Can diffusion tensor imaging predict cerebral palsy in term neonates with hypoxic ischemic encephalopathy?

Background Hypoxic ischemic encephalopathy (HIE) is a principal cause of pediatric mortality and morbidity, with possible neurologic sequel, such as cerebral palsy. Thus, it is of outmost importance to assess, shortly after birth, the prognosis of neonates with HIE. The purpose of this study was to assess the role of diffusion tensor imaging (DTI) in early prediction of cerebral palsy in term neonates with HIE. The study was carried out initially on 35 full-term neonates admitted to the neonatal intensive care unit (NICU) with manifestations of HIE. Imaging was done at the age of 10.32 ± 1.78 days including conventional MRI and DTI (for detection of white matter injury). Thirty-three infants out of the initially examined 35 were finally evaluated at the age of 1 year with the Bayley Scales of Infant and Toddler Development 3rd edition for development of cerebral palsy. Another MRI brain study was done at 1 year of age to evaluate the final brain imaging features and assess white matter integrity. Results Seventeen infants (17/33) were clinically normal while 16 (16/33) acquired cerebral palsy (CP) by the end of the first year. Initial conventional MRI showed false-negative results in 7 patients. Diffusion tensor imaging showed significantly different reduction in fractional anisotropy within the examined brain regions of interest (ROIs) between CP and normal outcome infants mostly at the posterior limb of the internal capsule, centrum semiovale, and corpus callosum with significant cutoff values of ≤ 0.435, ≤ 0.235, and ≤ 0.45, respectively. Conclusions Diffusion tensor imaging is a valuable tool for early prediction of CP in HIE neonates.