Publications
40 results found
Montaldo P, Chaban B, Lally PJ, et al., 2015, Quantification of ante-mortem hypoxic ischemic brain injury by post-mortem cerebral magnetic resonance imaging in neonatal encephalopathy, European Journal of Paediatric Neurology, Vol: 19, Pages: 665-671, ISSN: 1090-3798
Post-mortem (PM) magnetic resonance imaging (MRI) is increasingly used as an alternative to conventional autopsy in babies dying from neonatal encephalopathy. However, the confounding effect of post-mortem changes on the detection of ante-mortem ischemic injury is unclear. We examined whether quantitative MR measurements can accurately distinguish ante-mortem ischemic brain injury from artifacts using post-mortem MRI.Methods:We compared PM brain MRI (1.5 T Siemens, Avanto) in 7 infants who died with neonatal encephalopathy (NE) of presumed hypoxic-ischemic origin with 7 newborn infants who had sudden unexplained neonatal death (SUND controls) without evidence of hypoxic-ischemic brain injury at autopsy. We measured apparent diffusion coefficients (ADCs), T1-weighted signal intensity ratios (SIRs) compared to vitreous humor and T2 relaxation times from 19 predefined brain areas typically involved in neonatal encephalopathy.Results:There were no differences in mean ADC values, SIRs on T1-weighted images or T2 relaxation times in any of the 19 predefined brain areas between NE and SUND infants. All MRI images showed loss of cortical gray/white matter differentiation, loss of the normal high signal intensity (SI) in the posterior limb of the internal capsule on T1-weighted images, and high white matter SI on T2-weighted images.Conclusion:Normal post-mortem changes may be easily mistaken for ante-mortem ischemic injury, and current PM MRI quantitative assessment cannot reliably distinguish these. These findings may have important implications for appropriate interpretation of PM imaging findings, especially in medico-legal practice.
Montaldo P, Pauliah SS, Lally PJ, et al., 2015, Cooling in a low-resource environment: Lost in translation, SEMINARS IN FETAL & NEONATAL MEDICINE, Vol: 20, Pages: 72-79, ISSN: 1744-165X
- Author Web Link
- Cite
- Citations: 45
Pauliah S, Lally P, Price D, et al., 2014, PC.106 Cerebral Injury and Early Childhood Neurodevelopmental Outcome following Neonatal Encephalopathy in a Middle-income Country., Arch Dis Child Fetal Neonatal Ed, Vol: 99 Suppl 1, Pages: A72-A73
Although neonatal encephalopathy (NE), accounts for 1 million neonatal deaths annually in low-and middle-income countries (LMIC), underlying brain injury and long term outcomes are not well characterised in LMIC.
Pauliah S, Lally P, Bainbridge A, et al., 2014, 8.8 Neonatal Encephalopathy in the Cooling Therapy era - Preliminary Cerebral Magnetic Resonance results from the Marble Consortium., Arch Dis Child Fetal Neonatal Ed, Vol: 99 Suppl 1, Pages: A13-A14
Although cerebral metabolic changes during neonatal encephalopathy (NE) have been well characterised using magnetic resonance spectroscopy (MRS) in single-centre studies, the widespread effect of therapeutic hypothermia is less clear.
Lally P, Pauliah S, Price D, et al., 2014, PC.45 Quantification of N-Acetylaspartate Concentration in the Neonatal Brain: Initial Results from the Multi-Centre Marble Study., Arch Dis Child Fetal Neonatal Ed, Vol: 99 Suppl 1
Early cerebral proton magnetic resonance spectroscopy (MRS) predicts medium-term outcomes in neonatal encephalopathy (NE). Metabolite peak-area ratios are most commonly used for prognosis, but conflate pathological information from different metabolites. N-acetylaspartate (NAA) is predominantly neuronal and neuronal loss should result in reduced NAA absolute-concentration ([NAA]). Thus, thalamic [NAA] should offer significant prognostic value but is difficult to measure in a clinical setting. We have established a protocol for multi-centre [NAA] measurement with the aim to use it as a surrogate biomarker in phase II clinical trials.
