Magnetic resonance venography to evaluate cerebral sinovenous thrombosis in infants receiving therapeutic hypothermia

• Published in: Pediatric research 2023-03, Vol.93 (4), p.985-989
• Main Authors: Munster, Chelsea B., El-Shibiny, Hoda, Szakmar, Eniko, Yang, Edward, Walsh, Brian H., Inder, Terrie E., El-Dib, Mohamed
• Format: Article
• Language: English
• Subjects: Brain Diseases - complications; Clinical Research Article; Humans; Hypothermia; Hypothermia, Induced - adverse effects; Infant; Infant, Newborn; Magnetic Resonance Imaging; Magnetic Resonance Spectroscopy; Medicine; Medicine & Public Health; Pediatric Surgery; Pediatrics; Phlebography - adverse effects; Sinus Thrombosis, Intracranial - diagnostic imaging; Sinus Thrombosis, Intracranial - therapy; Thrombosis; Thrombosis - complications
• ISSN: 0031-3998; 1530-0447
• DOI: 10.1038/s41390-022-02195-5

Background The incidence of cerebral sinovenous thrombosis (CSVT) in infants receiving therapeutic hypothermia for neonatal encephalopathy remains controversial. The aim of this study was to identify if the routine use of magnetic resonance venography (MRV) in term-born infants receiving hypothermia is associated with diagnostic identification of CSVT. Methods We performed a retrospective review of 291 infants who received therapeutic hypothermia from January 2014 to March 2020. Demographic and clinical data, as well as the incidence of CSVT, were compared between infants born before and after adding routine MRV to post-rewarming magnetic resonance imaging (MRI). Results Before routine inclusion of MRV, 209 babies were cooled, and 25 (12%) underwent MRV. Only one baby (0.5%) was diagnosed with CSVT in that period, and it was detected by structural MRI, then confirmed with MRV. After the inclusion of routine MRV, 82 infants were cooled. Of these, 74 (90%) had MRV and none were diagnosed with CSVT. Conclusion CSVT is uncommon in our cohort of infants receiving therapeutic hypothermia for neonatal encephalopathy. Inclusion of routine MRV in the post-rewarming imaging protocol was not associated with increased detection of CSVT in this population. Impact Cerebral sinovenous thrombosis (CSVT) in infants with NE receiving TH may not be as common as previously indicated. The addition of MRV to routine post-rewarming imaging protocol did not lead to increased detection of CSVT in infants with NE. Asymmetry on MRV of the transverse sinus is a common anatomic variant. MRI alone may be sufficient in indicating the presence of CSVT.