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<meta name="DC.Title" content="Patterns of Brain Injury in Newborns Treated with Extracorporeal Membrane Oxygenation" />
<meta name="DC.Identifier" content="10.3174/ajnr.A5092" />
<meta name="DC.Date" content="2017-04-01" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
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<meta name="DC.Description" content="BACKGROUND AND PURPOSE: Neonates treated with extracorporeal membrane oxygenation are at risk for brain injury and subsequent neurodevelopmental compromise. Advances in MR imaging and improved accessibility have led to the increased use of routine MR imaging after extracorporeal membrane oxygenation. Our objective was to describe the frequency and patterns of extracorporeal membrane oxygenation–related brain injury based on MR imaging findings in a large contemporary cohort of neonates treated with extracorporeal membrane oxygenation.

MATERIALS AND METHODS: This was a retrospective study of neonatal patients treated with extracorporeal membrane oxygenation from 2005–2015 who underwent MR imaging before discharge. MR imaging and ultrasound studies were reviewed for location and type of parenchymal injury, ventricular abnormalities, and increased subarachnoid spaces. Parenchymal injury frequencies between patients treated with venoarterial and venovenous extracorporeal membrane oxygenation were compared by χ2 tests.

RESULTS: Of 81 neonates studied, 46% demonstrated parenchymal injury; 6% showed infarction, mostly in vascular territories (5% anterior cerebral artery, 5% MCA, 1% posterior cerebral artery); and 20% had hemorrhagic lesions. The highest frequency of injury occurred in the frontal (right, 24%; left, 25%) and temporoparietal (right, 14%; left, 19%) white matter. Sonography had low sensitivity for these lesions. Other MR imaging findings included volume loss (35%), increased subarachnoid spaces (44%), and ventriculomegaly (17% mild, 5% moderate, 1% severe). There were more parenchymal injuries in neonates treated with venoarterial (49%) versus venovenous extracorporeal membrane oxygenation (29%, P = .13), but the pattern of injury was consistent between both modes.

CONCLUSIONS: MR imaging identifies brain injury in nearly half of neonates after treatment with extracorporeal membrane oxygenation. The frontal and temporoparietal white matter are most commonly affected, without statistically significant laterality. This pattern of injury is similar between venovenous and venoarterial extracorporeal membrane oxygenation, though the frequency of injury may be higher after venoarterial extracorporeal membrane oxygenation.

