الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Hypoxic ischemic encephalopathy (HIE) is a major cause of pediatric mortality and morbidity, with possible long-term neurologic sequel, such as cerebral palsy. With improvements in care of at-risk neonates, more children survive. This makes it increasingly important to assess, soon after birth, the prognosis of children with hypoxic-ischemic encephalopathy.
The aim of the current study was assessment of the additive role of Diffusion Tensor Imaging (DTI) and Magnetic Resonance Spectroscopy (MRS) over conventional MRI in early prediction of cerebral palsy in term neonates with hypoxic ischemic encephalopathy.
The study was carried out initially on thirty-five (35) full term neonates admitted to NICU in Alexandria University Children’s Hospital (AUCH) with manifestations of HIE. Imaging was done at the age of 10.32±1.78 days including conventional MRI (3D T1, T2 and DWI), MRS (for detection of metabolic decompensation) and DTI (for detection of white matter injury).
Owing to loss of contact with two infants’ parents, 33 infants out of the examined 35 neonates were evaluated at the age of 1 year with the Bayley Scales of Infant and Toddler Development,3rd edition (Bayley III scale) for development of cerebral palsy. Another MRI brain study using conventional technique and DTI was also done at 1 year of age to evaluate the final brain imaging features and corticospinal tract (CST) integrity.
Seventeen infants (17/33) were clinically normal while sixteen (16/33) acquired cerebral palsy by the end of the first year. Initial conventional MRI showed false negative results in 7 patients. MRS showed significant difference between CP and normal outcome infants with high positive and negative predictive values for NAA/Choline and Lac/creatine ratios within the basal ganglia and white matter. NAA/Ch ratios below 0.53 and 0.60 and Lac/Cr ratios above 0.68 and 0.66 in the basal ganglia and white matter respectively were significantly predictive of pathological outcome.