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

基本信息

批准号：
9809943
负责人：
FLORENCE CHIANG
金额：
$ 7.69万
依托单位：
UNIVERSITY OF TEXAS HLTH SCIENCE CENTER
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-07-20 至 2021-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9809943
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 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 Hypoxia Image Image Analysis Immersion Investigative Technique 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

项目摘要

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.

项目概要/摘要这是一项初步研究，旨在确认继发于儿童急性缺氧性脑损伤 (ABI) 的局部病变使用磁共振成像 (MRI) 进行非致命性溺水溺水是第三大死亡原因。全球范围内的意外伤害，其中幼儿（1-4 岁）的发病率最高。溺水（即淹没/浸入液体中）会导致多器官损伤，这是最具破坏性的残疾脑损伤的结果。目前的诊断神经影像学结果（主要通过定性目视检查）是非特异性的，并提供对于儿科 ABI 后急性损伤阶段的预后或指导治疗干预几乎没有价值我们的初步 MRI 研究表明，慢性 ABI 的病变仅限于豆纹。分布，这是一个动脉末分水岭区域，类似于中风中看到的局灶性缺血。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，对扩散张量图像（DTI）进行分析。在患有非致命性溺水的成年人中，尚未报告仅限于豆纹分布的负担可能仅在儿童中观察到。由于不同的缺血性神经病理学导致的急性 ABI 可以在扩散加权图像上更快地检测到，如下所示根据提供的证据与其他结构 MRI 模式（即 T1 和 T2 加权图像）进行比较例如，在文献中，病变的检测发生在动物脉管系统闭塞后 30 分钟。此外，可以通过 16 检测到扩散加权图像上的中风模型。弥散加权图像上围产期窒息的小时数——这表明了类似的损伤模式豆纹状分布。该提案的总体目标是识别和验证非致命溺水中 ABI 的急性影像标记。为此，我们试图根据当前文献和我们的结果，使用结构 MRI 来测试 3 个目标。初步工作中，我们预计损伤模式局限于豆纹血管分布在损伤的急性期，我们将寻求证明病灶。 DTI（目标 1）和 T2 加权图像（目标 2）上的异常情况此外，我们还将关联异常情况。 DTI 与住院时间（目标 3），有望验证诊断和预后成像未来对急性损伤阶段神经保护剂的测试将利用来自的结论。本可行性研究。