CUS
:   cranial ultrasound
ECMO
:   extracorporeal membrane oxygenation
VA
:   venoarterial
VV
:   venovenous" />
<meta name="DC.Contributor" content="M.A. Wien" />
<meta name="DC.Contributor" content="M.T. Whitehead" />
<meta name="DC.Contributor" content="D. Bulas" />
<meta name="DC.Contributor" content="M. Ridore" />
<meta name="DC.Contributor" content="L. Melbourne" />
<meta name="DC.Contributor" content="G. Oldenburg" />
<meta name="DC.Contributor" content="B.L. Short" />
<meta name="DC.Contributor" content="A.N. Massaro" />
<meta name="article:published_time" content="2017-04-01" />
<meta name="article:section" content="PEDIATRICS" />
<meta name="citation_title" content="Patterns of Brain Injury in Newborns Treated with Extracorporeal Membrane Oxygenation" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;Neonates treated with extracorporeal membrane oxygenation are at risk for brain injury and subsequent neurodevelopmental compromise. Advances in MR imaging and improved accessibility have led to the increased use of routine MR imaging after extracorporeal membrane oxygenation. Our objective was to describe the frequency and patterns of extracorporeal membrane oxygenation–related brain injury based on MR imaging findings in a large contemporary cohort of neonates treated with extracorporeal membrane oxygenation.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;This was a retrospective study of neonatal patients treated with extracorporeal membrane oxygenation from 2005–2015 who underwent MR imaging before discharge. MR imaging and ultrasound studies were reviewed for location and type of parenchymal injury, ventricular abnormalities, and increased subarachnoid spaces. Parenchymal injury frequencies between patients treated with venoarterial and venovenous extracorporeal membrane oxygenation were compared by χ&lt;sup&gt;2&lt;/sup&gt; tests.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;Of 81 neonates studied, 46% demonstrated parenchymal injury; 6% showed infarction, mostly in vascular territories (5% anterior cerebral artery, 5% MCA, 1% posterior cerebral artery); and 20% had hemorrhagic lesions. The highest frequency of injury occurred in the frontal (right, 24%; left, 25%) and temporoparietal (right, 14%; left, 19%) white matter. Sonography had low sensitivity for these lesions. Other MR imaging findings included volume loss (35%), increased subarachnoid spaces (44%), and ventriculomegaly (17% mild, 5% moderate, 1% severe). There were more parenchymal injuries in neonates treated with venoarterial (49%) versus venovenous extracorporeal membrane oxygenation (29%, &lt;i&gt;P&lt;/i&gt; = .13), but the pattern of injury was consistent between both modes.&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;MR imaging identifies brain injury in nearly half of neonates after treatment with extracorporeal membrane oxygenation. The frontal and temporoparietal white matter are most commonly affected, without statistically significant laterality. This pattern of injury is similar between venovenous and venoarterial extracorporeal membrane oxygenation, though the frequency of injury may be higher after venoarterial extracorporeal membrane oxygenation.&lt;/p&gt;" />
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<meta name="twitter:title" content="Patterns of Brain Injury in Newborns Treated with Extracorporeal Membrane Oxygenation" />
<meta name="twitter:card" content="summary_large_image" />
<meta name="twitter:image" content="http://ajnr-stage2.stage.highwire.org/sites/default/files/highwire/ajnr/38/4.cover-source.jpg" />
<meta name="twitter:description" content="BACKGROUND AND PURPOSE: Neonates treated with extracorporeal membrane oxygenation are at risk for brain injury and subsequent neurodevelopmental compromise. Advances in MR imaging and improved accessibility have led to the increased use of routine MR imaging after extracorporeal membrane oxygenation. Our objective was to describe the frequency and patterns of extracorporeal membrane oxygenation–related brain injury based on MR imaging findings in a large contemporary cohort of neonates treated with extracorporeal membrane oxygenation.

MATERIALS AND METHODS: This was a retrospective study of neonatal patients treated with extracorporeal membrane oxygenation from 2005–2015 who underwent MR imaging before discharge. MR imaging and ultrasound studies were reviewed for location and type of parenchymal injury, ventricular abnormalities, and increased subarachnoid spaces. Parenchymal injury frequencies between patients treated with venoarterial and venovenous extracorporeal membrane oxygenation were compared by χ2 tests.

RESULTS: Of 81 neonates studied, 46% demonstrated parenchymal injury; 6% showed infarction, mostly in vascular territories (5% anterior cerebral artery, 5% MCA, 1% posterior cerebral artery); and 20% had hemorrhagic lesions. The highest frequency of injury occurred in the frontal (right, 24%; left, 25%) and temporoparietal (right, 14%; left, 19%) white matter. Sonography had low sensitivity for these lesions. Other MR imaging findings included volume loss (35%), increased subarachnoid spaces (44%), and ventriculomegaly (17% mild, 5% moderate, 1% severe). There were more parenchymal injuries in neonates treated with venoarterial (49%) versus venovenous extracorporeal membrane oxygenation (29%, P = .13), but the pattern of injury was consistent between both modes.

CONCLUSIONS: MR imaging identifies brain injury in nearly half of neonates after treatment with extracorporeal membrane oxygenation. The frontal and temporoparietal white matter are most commonly affected, without statistically significant laterality. This pattern of injury is similar between venovenous and venoarterial extracorporeal membrane oxygenation, though the frequency of injury may be higher after venoarterial extracorporeal membrane oxygenation.

