Rafael Ceschin, Presenter: Nothing to Disclose

Vasuda Arora, Abstract Co-Author: Nothing to Disclose

Jessica Lee Wisnowski PhD, Abstract Co-Author: Nothing to Disclose

Lisa Paquette, Abstract Co-Author: Nothing to Disclose

Beena Sood MD, Abstract Co-Author: Nothing to Disclose

Nancy Katherine Rollins MD, Abstract Co-Author: Nothing to Disclose

Stefan Bluml PhD, Abstract Co-Author: Nothing to Disclose

Natasha Lepore PhD, Abstract Co-Author: Nothing to Disclose

Ashok Panigrahy MD, Abstract Co-Author: Nothing to Disclose

To determine if neonates treated with ECMO have regional specific quantitative brain volume loss using both conventional and volumetric MRI compared to age-matched controls.

: A total of 33 neonates who underwent ECMO (mean age: 43.5 ± 3.8 weeks) were compared to a group of 60 neonates (43.9 ± 3.8 weeks) who underwent neuroimaging at the same institution during the same time period for other indications (e.g., r/o meningitis) and were negative for brain abnormalities, chromosomal abnormalities or metabolic syndromes and other strict exclusion criteria .   Neonates with congenital heart disease were excluded .All MRIs were centrally reviewed by two pediatric neuroradiologists. Assessment of regional brain volume was carried out in two manners: (1) Manual measurement of brain metrics based on conventional MR sequences (Inder et al, AJNR, 2009) (2) Automated tissue segmentation in those cases in which 3D SPGR and T2-weighted imaging was available  Regarding (2): volumes of gray matter (GM), white matter (WM) and cerebral spinal fluid (CSF) were estimated for each subject using Oxford University’s FMRIB software library (FSL) based on combined information from the SPGR and T2-weighted data. GM, WM and CSF volumes for ECMO patients were compared with those from comparison cases using two sample t-tests.

Manual measurement of 12 brain metrics revealed: increased extra-cerebral space (cranial-caudal inter-opercular distance [p< .01] and inter-hemispheric distance [p < 0.001]) and increased ventricle size (third ventricle [p < 0.001] /lateral ventricle [p < 0.05]) in the ECMO cases compared to comparison patients. Results from the tissue segmentation revealed decreased white matter volumes in the ECMO patients relative to the comparison cases (p< 0.05) .

Quantitative assessment of MRI data from neonates who underwent ECMO revealed increased extra-axial space and ventriculomegaly suggesting generalized volume loss compared to age matched controls. Additional segmentation  results suggested that the generalized volume loss reflected underlying damage to the developing white matter. Supported by NS063371, Rudi Shulte Foundation and P50NS019632-28

This study shows the added value of quantitative volumetric techniques in the evaluation of brain injury in neonates treated with ECMO

Ceschin, R, Arora, V, Wisnowski, J, Paquette, L, Sood, B, Rollins, N, Bluml, S, Lepore, N, Panigrahy, A, Quantitative Assessment of Regional Brain Volume in Neonates Treated with ECMO.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11013817.html