CT and MR in non-neonatal hypoxic-ischemic encephalopathy: radiological findings with pathophysiological correlations

被引:66
作者
Gutierrez, Leonardo Guilhermino [1 ,2 ]
Rovira, Alex [4 ]
Pezzi Portela, Luiz Antonio [1 ,2 ]
Leite, Claudia da Costa [3 ]
Lucato, Leandro Tavares [1 ,2 ,3 ]
机构
[1] Hosp Alemao Oswaldo Cruz, Diagnost Imaging Div, BR-01327904 Sao Paulo, Brazil
[2] Hosp Coracao, BR-01327904 Sao Paulo, Brazil
[3] Univ Sao Paulo, Sch Med, Clin Hosp, Dept Radiol, Sao Paulo, Brazil
[4] Univ Hosp Vall Hebron, Dept Radiol, MR Unit, Barcelona, Spain
关键词
Hypoxic-ischemic encephalopathy; Neuroimaging; Prognostication; MR spectroscopy; MR diffusion-weighted imaging; Magnetic resonance; Computed tomography; CEREBRAL-BLOOD-FLOW; DELAYED POSTANOXIC ENCEPHALOPATHY; CORTICAL LAMINAR NECROSIS; MAGNETIC-RESONANCE-SPECTROSCOPY; CARBON-MONOXIDE INTOXICATION; TRAUMATIC BRAIN-INJURY; WHITE-MATTER INJURY; COMPUTED TOMOGRAPHIC ANGIOGRAPHY; PSEUDO-SUBARACHNOID HEMORRHAGE; DIFFUSION TENSOR MRI;
D O I
10.1007/s00234-010-0728-z
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Non-neonatal hypoxic-ischemic encephalopathy is a clinical condition often related to cardiopulmonary arrest that demands critical management and treatment decisions. Management depends mainly on the degree of neurological impairment and prognostic considerations. Computed tomography (CT) is often used to exclude associated or mimicking pathology. If any, only nonspecific signs such as cerebral edema, sulci effacement, and decreased gray matter (GM)/white matter (WM) differentiation are evident. Pseudosubarachnoid hemorrhage, a GM/WM attenuation ratio < 1.18, and inverted GM attenuation are associated with a poor prognosis. Magnetic resonance (MR) imaging is more sensitive than CT in assessing brain damage in hypoxic-ischemic encephalopathy. Some MR findings have similarities to those seen pathologically, based on spatial distribution and time scale, such as lesions distributed in watershed regions and selective injury to GM structures. In the acute phase, lesions are better depicted using diffusion-weighted imaging (DWI) because of the presence of cytotoxic edema, which, on T2-weighted images, only become apparent later in the early subacute phase. In the late subacute phase, postanoxic leukoencephalopathy and contrast enhancement could be observed. In the chronic phase, atrophic changes predominate over tissue signal changes. MR can be useful for estimating prognosis when other tests are inconclusive. Some findings, such as the extent of lesions on DWI and presence of a lactate peak and depleted N-acetyl aspartate peak on MR spectroscopy, seem to have prognostic value.
引用
收藏
页码:949 / 976
页数:28
相关论文
共 158 条
[1]   EFFECTS OF SYSTEMIC HYPOTENSION UPON HUMAN BRAIN . CLINICAL AND NEUROPATHOLOGICAL OBSERVATIONS IN 11 CASES [J].
ADAMS, JH ;
BRIERLEY, JB ;
CONNOR, RCR ;
TREIP, CS .
BRAIN, 1966, 89 :235-&
[2]   Diffusion tensor imaging of the brain [J].
Alexander, Andrew L. ;
Lee, Jee Eun ;
Lazar, Mariana ;
Field, Aaron S. .
NEUROTHERAPEUTICS, 2007, 4 (03) :316-329
[3]   MRI brain lesion patterns in patients in anoxia-induced vegetative state [J].
Ammermann, Heidi ;
Kassubek, Jan ;
Lotze, Martin ;
Gut, Ernst ;
Kaps, Michael ;
Schmidt, Joachim ;
Rodden, Frank A. ;
Grodd, Wolfgang .
JOURNAL OF THE NEUROLOGICAL SCIENCES, 2007, 260 (1-2) :65-70
[4]   The DWI 'reversal sign' of white matter hypoxic ischaemic injury in older children: an unusual MRI pattern for age [J].
Andronikou, Savvas ;
Van Toorn, Ronald .
PEDIATRIC RADIOLOGY, 2009, 39 (03) :293-298
[6]  
Arbelaez A, 1999, AM J NEURORADIOL, V20, P999
[7]   Autophagy in hypoxia-ischemia induced brain injury Evidence and speculations [J].
Balduini, Walter ;
Carloni, Silvia ;
Buonocore, Giuseppe .
AUTOPHAGY, 2009, 5 (02) :221-223
[8]   CEREBRAL BLOOD-FLOW AND METABOLISM IN MAN FOLLOWING CARDIAC-ARREST [J].
BECKSTEAD, JE ;
TWEED, WA ;
LEE, J ;
MACKEEN, WL .
STROKE, 1978, 9 (06) :569-573
[9]   EARLY DETERMINATION OF NEUROLOGICAL OUTCOME AFTER PREHOSPITAL CARDIOPULMONARY-RESUSCITATION [J].
BEREK, K ;
LECHLEITNER, P ;
LUEF, G ;
FELBER, S ;
SALTUARI, L ;
SCHINNERL, A ;
TRAWEGER, C ;
DIENSTL, F ;
AICHNER, F .
STROKE, 1995, 26 (04) :543-549
[10]   Brain Death Confirmation: Comparison of Computed Tomographic Angiography With Nuclear Medicine Perfusion Scan [J].
Berenguer, Christina M. ;
Davis, Frank E. ;
Howington, Jay U. .
JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, 2010, 68 (03) :553-558