To evaluate the role of MRI of hypoxic ischemic encephalopathy

Abstract

Background: Hypoxic ischemic encephalopathy (HIE) is one the common causes of neonatal fatality due to perinatal asphyxia. The long-term outcomes of HIE are impaired mental and motor development, hearing loss, recurrent seizures and cerebral palsy. MRI is increasingly becoming the gold standard in diagnosis of HIE as it involves no radiation and can be performed during a neonate physiological sleep. Material and Methods :This prospective study was conducted in a tertiary care hospital for a period of 1 year from March 2019 to February 2020. at Subbaiah Institute of Medical Sciences. A total of 60 patients with history of birth asphyxia were included in the study who underwent MRI of brain and were followed up clinically at the end of one year to assess the neurological outcome. MRI was done on Philips Achieva 1.5 Tesla MRI system. The neonate was sedated using pedichloryl syrup or intravenous Ketamine/Propofol before start of study was administered by the attending anaesthetist and was placed in the supine position. The section thickness was 3-4 millimeter. Only plain MRI studies were done without using intravenous contrast. Result :A total of 60 patients who fulfilled the selection criteria during the study were enrolled. In this study, the maximum number of patients were in the age group of <1 year which were 45% (n =27). Of the 60 babies, 37 were males and 23 females, which correspond to 61.6% of male and the rest female babies. Out of the 60 babies 39 were term babies, which corresponds to 65% and 35% of pre-terms. In our study, maximum patients, i.e., 51.6% (n = 31) were having Apgar score of 4-6 followed by ≤3 score were26.6% and least were > 7 score were 21.6%. In HIE 2 cases, 31.6% had involvement of corpus callosam. 23.3% had PVL, 21.6% had basal ganglia or thalamus lesion. There was no MRI evidence of HIE in 13.3%. Out of 6 babies with stage 3 HIE, 55% had involvement of bilateral basal ganglia. 30% had bilateral thalami lesion and the rest showed subcortical white matter lesion. Conclusion :MRI is useful in establishing the clinical diagnosis, assessing the severity of injury, and thereby prognosticating the outcome. Familiarity with imaging spectrum and insight into factors affecting the injury will enlighten the radiologist to provide an appropriate diagnosis