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

Abstract：

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) produces 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-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.

journal_name

Resuscitation

journal_title

Resuscitation

authors

Wagner F,Haenggi MM,Wagner B,Weck A,Weisstanner C,Grunt S,Z'Graggen WJ,Gralla J,Wiest R,Verma RK

doi

10.1016/j.resuscitation.2014.12.024

subject

Has Abstract

pub_date

2015-03-01 00:00:00

pages

75-80

eissn

0300-9572

issn

1873-1570

pii

S0300-9572(15)00006-4

journal_volume

88

pub_type

杂志文章

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