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Background and purpose  To determine the apparent diffusion coefficient (ADC) in specific infratentorial brain structures during the first week of life and its relation with neuromotor outcome for Hypoxic-ischemic encephalopathy (HIE) in term neonates with and without whole-body hypothermia (TH).    Materials and methods  We retrospectively evaluated 45 MRI studies performed in the first week of life of term neonates born between 2010 and 2013 at Boston Children's Hospital. Selected cases were classified into three groups: 1) HIE neonates who underwent TH, 2) HIE normothermics (TN), and 3) controls. The neuromotor outcome was categorized as normal, abnormal and death. The ADC mean  was calculated for six infratentorial brain regions.    Results  A total of 45 infants were included: 28 HIE TH treated, 8 HIE TN, and 9 controls. The mean gestational age was 39 weeks; 57.8% were male; 11.1% were non-survivors. The median age at MRI was 3 days (interquartile range, 1–4 days). A statistically significant relationship was shown between motor outcome or death and the ADC mean  in the vermis ( P  = 0.002), cerebellar left hemisphere ( P  = 0.002), midbrain ( P  = 0.009), pons ( P  = 0.014) and medulla ( P  = 0.005). In patients treated with TH, the ADC  mean  remained significantly lower than that in the controls only in the hemispheres ( P  = 0.01). In comparison with abnormal motor outcome, ADC mean  was lowest in the left hemisphere ( P  = 0.003), vermis ( P  = 0.003), pons ( P  = 0.0036) and medulla ( P  = 0.008) in case of death.    Conclusion  ADC mean  values during the first week of life in the left hemisphere, vermis, pons and medulla are related to motor outcome or death in infants with HIE either with or without hypothermic therapy. Therefore, this objective tool can be assessed prospectively to determine if it can be used to establish prognosis in the first week of life, particularly in severe cases of HIE.

plos one

Can cerebellar and brainstem apparent diffusion coefficient (ADC) values predict neuromotor outcome in term neonates with hypoxic-ischemic encephalopathy (HIE) treated with hypothermia?