Effects of Tissue Temperature and Injury on ADC during Therapeutic Hypothermia in Newborn Hypoxic-Ischemic Encephalopathy

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FIG 1.
MR spectroscopy voxel placement and select regions of tissue temperature measurement (A). Sample manual tracing of ADC ROIs within the right basal ganglia voxels and averaging ADC values of 3 consecutive axial cuts (B). A indicates area of ROI; P, perimeter; M, mean ADC.
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FIG 2.
Baseline ADC on early MR imaging in the no-injury-versus-injury groups. Black thick horizontal lines represent medians, and thin horizontal lines represent IQRs. There was no statistical difference in the median ADC (Mann-Whitney, P = .4), but the cumulative distribution (Kolmogorov-Smirnov, P < .02) was different between groups.
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FIG 3.
Changes in ADC from during TH to after TH in the no-injury (A) and injury groups (B).
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FIG 4.
Relationship between ADC and brain temperature during TH in the no-injury group color coded by ROIs (A). The relationship between ADC and brain temperature during TH (blue circles) and after TH (red squares) in no-injury group (B). Best-fit curves by linear regression are shown. The lines appear parallel (similar b-values) and signify that the ΔADCs per ΔTemperature are similar during and after TH. Note the difference in the y-intercept of the 2 best-fit lines, which could be secondary to postnatal brain-water content changes during the first week of life.

Clinical demographics of study cohort^{^a}

	All Infants (n = 39)	No-Injury (n = 23)	Injury (n = 16)	P Value
GA (weeks)	39 (SD, 2)	38 (SD, 2)	39 (SD, 3)	.58
BW (g)	3237 (SD, 607)	3176 (SD, 542)	3325 (SD, 698)	.46
1- minute Apgar	2 (SD, 2)	2 (SD, 2)	2 (SD, 2)	.91
5-minute Apgar	4 (SD, 2)	4 (SD, 2)	3 (SD, 3)	.21
Cord pH	6.91 (SD, 0.11)	6.9 (SD, 0.09)	6.9 (SD, 0.13)	.23
Base deficit	16.6 (SD, 5.1)	15.9 (SD, 4.7)	17.6 (SD, 5.6)	.40
1st MR imaging (days)	2.2 (SD, 0.5)	2.3 (SD, 0.5)	2.1 (SD, 0.7)	.48
2nd MR imaging (days)	6.9 (SD, 2.7)	6.8 (SD, 2.6)	7 (SD, 2.9)	.85
Time between MRIs (days)	4.7 (SD, 2.5)	4.5 (SD, 2.5)	4.8 (SD, 2.8)	.72
Poor clinical outcome^b at 24–36 months (%) (No.)	21 (8)	0 (0)	50 (8)	<.001

Note:—GA indicates gestational age; BW, birth weight.
↵a Data are means unless otherwise indicated.
↵b Poor clinical outcome is defined as any of the following: Gross Motor Function Classification system levels 3–5, Mental Developmental Index score of <70 on the Bayley Scales of Infant Developmental III, visual impairment with no useful vision, tracheostomy, gastrostomy tube, and death.