Lally P, Price D, Bainbridge A, et al., 2014, PC.26 Feasibility of Magnetic Resonance Spectroscopy in Examining Thalamic Metabolite Concentrations in a Multi-Centre Study of Neonatal Encephalopathy., Arch Dis Child Fetal Neonatal Ed, Vol: 99 Suppl 1, Pages: A44-A45
Proton magnetic resonance spectroscopy (MRS) has high prognostic value in hypoxic ischaemic encephalopathy (HIE), however its multi-centre application is limited by inconsistencies between scanners and protocols. N-acetylaspartate (NAA) is predominantly neuronal: cerebral NAA concentration may be a more reliable HIE-severity biomarker than lactate/NAA.
Lally P, Zhang H, Pauliah S, et al., 2014, 8.9 Microstructural Changes in Neonatal Encephalopathy Revealed with the Neurite Orientation Dispersion and Density Imaging (NODDI) Model., Arch Dis Child Fetal Neonatal Ed, Vol: 99 Suppl 1
Although diffusion tensor imaging (DTI) fractional anisotropy (FA) is commonly used to quantify neural injury, it is non-specific and affected by a number of microstructural changes.
Lally P, Arthurs O, Addison S, et al., 2014, PFM.33 Estimating Maceration Severity Using Whole Body Magnetic Resonance T2 Relaxometry., Arch Dis Child Fetal Neonatal Ed, Vol: 99 Suppl 1, Pages: A92-A93
Magnetic resonance (MR) imaging is an ideal modality to observe gross global changes in tissue structure, as is present with maceration. As tissue degrades, its MR transverse relaxation time (T2) should increase, with relaxometry methods enabling quantitative measurement of this.
Addison S, Arthurs O, Lally P, et al., 2014, PFM.25 Assessment of visceral maceration using post-mortem magnetic resonance imaging in fetuses., Arch Dis Child Fetal Neonatal Ed, Vol: 99 Suppl 1
Post-mortem magnetic resonance imaging (PM MRI) is increasingly used as an alternative for perinatal autopsy, however the artefacts related to maceration has not been described.
Lally PJ, Price DL, Pauliah SS, et al., 2014, Neonatal encephalopathic cerebral injury in south india assessed by perinatal magnetic resonance biomarkers and early childhood neurodevelopmental outcome, PLOS One, Vol: 9, ISSN: 1932-6203
Although brain injury after neonatal encephalopathy has been characterised well in high-income countries, little is known about such injury in low- and middle-income countries. Such injury accounts for an estimated 1 million neonatal deaths per year. We used magnetic resonance (MR) biomarkers to characterise perinatal brain injury, and examined early childhood outcomes in South India.MethodsWe recruited consecutive term or near term infants with evidence of perinatal asphyxia and a Thompson encephalopathy score ≥6 within 6 h of birth, over 6 months. We performed conventional MR imaging, diffusion tensor MR imaging and thalamic proton MR spectroscopy within 3 weeks of birth. We computed group-wise differences in white matter fractional anisotropy (FA) using tract based spatial statistics. We allocated Sarnat encephalopathy stage aged 3 days, and evaluated neurodevelopmental outcomes aged 3½ years using Bayley III.ResultsOf the 54 neonates recruited, Sarnat staging was mild in 30 (56%); moderate in 15 (28%) and severe in 6 (11%), with no encephalopathy in 3 (6%). Six infants died. Of the 48 survivors, 44 had images available for analysis. In these infants, imaging indicated perinatal rather than established antenatal origins to injury. Abnormalities were frequently observed in white matter (n = 40, 91%) and cortex (n = 31, 70%) while only 12 (27%) had abnormal basal ganglia/thalami. Reduced white matter FA was associated with Sarnat stage, deep grey nuclear injury, and MR spectroscopy N-acetylaspartate/choline, but not early Thompson scores. Outcome data were obtained in 44 infants (81%) with 38 (79%) survivors examined aged 3½ years; of these, 16 (42%) had adverse neurodevelopmental outcomes.ConclusionsNo infants had evidence for established brain lesions, suggesting potentially treatable perinatal origins. White matter injury was more common than deep brain nuclei injury. Our results support the need for rigorous evaluation of the efficacy of rescue
This data is extracted from the Web of Science and reproduced under a licence from Thomson Reuters. You may not copy or re-distribute this data in whole or in part without the written consent of the Science business of Thomson Reuters.