The Value of 3D arterial spin labeling in early diagnosis and short-term prognostic grouping of Full-Term neonatal hypoxic-ischemic encephalopathy

Abstract

Abstract Purpose To investigate the value of 3D arterial spin labeling(ASL) perfusion imaging and DWI for the early diagnosis of hypoxic-ischemic encephalopathy(HIE) in term neonates and the predictive value of 3D ASL for patient prognosis. Methods A total of 60 full-term neonates clinically diagnosed with HIE in our hospital from January 2018 to October 2021 and 60 control group was selected. All HIE neonates were divided into favourable outcome and adverse outcome groups according to their prognosis,and all subjects underwent 3D ASL and DWI simultaneously to compare cerebral blood flow (CBF) and apparent diffusion coefficient (ADC) in each region of interest and analyze the agreement.The areas of interest included bilateral basal ganglia, thalamus, and frontal white matter, and the final average was bilaterally taken.To investigate the correlation between CBF value of HIE in neonates and neonatal behavioral neurological assessment (NBNA), the relationship between early changes of CBF value and prognosis of neonates with HIE。 Results The CBF values of basal ganglia and thalamus in the adverse outcome group were higher than those in the favourable outcome group, and the difference was statistically significant (P < 0.01); the CBF value of frontal white matter in the adverse outcome group and the favourable outcome group were statistically significant (P < 0.01); the CBF values in the basal ganglia and thalamus of neonates in the HIE group were greater than those of normal controls, and the differences were statistically significant (P < 0.01); the CBF values in the frontal white matter area of neonates in the HIE group were smaller than those in the normal control group, and the differences were statistically significant (P < 0.01). The area under the ROC curve for CBF value was 0.973, the specificity and sensitivity of CBF values were 97.5% and 90.2%;the ADC values of area under the ROC curve was 0.881, and the sensitivity and specificity were 82.5% and 92.7%.respectively CBF values in the basal ganglia region were highly correlated with NBNA scores (r=-0.8196,p < 0.01) and negatively correlated; thalamic CBF values were highly correlated with NBNA scores (r=-0.8504,p < 0.01) and negatively correlated; frontal CBF values were not correlated with NBNA scores (r=-0.0802,p = 0.62). Conclusion ASL findings within 1 day after birth in full-term neonates were highly correlated with NBNA scores. It can diagnose HIE early and predict the outcome of functional brain damage with better diagnostic efficacy than DWI.