Article

Automated core-penumbra quantification in neonatal ischemic brain injury.

Department of Pediatrics, Loma Linda University, Loma Linda, California, USA.
Journal of cerebral blood flow and metabolism: official journal of the International Society of Cerebral Blood Flow and Metabolism (Impact Factor: 5.46). 08/2012; DOI: 10.1038/jcbfm.2012.121
Source: PubMed

ABSTRACT Neonatal hypoxic-ischemic brain injury (HII) and arterial ischemic stroke (AIS) result in irreversibly injured (core) and salvageable (penumbral) tissue regions. Identification and reliable quantification of salvageable tissue is pivotal to any effective and safe intervention. Magnetic resonance imaging (MRI) is the current standard to distinguish core from penumbra using diffusion-perfusion mismatch (DPM). However, subtle MR signal variations between core-penumbral regions make their visual delineation difficult. We hypothesized that computational analysis of MRI data provides a more accurate assessment of core and penumbral tissue evolution in HII/AIS. We used two neonatal rat-pup models of HII/AIS (unilateral and global hypoxic-ischemia) and clinical data sets from neonates with AIS to test our noninvasive, automated computational approach, Hierarchical Region Splitting (HRS), to detect and quantify ischemic core-penumbra using only a single MRI modality (T2- or diffusion-weighted imaging, T2WI/DWI). We also validated our approach by comparing core-penumbral images (from HRS) to DPM with immunohistochemical validation of HII tissues. Our translational and clinical data results showed that HRS could accurately and reliably distinguish the ischemic core from penumbra and their spatiotemporal evolution, which may aid in the vetting and execution of effective therapeutic interventions as well as patient selection.Journal of Cerebral Blood Flow & Metabolism advance online publication, 29 August 2012; doi:10.1038/jcbfm.2012.121.

0 Bookmarks
 · 
168 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: The incidence of perinatal stroke is high, similar to that in the elderly, and produces a significant morbidity and severe long-term neurologic and cognitive deficits, including cerebral palsy, epilepsy, neuropsychological impairments, and behavioral disorders. Emerging clinical data and data from experimental models of cerebral ischemia in neonatal rodents have shown that the pathophysiology of perinatal brain damage is multifactorial. These studies have revealed that, far from just being a smaller version of the adult brain, the neonatal brain is unique with a very particular and age-dependent responsiveness to hypoxia-ischemia and focal arterial stroke. In this review, we discuss fundamental clinical aspects of perinatal stroke as well as some of the most recent and relevant findings regarding the susceptibility of specific brain cell populations to injury, the dynamics and the mechanisms of neuronal cell death in injured neonates, the responses of neonatal blood-brain barrier to stroke in relation to systemic and local inflammation, and the long-term effects of stroke on angiogenesis and neurogenesis. Finally, we address translational strategies currently being considered for neonatal stroke as well as treatments that might effectively enhance repair later after injury.Journal of Cerebral Blood Flow & Metabolism advance online publication, 26 March 2014; doi:10.1038/jcbfm.2014.41.
    Journal of cerebral blood flow and metabolism: official journal of the International Society of Cerebral Blood Flow and Metabolism 03/2014; · 5.46 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background:Gender is increasingly recognized as an important influence on brain development, disease susceptibility, and response to pharmacologic/rehabilitative treatments. In regenerative medicine, it remains entirely unknown whether there is an interaction between transplanted stem cells and host gender that might bias efficacy and safety in some patients but not others.Methods:We examined the role of recipient gender in a neonatal rat hypoxia-ischemic injury (HII) model, treated with human female neural stem cells (hNSCs), labeled with superparamagnetic iron-oxide (SPIO) particles implanted into the contralateral cerebral ventricle. We monitored HII evolution (by MRI, histopathology, behavioral testing) and hNSC fate (migration, replication, viability).Results:Recipient gender after implantation did not influence the volume or location of ischemic injury (1, 30, or 90d) or behavior (90d). SPIO labeling did not influence HII evolution. Implantation had its greatest benefit on mild/moderate injuries which remained stable rather than increasing as in severe HII as is the natural history for such lesions.Conclusions:Our results suggest that hNSC treatment (including using hNSCs that are pre-labeled with iron to allow tracking in real time by MRI) would be equally safe and effective for male and female human newborns with mild-to-moderate HII.Pediatric Research (2014); doi:10.1038/pr.2014.7.
    Pediatric Research 01/2014; · 2.84 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: We compared the efficacy of three automated brain injury detection methods, namely symmetry-integrated region growing (SIRG), hierarchical region splitting (HRS) and modified watershed segmentation (MWS) in human and animal magnetic resonance imaging (MRI) datasets for the detection of hypoxic ischemic injuries (HIIs). Diffusion weighted imaging (DWI, 1.5T) data from neonatal arterial ischemic stroke (AIS) patients, as well as T2-weighted imaging (T2WI, 11.7T, 4.7T) at seven different time-points (1, 4, 7, 10, 17, 24 and 31days post HII) in rat-pup model of hypoxic ischemic injury were used to assess the temporal efficacy of our computational approaches. Sensitivity, specificity, and similarity were used as performance metrics based on manual ('gold standard') injury detection to quantify comparisons. When compared to the manual gold standard, automated injury location results from SIRG performed the best in 62% of the data, while 29% for HRS and 9% for MWS. Injury severity detection revealed that SIRG performed the best in 67% cases while 33% for HRS. Prior information is required by HRS and MWS, but not by SIRG. However, SIRG is sensitive to parameter-tuning, while HRS and MWS are not. Among these methods, SIRG performs the best in detecting lesion volumes; HRS is the most robust, while MWS lags behind in both respects.
    Medical Image Analysis 10/2014; · 3.68 Impact Factor

Full-text (2 Sources)

Download
24 Downloads
Available from
Jul 3, 2014