• A Tekes, A Poretti, M M Scheurkogel, T A G M Huisman, J A Howlett, E Alqahtani, J-H Lee, C Parkinson, K Shapiro, S-E Chung, J M Jennings, M M Gilmore, C W Hogue, L J Martin, R C Koehler, F J Northington, and J K Lee.
• From the Division of Pediatric Radiology and Pediatric Neuroradiology (A.T., A.P., M.M.S., T.A.G.M.H., E.A.), Department of Radiology Neurosciences Intensive Care Nursery Program (A.T., A.P., T.A.G.M.H, J.A.H., C.P., K.S., M.M.G., F.J.N., J.K.L.) atekes1@jhmi.edu.
• AJNR Am J Neuroradiol. 2015 Jan 1; 36 (1): 188-93.

Background And PurposeNeurologic morbidity remains high in neonates with perinatal hypoxic-ischemic injury despite therapeutic hypothermia. DTI provides qualitative and quantitative information about the microstructure of the brain, and a near-infrared spectroscopy index can assess cerebrovascular autoregulation. We hypothesized that lower ADC values would correlate with worse autoregulatory function.Materials And MethodsThirty-one neonates with hypoxic-ischemic injury were enrolled. ADC scalars were measured in 27 neonates (age range, 4-15 days) in the anterior and posterior centrum semiovale, basal ganglia, thalamus, posterior limb of the internal capsule, pons, and middle cerebellar peduncle on MRI obtained after completion of therapeutic hypothermia. The blood pressure range of each neonate with the most robust autoregulation was identified by using a near-infrared spectroscopy index. Autoregulatory function was measured by blood pressure deviation below the range with optimal autoregulation.ResultsIn neonates who had MRI on day of life ≥10, lower ADC scalars in the posterior centrum semiovale (r = -0.87, P = .003, n = 9) and the posterior limb of the internal capsule (r = -0.68, P = .04, n = 9) correlated with blood pressure deviation below the range with optimal autoregulation during hypothermia. Lower ADC scalars in the basal ganglia correlated with worse autoregulation during rewarming (r = -0.71, P = .05, n = 8).ConclusionsBlood pressure deviation from the optimal autoregulatory range may be an early biomarker of injury in the posterior centrum semiovale, posterior limb of the internal capsule, and basal ganglia. Optimizing blood pressure to support autoregulation may decrease the risk of brain injury in cooled neonates with hypoxic-ischemic injury.© 2015 by American Journal of Neuroradiology.

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