Ashok Panigrahy MD, Presenter: Nothing to Disclose

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

Vasuda Arora, 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

Lisa Paquette, Abstract Co-Author: Nothing to Disclose

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

Cerebral atrophy is seen in ≈ 50% of survivors of ECMO and correlates with poor neurodevelopmental outcome. We compared metabolic profiles in brains of ECMO neonates with age-matched controls. We also determined whether metabolic abnormalities differ in ECMO survivors with normal and abnormal MRIs.

Data from 34 neonates (mean post-conceptional age: 43.4±3.3 weeks) who had undergone ECMO for sepsis, meconium aspiration, primary pulmonary hypertension, and/or congenital diaphragmatic hernia were analyzed. Infants with congenital heart disease were excluded. Control data were obtained from 60 neonates (age: 43.9±3.8 weeks) who underwent neuroimaging for other indications, with negative MRI and without chromosomal abnormalities or metabolic syndromes. MRIs were reviewed by two readers using a modified Rutherford scale. All studies were performed on a 1.5 T scanner using a single-voxel PRESS with an echo time of 35ms. Four brain regions were examined: Parietal and frontal white matter (pWM, fWM), occipital grey matter (GM), and the pons. Absolute concentrations and metabolite ratios were compared between ECMO and controls for different brain regions. In addition, Z-scores were analyzed in subgroups of ECMO patients with different imaging findings.

70 spectra from ECMO patients and 127 spectra from controls were analyzed. N-acetyl-aspartate relative to creatine (NAA/Cr) was reduced in pWM (p<0.01), fWM (p<0.05), and pons (p<0.05) but was not different in GM. Choline (Cho) was higher in ECMO than in controls in all locations. When the z-scores of the subgroup of ECMO patients with unremarkable MRI were analyzed (28 studies in 14 patients), Cho and Cr were significantly elevated (both p<0.05) but NAA and NAA/Cr did not reach significance. In contrast, in ECMO patients with abnormal MRI, NAA and NAA/Cr were highly significantly decreased (p<0.001 and p<0.000001).

Metabolic abnormalities, predominantly in white matter, were observed in ECMO patients. Reduced NAA and NAA/Cr in immature white matter of may reflect axonal and/or pre-oligodendrocyte injury.

This study highlights the ability of MRS to be a surrogate imaging biomarker of selective white matter injury in neonates treated with ECMO

Panigrahy, A, Wisnowski, J, Arora, V, Sood, B, Rollins, N, Paquette, L, Bluml, S, Selective Metabolic Abnormalities in the Cerebral White Matter of Neonates Treated with ECMO: A Quantitative Proton MR Spectroscopy Study.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11014464.html