Distribution of Intra-Thalamic Injury According to Nuclei and Vascular Territories in Children with Term Hypoxic-Ischemic Injury



      Term hypoxic-ischemic injury (HII) on MRI is described as the basal ganglia thalamus [BGT], watershed [WS], or combined [BGT/WS]. We aimed to determine differences between HII groups in intra-thalamic distribution.


      Delayed MRIs of children with HII and thalamic injury were reviewed. Custom tools were placed over T2-W/FLAIR axial images to determine distribution of intra-thalamic injury: a) 6 subjective (whole/near-whole, central, anterior, posterior, lateral, medial), b) 4 nuclear (anterior [AN], ventrolateral [VLN], medial [MN], and pulvinar [PN]), and c) 3 arterial (thalamo perforating [TPA], thalamogeniculate [TGA], and posterior choroidal [PCA]) locations. We compared the frequency of injury of the above intra-thalamic locations between HII groups (BGT, WS, and BGT/WS) using Chi-square analysis.


      The 128 children (mean age at MRI 7.35±3.6 years) comprised 41% (n=53) BGT, 26% (n=33) WS and 33% (n=42) BGT/WS. The VLN was most frequently involved (66%, n=85), followed by PN (56%, n=72), MN (44%, n=56), and AN (28%, n=36). The TGA (93%, n=128), was the most frequent arterial region involved, followed by TPA (54%, n=69), and PCA (48%, n=61). VLN injury occurred more frequently in the BGT group (p<0.001); PN in the WS group (p<0.001); AN (p<0.001), MN (p<0.001), PN (p=0.001) and all nuclei together (p<0.001) in the BGT/WS group. The combination of all vascular territories was significantly associated with BGT/WS.


      There are significant differences in intra-thalamic nuclear and arterial injuries between the different types of HII, likely due to different pathogenesis.


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