The value of susceptibility-weighted imaging (SWI) in patients with non-neonatal hypoxic-ischemic encephalopathy

Wagner, Franca; Hänggi, Matthias; Wagner, Bendicht Peter; Weck, Anja; Weisstanner, Christian; Grunt, Sebastian; Z'Graggen, Werner Josef; Gralla, Jan; Wiest, Roland; Verma, Rajeev Kumar (2015). The value of susceptibility-weighted imaging (SWI) in patients with non-neonatal hypoxic-ischemic encephalopathy. Resuscitation, 88, pp. 75-80. Elsevier Science Ireland 10.1016/j.resuscitation.2014.12.024

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OBJECTIVE In susceptibility-weighted imaging (SWI) in the normal brain, cortical veins appear hypointense due to paramagnetic properties of deoxy-hemoglobin. Global cerebral anoxia decreases cerebral oxygen metabolism, thereby increasing oxy-hemoglobin levels in cerebral veins. We hypothesized that a lower cerebral oxygen extraction fraction in comatose patients with non-neonatal hypoxic ischemic encephalopathy (IHE) produce a pattern of global rarefied or pseudo-diminished cortical veins due to higher oxy-hemoglobin. PURPOSE 1. To investigate the topographic relationship between susceptibility effects in cortical veins and related diffusion restrictions on diffusion-weighted imaging (DWI) in patients with IHE. 2. To relate imaging findings to patterns of altered resting activity on surface EEG. METHODS Twenty-three IHE patients underwent MRI. EEG patterns were used to classify the depth of coma. Regional vs. global susceptibility changes on SWI and patterns of DWI restrictions were compared with the depth of coma. RESULTS All patients exhibited areas of restricted cortical diffusion and SWI abnormalities. The dominant DWI restrictions encompassed widespread areas along the precuneus, frontal and parietal association cortices and basal ganglia. For SWI, nineteen patients had generalized bi-hemispherical patterns, the EEG patterns correlated with coma grades III to V. Four patients had focal decreases of deoxy-hemoglobin following DWI restrictions; associated with normal EEGs. CONCLUSION Focal patterns of diamagnetic effects on SWI according to relative decreases in deoxy-hemoglobin due to reduced metabolic demand are associated with normal EEG in IHE patients. Global patterns indicated increased depth of coma and widespread cortical damage. CLINICAL RELEVANCE The results indicate a potential diagnostic value of SWI in patients with IHE.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Gynaecology, Paediatrics and Endocrinology (DFKE) > Clinic of Paediatric Medicine
04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic of Intensive Care
04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic and Interventional Neuroradiology
04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurosurgery
04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > Forschungsbereich Pavillon 52 > Forschungsgruppe Intensivmedizin

UniBE Contributor:

Wagner, Franca; Hänggi, Matthias; Wagner, Bendicht Peter; Weck, Anja; Weisstanner, Christian; Grunt, Sebastian; Z'Graggen, Werner Josef; Gralla, Jan; Wiest, Roland and Verma, Rajeev Kumar

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0300-9572

Publisher:

Elsevier Science Ireland

Language:

English

Submitter:

Martin Zbinden

Date Deposited:

23 Jan 2015 15:47

Last Modified:

13 May 2016 16:05

Publisher DOI:

10.1016/j.resuscitation.2014.12.024

PubMed ID:

25576980

Uncontrolled Keywords:

Coma, EEG, IHE, SWI

BORIS DOI:

10.7892/boris.61865

URI:

https://boris.unibe.ch/id/eprint/61865

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