Magnetic Resonance Imaging and Spectroscopy Biomarkers of Neonatal Hypoxic Ischemic Encephalopathy
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Purpose
Neonatal hypoxic ischemic encephalopathy (HIE) is a serious neurological condition characterised by acute or subacute brain injury arising from perinatal hypoxia. HIE is thought to affect approximately 0.2% of live births, and is associated with a high risk of mortality or long-term neurological disability.
Accurate biomarkers for long-term neuro-developmental outcome following HIE are extremely important both for clinical management and the evaluation of therapeutic approaches. According to a recent meta-analysis, the ratio of the cerebral concentrations of lactate and N-acetyl aspartate (NAA), two neuro-metabolites detectable with magnetic resonance spectroscopy (MRS), currently represents the most accurate prognostic indicator of outcome following HIE. However, for various technical reasons standard MRS methods do not offer optimal sensitivity for detecting lactate, which may potentially be improved with a custom lactate editing MRS sequence. In addition, while perfusion has also been suggested as a potential biomarker for neuro-developmental outcome following HIE, due to a paucity of MR perfusion imaging studies in neonates, the prognostic accuracy of perfusion MR measures has not been evaluated in comparison with more established MR biomarkers. The aims of this study are:
- to evaluate the relative sensitivity of a custom lactate editing MRS pulse sequence (specialist software) relative to the standard point resolved (PRESS) MRS sequence for detecting lactate in neonates with suspected HIE.
- to evaluate the sensitivity and specificity of MR perfusion measures in comparison to MRS measures as predictors of neuro-developmental outcome at 2 years.
| Condition |
|---|
|
Hypoxic Ischemic Encephalopathy |
| Study Type: | Observational |
| Study Design: | Observational Model: Cohort Time Perspective: Prospective |
| Official Title: | Magnetic Resonance Imaging (MRI) and Spectroscopy (MRS) Biomarkers of Neonatal Hypoxic Ischemic Encephalopathy |
- sensitivity of lactate editing MR spectroscopy sequence (software) relative to that of the standard MR spectroscopy sequence. [ Time Frame: 12 months ] [ Designated as safety issue: No ]The primary end-point will be reached when lactate and perfusion data have been collected from 30 neonates. The efficacy of the custom-MRS lactate editing sequence will be assessed relative to that of the standard MRS sequence for the detection of lactate (by comparing the lactate concentration (in mM) measured from the lactate edited MR spectra to that measured from the standard MR spectra).
- prognostic accuracy (sensitivity and specificity) of MRI and MRS for predicting motor outcome at age 2 [ Time Frame: 3 years ] [ Designated as safety issue: No ]The secondary end-point will be reached upon completion of a neurological development assessment at the age of 2 years. Patients will be classified as having a good or poor outcome based on their motor skills at age 2, and the prognostic accuracy (eg sensitivity and specificity for predicting neuromotor outcome) of the standard and new MRI and MRS sequences will be assessed.
| Estimated Enrollment: | 30 |
| Study Start Date: | November 2011 |
| Estimated Study Completion Date: | May 2014 |
| Estimated Primary Completion Date: | May 2014 (Final data collection date for primary outcome measure) |
| Groups/Cohorts |
|---|
|
neonates with perinatal asphyxia
neonates with suspected perinatal asphyxia (HIE)
|
Eligibility| Ages Eligible for Study: | up to 2 Weeks |
| Genders Eligible for Study: | Both |
| Accepts Healthy Volunteers: | No |
| Sampling Method: | Non-Probability Sample |
neonates with suspected hypoxic ischemic encephalopathy
Inclusion Criteria:
- Newborn infants (born at >36 weeks) with suspected perinatal asphyxia. Written informed consent from both parents.
Exclusion Criteria:
- Prematurity (born at < 36 weeks). Lack of written informed consent from both parents.
Contacts and Locations| Contact: Ruth L OGorman, PhD | +41 44 266 7356 | ruth.ogorman@kispi.uzh.ch |
| Switzerland | |
| University Children's Hospital Zurich, MRI Center | Recruiting |
| Zürich, Switzerland, 8032 | |
| Principal Investigator: | Ruth L O'Gorman, phD | University Children's Hospital Zurich, MRI Center |
More Information
No publications provided
| Responsible Party: | University Children's Hospital, Zurich |
| ClinicalTrials.gov Identifier: | NCT01481207 History of Changes |
| Other Study ID Numbers: | CIV-11-11-002981 |
| Study First Received: | November 21, 2011 |
| Last Updated: | February 13, 2013 |
| Health Authority: | Switzerland: Swissmedic |
Keywords provided by University Children's Hospital, Zurich:
|
magnetic resonance spectroscopy magnetic resonance imaging |
Additional relevant MeSH terms:
|
Brain Ischemia Ischemia Brain Damage, Chronic Delirium Encephalitis Hepatic Encephalopathy Neurotoxicity Syndromes Hypoxia-Ischemia, Brain Cerebrovascular Disorders Brain Diseases Central Nervous System Diseases Nervous System Diseases Vascular Diseases Cardiovascular Diseases Pathologic Processes |
Confusion Neurobehavioral Manifestations Neurologic Manifestations Signs and Symptoms Delirium, Dementia, Amnestic, Cognitive Disorders Mental Disorders Central Nervous System Viral Diseases Virus Diseases Central Nervous System Infections Liver Failure Hepatic Insufficiency Liver Diseases Digestive System Diseases Brain Diseases, Metabolic Metabolic Diseases |
ClinicalTrials.gov processed this record on May 23, 2013