Purpose: Tocompare diffusion weighted (DWI) and non DWIMRI, proton MR spectroscopy (MRS), and clinical biomarkers for prediction of intellectual and motor function at 2 years of age in term infants with hypoxic ischaemic brain injury.

Method and Materials 20 consecutive infants > or = 36 weeks' gestation with HIE were enrolled between December 2005 and March 2009 . MRI was performed day 3-7 (mean =5) includingDWI and MRS. Baseline data included gender, 5 minute Apgar, Sarnat score, pH (cord blood, arterial, or capillary), and seizures. MRI was scored independently by 3 radiologists, blinded to clinical information and outcome,following development of a detailed imagescoring system that was trialled on a training set of 5 other MRI studies in term infants with...

Results: Agreement of the3 readerson DWI score was significantly higher (68%) than for non-DWI score (45%), chi-square =32 on 5 d.f. (P <0.0001). Univariate analysis showed Lac:NAA was not significantly associated with outcome (OR = 1.12, p=0.72) nor were 5 minute Apgar, pH, Sarnat score, seizures, or gender (p values = 0.47- 0.93). Thalamic DWI score (OR = 167; 2.5-11,294; p=0.017) and posterior limb internal capsule DWI score (OR=33; 1.5-720, p=0.03) and composite score for putamen, thalamus, subthalamic nucleus and posterior limb of internal capsule...

Conclusion: Agreement on DWI score was signficantly higher than non DWI. Composite DWI score for basal ganglia, thalamus, subthalamic nucleus and posterior limb internal capsule was significantly associated with poor outcome. Our findings contradict the conclusions of a recent systematic review by Thayli which found that image analysis was not predictive of outcome in infants with HIE but lactate to NAA ratio was.

Nil