Can radiomics be used to detect hypoxic-ischemic encephalopathy in neonates without magnetic resonance imaging abnormalities?

BACKGROUND: No study has assessed normal magnetic resonance imaging (MRI) findings to predict potential brain injury in neonates with hypoxic-ischemic encephalopathy (HIE). OBJECTIVE: We aimed to evaluate the efficacy of MRI-based radiomics models of the basal ganglia, thalami and deep medullary veins to differentiate between HIE and the absence of MRI abnormalities in neonates. MATERIALS AND METHODS: In this study, we included 38  full-term neonates with HIE and normal MRI findings and 89 normal neonates. Radiomics features were extracted from T1-weighted images, T2-weighted images, diffusion-weighted imaging and susceptibility-weighted imaging (SWI). The different models were evaluated using receiver operating characteristic curve analysis. Clinical utility was evaluated using decision curve analysis. RESULTS: The SWI model exhibited the best performance among the seven single-sequence models. For the training and validation cohorts, the area under the curves (AUCs) of the SWI model were 1.00 and 0.98, respectively. The combined nomogram model incorporating SWI Rad-scores and independent predictors of clinical characteristics was not able to distinguish HIE in patients without MRI abnormalities from the control group (AUC, 1.00). A high degree of fitting and favorable clinical utility was detected using the calibration curve with the Hosmer-Lemeshow test. Decision curve analysis was used for the SWI, clinical and combined nomogram models. The decision curve showed that the SWI and combined nomogram models had better predictive performance than the clinical model. CONCLUSIONS: HIE can be detected in patients without MRI abnormalities using an MRI-based radiomics model. The SWI model performed better than the other models.

Subpial hemorrhages in neonates: imaging features, clinical factors and outcomes.

Neonatal subpial hemorrhage is a poorly understood type of intracranial hemorrhage. Herein, we reported on 34 neonates with subpial hemorrhages, focusing on the imaging features, clinical factors, and outcomes of this type of intracranial hemorrhage. This retrospective case series enrolled 34 neonates with subpial hemorrhages. We analyzed their magnetic resonance (MR) images, clinical manifestations, and prognoses. We categorized, for the first time, the MR images of patients with subpial hemorrhages into three imaging patterns; moreover, on the basis of a yin-yang sign, we added a sandwich sign, attaining an MR image feature that was easier to understand. MR Patterns A and B both have good prognoses, and most patients had normal clinical outcomes. Subpial hemorrhage in neonates may be diagnosed via imaging patterns. Recognizing this pattern of hemorrhage may help gain a better understanding of the associated risk factors.

Radiomics based of deep medullary veins on susceptibility-weighted imaging in infants: predicting the severity of brain injury of neonates with perinatal asphyxia.

OBJECTIVE: This study aimed to apply radiomics analysis of the change of deep medullary veins (DMV) on susceptibility-weighted imaging (SWI), and to distinguish mild hypoxic-ischemic encephalopathy (HIE) from moderate-to-severe HIE in neonates. METHODS: A total of 190 neonates with HIE (24 mild HIE and 166 moderate-to-severe HIE) were included in this study. All of them were born at 37 gestational weeks or later. The DMVs were manually included in the regions of interest (ROI). For the purpose of identifying optimal radiomics features and to construct Rad-scores, 1316 features were extracted. LASSO regression was used to identify the optimal radiomics features. Using the Red-score and the clinical independent factor, a nomogram was constructed. In order to evaluate the performance of the different models, receiver operating characteristic (ROC) curve analysis was applied. Decision curve analysis (DCA) was implemented to evaluate the clinical utility. RESULTS: A total of 15 potential predictors were selected and contributed to Red-score construction. Compared with the radiomics model, the nomogram combined model incorporating Red-score and urea nitrogen did not better distinguish between the mild HIE and moderate-to-severe HIE group. For the training cohort, the AUC of the radiomics model and the combined nomogram model was 0.84 and 0.84. For the validation cohort, the AUC of the radiomics model and the combined nomogram model was 0.80 and 0.79, respectively. The addition of clinical characteristics to the nomogram failed to distinguish mild HIE from moderate-to-severe HIE group. CONCLUSION: We developed a radiomics model and combined nomogram model as an indicator to distinguish mild HIE from moderate-to-severe HIE group.

Autoimmune glial fibrillary acidic protein astrocytopathy in children: a retrospective study.

OBJECTIVE: To describe the clinical features of autoimmune glial fibrillary acidic protein (GFAP) astrocytopathy in children. METHOD: Data from 11 pediatric patients with autoimmune GFAP astrocytopathy were retrospectively analyzed. RESULTS: All of the patients showed encephalitis and meningoencephalitis or meningoencephalomyelitis with or without myelitis. 45.4% of the patients had fever, 27.3% headaches, 18.2% dizziness, 18.2% drowsiness, and 18.2% mental disorders. Cerebrospinal fluid (CSF) was detected in all patients. The white blood cell counts (WBC) (90.9%), lactic dehydrogenase levels (72.7%), protein level (36.4%), and adenosine deaminase activity (ADA) level (27.3%) were elevated, and the CSF glucose levels (72.7%) were slightly reduced. Nine patients (90%) were found to have brain abnormalities, of which five (50.0%) patients had abnormal symmetrical laminar patterns or line patterns hyperintensity lesions on T2-weighted and fluid-attenuated inversion recovery (FLAIR) images in the basal ganglia, hypothalamus, subcortical white matter and periventricular white matter. The linear radial enhancement pattern of the cerebral white matter was only seen in two patients, with the most common being abnormal enhancement of leptomeninges (50%). Five patients had longitudinally extensive spinal cord lesions. CONCLUSION: The findings of pediatric patients with autoimmune GFAP astrocytopathy are different from previous reports.

A radiomics-based study of deep medullary veins in infants: Evaluation of neonatal brain injury with hypoxic-ischemic encephalopathy via susceptibility-weighted imaging.

Objective: The deep medullary veins (DMVs) can be evaluated using susceptibility-weighted imaging (SWI). This study aimed to apply radiomic analysis of the DMVs to evaluate brain injury in neonatal patients with hypoxic-ischemic encephalopathy (HIE) using SWI. Methods: This study included brain magnetic resonance imaging of 190 infants with HIE and 89 controls. All neonates were born at full-term (37+ weeks gestation). To include the DMVs in the regions of interest, manual drawings were performed. A Rad-score was constructed using least absolute shrinkage and selection operator (LASSO) regression to identify the optimal radiomic features. Nomograms were constructed by combining the Rad-score with a clinically independent factor. Receiver operating characteristic curve analysis was applied to evaluate the performance of the different models. Clinical utility was evaluated using a decision curve analysis. Results: The combined nomogram model incorporating the Rad-score and clinical independent predictors, was better in predicting HIE (in the training cohort, the area under the curve was 0.97, and in the validation cohort, it was 0.95) and the neurologic outcomes after hypoxic-ischemic (in the training cohort, the area under the curve was 0.91, and in the validation cohort, it was 0.88). Conclusion: Based on radiomic signatures and clinical indicators, we developed a combined nomogram model for evaluating neonatal brain injury associated with perinatal asphyxia.