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Objective dystonia prediction with MRI after neonatal hypoxic-ischemic encephalopathy

Aim: To determine an objective and clinically-feasible method to predict dystonia in cerebral palsy (CP) using magnetic resonance imaging (MRI) following neonatal hypoxic-ischemic encephalopathy (HIE). Methods: In this retrospective case-control study, we examined brain MRIs in neonates at age 4-5 days who underwent therapeutic hypothermia for HIE at a single tertiary care center. The lower average apparent diffusion coefficient (ADC) values between the left and right striatum and thalamus were determined using clinically-integrated software (IBM iConnect Access). Neonatal neurology, movement disorder, and cerebral palsy specialist notes were screened through age 5 years for motor abnormality documentation. Results: In 50 subjects, ADC values significantly predicted dystonia in CP with receiver operator characteristic areas under the curve of 0.862 (p=0.0004) in the striatum and 0.838 (p=0.001) in the thalamus. Striatal ADC values less than 1.014x10-3 mm2/s provided 100% specificity and 70% sensitivity for dystonia. Thalamic ADC values less than 0.973x10-3 mm2/s provided 100% specificity and 80% sensitivity for dystonia. Interpretation: In this small retrospective study, analysis of clinically-acquired MRIs predicted dystonia with high specificity following neonatal HIE. This could be a useful prognostication adjunct guiding when to establish appropriate vigilance for dystonia in CP.