Therapeutic Hypothermia for Neonatal Encephalopathy Results in Improved Microstructure and Metabolism in the Deep Gray Nuclei

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Fig 1.
Regions of interest were drawn on T2-weighted images and were later applied to diffusion maps. A, T2-weighted image (transaxial section) shows ROIs drawn bilaterally for the BG and thalamus (Thal) structures. B, ADC map shows the same ROIs applied onto the corresponding transaxial section. L indicates left side; R, right side.
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Fig 2.
¹H-MR spectroscopy spectral array was generated for the entire brain and later extracted for the studied structures. T2-weighted image (transaxial section) shows the ¹H-MR spectroscopy brain selected region grid and the corresponding spectral arrays generated (on the right). Peak ratios calculated from the sections covering the BG and thalamus (Thal) bilaterally were used for the study. L indicates left side; R, right side.
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Fig 3.
ADC values in the basal ganglia and regression lines for each treatment group. ADC values and fitted regression lines show the mean ADC values in the basal ganglia for each treatment group and the interaction between treatment and age at imaging. As age at imaging increases, the difference in the mean ADC values between the groups decreases.

Table 1:

Clinical characteristics and the distribution of brain injury patterns in neonates with encephalopathy^a

Clinical Characteristics	Treated (n = 29)	Nontreated (n = 12)	P Value
Male	14 (48.3%)	6 (50%)	1.0^b
Gestational age	39.54 (±1.34)	39.27 (±1.91)	.60
Birth weight (g)	3380.79 (±587.31)	3413.58 (±620.28)	.87
Apgar 5 minutes	3 (2,4)	5 (2.25,5)	.21^b
Apgar 10 minutes	5 (3,6)	6 (3,7)	.26^b
Cardiac massage	11 (37.9%)	1 (8.3%)	.06^b
Umbilical artery pH	7.02 (±0.23)	7.06 (±0.22)	.54
Age at MRI (days)	5 (4,6)	4 (3,5)	.02^b
Encephalopathy score	4 (4,5)	5 (4,5)	.08^b
Age reached 33.5°C	5.5 hours (±1.87)	N/A
Death	1 (3.4%)	1 (8.3%)	.51^b
MRI pattern of brain injury
Normal	12 (41.4%)	0	.03^b
BG/thalamus	7 (24.1%)	5 (41.7%)
WS	10 (34.5%)	7 (58.3)

Table 2:

DTI and ¹H-MRS findings in neonates with neonatal encephalopathy^a

Table 3:

DTI and ¹H-MRS findings in neonates with predominant qualitative injury to the basal ganglia/thalamus^a

Table 4:

DTI and ¹H-MRS findings in neonates with normal conventional MRI findings^a