It is likely that new treatments for neonatal cerebral injury will be developed in the near future. These treatments will probably require administration as soon as possible at the onset of injury. This makes it desirable to rapidly detect and quantitate cerebral injury in the newborn; both for determining when or whether to initiate treatment, and to evaluate the effects of treatment. At this time, there is no method for rapid detection and quantitation of such injury. Traditional methods of detecting injury -- history, examination, and imaging studies (mainly head ultrasound and computed tomography) -- take many hours to days to reveal injury. We propose to evaluate three forms of NMR image contrast for early detection and quantitation of cerebral injury. The NMR imaging methods to be studied will involve: 1) measurement of the apparent diffusion coefficient (ADC) of brain water, 2) detection of blood movement using a modification of the intravoxel incoherent method (IVIM), and 3) detection of blood movement using arterial water labeling techniques. With regards to determination of ADC, we will first determine standard, """"""""normal"""""""" values in term and preterm neonates. We will then make ADC measurements in neonates with known cerebral injury to evaluate the sensitivity of this method to such injury. Similarly, images of normal and abnormal brain will be obtained using imaging sequences sensitized to blood movement through either the IVIM method or arterial water labeling technique. Results from these three imaging modalities will be interpreted in the context of both the patient's initial history and physical examination, and the long-term outcome as monitored through the Follow-up core. It is our hope that these NMR methods will provide a method for rapid, precise assessment of neonatal brain injury and evaluation of the response of such injury to therapy.
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