Association of hypoxic-ischemic injury with MRI-derived glymphatic function markers in neonates: analysis of perivascular space volume and diffusion-tensor imaging
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Objective
To evaluate the relationship between hypoxic-ischemic injury (HII) and glymphatic function in neonates using two imaging biomarkers—basal ganglia perivascular space (BG-PVS) volume and diffusion-tensor imaging along the perivascular space (DTI-ALPS)—and to explore their interconnection.
Methods
This retrospective single-institution study collected neonatal brain MRIs from July 2020 to July 2022. BG-PVS volume and fraction were automatically extracted from 3D T2-weigthed images processing. DTI-ALPS indices were derived from DTI maps. Comparisons of BG-PVS parameters and DTI-ALPS indices were performed between neonates with and without HII. Logistic regression adjusted for age, sex, birth weight, and delivery mode. Correlations between BG-PVS parameters and DTI-ALPS indices were also evaluated.
Results
The study included 97 neonates without HII (median gestational age 252 days; 46 males) and 30 with HII (252 days; 16 males). Neonates with HII had smaller BG-PVS volumes (19 vs. 33 mm³, p = 0.001) and fractions (0.29% vs. 0.54%, p = 0.003) compared to neonates without HII. Logistic regression revealed a negative association between BG-PVS volume (OR: 0.96, 95% CI: 0.93–0.99) and fraction (OR: 0.15, 95% CI: 0.03–0.79) with HII. DTI-ALPS indices showed no evidence of differences between the neonates with and without HII ( p = 0.54) or association with HII ( p = 0.41). BG-PVS parameters and DTI-ALPS indices showed no evidence of correlation (coefficient = -0.28 – -0.08, p s > 0.05).
Conclusion
Neonates with HII demonstrated smaller BG-PVS volume and fraction compared to those without injury, indicating potential alterations in glymphatic function among affected newborns.
Question
Hypoxic-ischemic injury in neonates is a critical clinical concern, yet the relationship between this injury and glymphatic function remains unclear
Findings
Neonates with hypoxic-ischemic injury showed smaller basal ganglia perivascular spaces, while diffusion-tensor imaging analysis along perivascular space showed no significant difference.
Clinical Relevance
Basal ganglia perivascular space volume assessment provides a potential imaging biomarker for evaluating glymphatic system alterations in neonates with hypoxic-ischemic injury.
