neonatal meningitis: magnetic-resonance-imaging-based scores analysis in preterm and term newborns...
TRANSCRIPT
Neonatal Meningitis: Magnetic-resonance-imaging-
based Scores Analysis in Preterm and Term Newborns
Department of Radiology, Children Hospital of Fudan University, Shanghai 201102, China
ASNR 2015, Chicago, USAEP-123
Mingshu Yang, Zhongwei Qiao
Purpose
To describe the magnetic resonance
imaging (MRI) patterns of brain
damage in neonatal meningitis and to
investigate the difference between
preterm and term newborn by using
MRI-based score analysis
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Materials and Methods (1)
65 newborns with meningitis
18 preterms
47 terms
clinical information
MRI dataset
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Materials and Methods (2)
Items MRI Abnormalities Score 1 Score 2 Score 3
1 Ventricular dilatation# Negative Mild Moderate, or severe2 Periventricular white matter volume loss Negative Positive /3 Cystic abnormality Negative Focal Extensive
4Abnormal myelination of the posterior limb of the
internal capsuleNegative
Positive at corrected age ≥37 wk
/
5 Cortical gray matter signal abnormality Negative Focal ≥ 2 lesions, or extensive6 Intracranial extracerebral space abnormality Negative Focal ≥ 2 lesions, or extensive7 Basal ganglia signal abnormality Negative Focal ≥ 2 lesions, or extensive8 Non-cystic white matter signal abnormality$ Negative Mild Moderate, or severe9 Intraventricular hemorrhage Negative Grade I, Grade II Grade III, or Grade IV
10 Pyocephalus Negative Focal ≥ 2 lesions, or extensive
11 Abnormal meningeal enhancement Negative Focal ≥ 2 lesions, or extensive
12 Abnormal ependymal enhancement Negative Focal Extensive
13 Encephalopyosis Negative Focal and diameter < 3 cmExtensive or diameter ≥3
cm
Table 1 The brain abnormalities identified on MRI and MRI-based grading scores
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Materials and Methods (3)
These 13 patterns were classified into
three groups
White matter abnormalities (WMA)
Gray matter abnormalities (GMA)
Non-parenchyma abnormalities
(NPA)
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Results (1)
Fig. 1 The brain regions involved by meningitis in newborns observed on magnetic resonance imaging (MRI). There were 60% (39/65) patients showed lesions in cerebra, 3% (2/65) in cerebra and cerebella, 2% (1/65) in brain stems, but 35% (23/65) did not demonstrate any abnormalities on MRI. 7ASNR 53rd Annual Meeting, 2015, Chicago, USA. EP-123
Results (2)
Fig. 2 & 3 The frequencies and MRI-based scores of abnormal myelination of the posterior limb of internal capsules, ventricular dilatation and periventricular white matter volume loss were higher in the preterm than the term.
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Results (3)
Fig. 4 Regarding the WMA, GMA and NPA, the score of WMA in the preterm was significantly higher than that of the term (p = .000). While the differences of GMA and NPA scores between the preterm and the term were not significant (p = .076, .224, respectively).
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Conclusions
• The preterm neonates with meningitis
were inclined to have white matter
abnormalities and resulted in much
more severe brain damages than the
term ones
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References
1. Woodward LJ, Anderson PJ, Austin NC, Howard K, Inder TE. Neonatal MRI to predict neurodevelopmental outcomes in preterm infants. N Engl J Med 2006;355:685.
2. Diffusion-weighted MR imaging of subdural empyemas in children. AJNR Am J Neuroradiol 2004;25:1016.
3. Mohan S, Jain KK, Arabi M, Shah GV. Imaging of meningitis and ventriculitis. Neuroimaging Clin N Am 2012;22:557.
4. Shah DK, Daley AJ, Hunt RW, Volpe JJ, Inder TE. Cerebral white matter injury in the newborn following Escherichia coli meningitis. Eur J Paediatr Neurol 2005;9:13.
5. Stoll BJ, Hansen NI, Adams-Chapman I, Fanaroff AA, Hintz SR, Vohr B, Higgins RD. Neurodevelopmental and growth impairment among extremely low-birth-weight infants with neonatal infection. JAMA 2004;292:2357.
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