Characterization of Acute Pediatric Anoxic Brain Injury in Non-fatal Drowning Using MRI

使用 MRI 表征非致命性溺水中的急性小儿缺氧性脑损伤

• 批准号: 9982115
• 负责人: FLORENCE CHIANG
• 金额: $ 7.7万
• 依托单位: UNIVERSITY OF TEXAS HLTH SCIENCE CENTER
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-07-20 至 2022-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9982115
• 关键词: Accidental Injury; Acute; Admission activity; Adult; Affect; Age; Animals; Anisotropy; Anoxic Encephalopathy; Area; Arteries; Asphyxia Neonatorum; Atrophic; Basal Ganglia; Blood Vessels; Brain Hypoxia-Ischemia; Brain Injuries; Cause of Death; Child; Childhood; Chronic; Chronic Phase; Clinical; Cognitive; Detection; Diagnostic; Diffuse; Diffusion Magnetic Resonance Imaging; Drowning; Edema; Etiology; Exhibits; Feasibility Studies; Functional disorder; Future; Goals; Hour; Image; Immersion; Incidence; Injury; Internal Capsule; Ischemia; Length; Length of Stay; Lesion; Limb structure; Liquid substance; Literature; Localized Lesion; Magnetic Resonance Imaging; Magnetic Resonance Spectroscopy; Methods; Neuroprotective Agents; Patients; Pattern; Phase; Pilot Projects; Practice Management; Prognostic Marker; Reporting; Secondary to; Severities; Spatial Distribution; Stroke; Structure; Submersion; T2 weighted imaging; Testing; Thalamic structure; Therapeutic; Therapeutic Intervention; Visual; Work; base; cytotoxic; diagnostic biomarker; disability; gray matter; imaging biomarker; imaging modality; imaging study; improved; motor impairment; multiorgan damage; neuroimaging; neuropathology; outcome forecast; prognostic; quantitative imaging; stroke model; therapeutic target; white matter

Project Summary/Abstract This is a pilot study to confirm localized lesions in acute pediatric anoxic brain injury (ABI) secondary to nonfatal drowning using magnetic resonance imaging (MRI). Drowning is the third leading cause of death due to unintentional injury worldwide, with the highest incidence in young children (ages 1-4 years). Although drowning (i.e. submersion/immersion in liquid) results in multi-organ damage, the most devastating disability results from brain injury. Current diagnostic neuroimaging findings (largely via qualitative visual inspection) are nonspecific and offer little value for prognosis or for directing therapeutic interventions in the acute injury phase of pediatric ABI post- drowning. Our preliminary MRI studies show that chronic ABI displays lesions limited to the lenticulostriate distribution, which is an end-arterial watershed zone, similar to focal ischemia seen in stroke. We found that this localized pattern of injury exhibits gray matter atrophy and also white matter microstructural abnormalities on diffusion-tensor images (DTI), by using fully automated quantitative imaging analysis. Interestingly, lesion burden limited to the lenticulostriate distribution has not been reported in adults with nonfatal drowning and may be observed only in children. Acute ABI due to different ischemic neuropathologies can be detected sooner on diffusion-weighted images as compared to other structural MRI modalities (i.e. T1 and T2-weighted images) according to evidence provided in the literature. For example, detection of lesions occurs by 30 minutes after occlusion of vasculature in animal stroke models on diffusion-weighted images. Further, focal microstructural compromise can be detected by 16 hours in perinatal asphyxia on diffusion-weighted images—which demonstrates a similar injury pattern in the lenticulostriate distribution. The overall goal of the proposal is to identify and validate acute-imaging markers for ABI in nonfatal drowning. To this end, we seek to test 3 aims using structural MRI. Based on current literature and results from our preliminary work, we expect an injury pattern that is localized to the lenticulostriate vascular distribution affecting both gray and white matter. In the acute phase of injury, we will seek to demonstrate focal abnormalities on DTI (Aim 1) and T2-weighted images (Aim 2). Additionally, we will correlate abnormalities on DTI with duration of hospital stay (Aim 3), which promises to validate diagnostic and prognostic imaging markers. Future testing of neuroprotective agents in the acute injury phase would leverage conclusions from this feasibility study.

项目摘要/摘要 这是一项试点研究，旨在确认继发于急性小儿缺氧脑损伤（ABI）的局部病变。 使用磁共振成像（MRI）的非致命溺水。溺水是应得的第三大死亡原因 全世界无意的伤害，在幼儿中发生了最高的事件（1-4岁）。虽然 溺水（即浸入液体中的沉浸/浸入）导致多器官损害，这是最具破坏性的残疾 脑损伤的结果。 当前的诊断神经影像学发现（主要通过定性视觉检查）是非特异性的，并且提供 在小儿ABI的急性损伤阶段进行预后或指导治疗干预措施的价值很小 溺水。我们的初步MRI研究表明，慢性ABI显示病变仅限于毛发肌延伸物 分布是一个最终流域区域，类似于中风中的局部缺血。我们发现 这种局部损伤模式表现出灰质萎缩和白质微观结构异常 通过使用全自动定量成像分析，在扩散调节图像（DTI）上。有趣的是，病变 在非致命溺水和 只能在儿童中观察到。 由于不同的缺血性神经病理学引起的急性ABI可以在差异加权图像上更快地检测到 根据提供的证据，与其他结构性MRI模式（即T1和T2加权图像）相比 在文献中。例如，在动物中闭塞血管后30分钟发生病变的检测 扩散加权图像上的中风模型。此外，局灶性微观结构妥协可以通过16检测到 在扩散加权图像上，围产期窒息的小时在 扁豆分布。 该提案的总体目标是识别和验证非致命溺水中ABI的急性成像标记。 为此，我们寻求使用结构MRI测试3个目标。基于当前的文献和我们的结果 初步工作，我们期望一种损伤模式，该模式定位于扁豆的血管分布 影响灰色和白质。在受伤的急性阶段，我们将寻求展示焦点 DTI（AIM 1）和T2加权图像（AIM 2）的异常。此外，我们将相关的异常 DTI随着住院时间的持续时间（AIM 3），有望验证诊断和预后成像 标记。在急性损伤阶段对神经保护剂的未来测试将利用结论 这项可行性研究。