (CS), Doppler sonography (DS), magnetic resonance imaging (MRI), and in some cases, computed tomography (CT) (2–4). Based on the studies published between 1994 and 2002, the potential of CS for the evaluation of hypoxic lesions in full-term newborns is rather low, but the majority of these studies were retrospective where CS and MRI were performed with a long time interval between them (3). According to Daneman et al, CS and MRI have a strong correlation if performed with a minimum time interval between these 2 investigations (3).
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