CUS
:   cranial ultrasound
ECMO
:   extracorporeal membrane oxygenation
VA
:   venoarterial
VV
:   venovenous" />
<meta name="og-title" property="og:title" content="Patterns of Brain Injury in Newborns Treated with Extracorporeal Membrane Oxygenation" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/38/4/820" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: Neonates treated with extracorporeal membrane oxygenation are at risk for brain injury and subsequent neurodevelopmental compromise. Advances in MR imaging and improved accessibility have led to the increased use of routine MR imaging after extracorporeal membrane oxygenation. Our objective was to describe the frequency and patterns of extracorporeal membrane oxygenation–related brain injury based on MR imaging findings in a large contemporary cohort of neonates treated with extracorporeal membrane oxygenation.

MATERIALS AND METHODS: This was a retrospective study of neonatal patients treated with extracorporeal membrane oxygenation from 2005–2015 who underwent MR imaging before discharge. MR imaging and ultrasound studies were reviewed for location and type of parenchymal injury, ventricular abnormalities, and increased subarachnoid spaces. Parenchymal injury frequencies between patients treated with venoarterial and venovenous extracorporeal membrane oxygenation were compared by χ2 tests.

RESULTS: Of 81 neonates studied, 46% demonstrated parenchymal injury; 6% showed infarction, mostly in vascular territories (5% anterior cerebral artery, 5% MCA, 1% posterior cerebral artery); and 20% had hemorrhagic lesions. The highest frequency of injury occurred in the frontal (right, 24%; left, 25%) and temporoparietal (right, 14%; left, 19%) white matter. Sonography had low sensitivity for these lesions. Other MR imaging findings included volume loss (35%), increased subarachnoid spaces (44%), and ventriculomegaly (17% mild, 5% moderate, 1% severe). There were more parenchymal injuries in neonates treated with venoarterial (49%) versus venovenous extracorporeal membrane oxygenation (29%, P = .13), but the pattern of injury was consistent between both modes.

CONCLUSIONS: MR imaging identifies brain injury in nearly half of neonates after treatment with extracorporeal membrane oxygenation. The frontal and temporoparietal white matter are most commonly affected, without statistically significant laterality. This pattern of injury is similar between venovenous and venoarterial extracorporeal membrane oxygenation, though the frequency of injury may be higher after venoarterial extracorporeal membrane oxygenation.

CUS
:   cranial ultrasound
ECMO
:   extracorporeal membrane oxygenation
VA
:   venoarterial
VV
:   venovenous" />
<meta name="og-type" property="og:type" content="article" />
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    <div class="highwire-article-citation highwire-citation-type-highwire-article node54048--5" data-node-nid="54048" id="top-node-54048--61641556070" data-pisa="ajnr;38/4/820" data-pisa-master="ajnr;ajnr.A5092" data-apath="/ajnr/38/4/820.atom" data-hw-author-tooltip-instance="highwire_author_tooltip"><div class="highwire-cite highwire-cite-highwire-article highwire-citation-jcore-article-title-complete clearfix has-author-tooltip highwire-citation-highwire-article-top-a">
  
  
      <div class="highwire-cite-overline"><span  class="highwire-cite-metadata-article-type highwire-cite-metadata">Research Article</span><span class="separator-pipe"></span><span  class="highwire-cite-metadata-art-cat highwire-cite-metadata"><span class="wrapper">PEDIATRICS</span></span></div>
  
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      <h1 class="highwire-cite-title" id="page-title">Patterns of Brain Injury in Newborns Treated with Extracorporeal Membrane Oxygenation</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">M.A. Wien</span>, <span class="highwire-citation-author" data-delta="1">M.T. Whitehead</span>, <span class="highwire-citation-author" data-delta="2">D. Bulas</span>, <span class="highwire-citation-author" data-delta="3">M. Ridore</span>, <span class="highwire-citation-author" data-delta="4">L. Melbourne</span>, <span class="highwire-citation-author" data-delta="5">G. Oldenburg</span>, <span class="highwire-citation-author" data-delta="6">B.L. Short</span> and <span class="highwire-citation-author" data-delta="7">A.N. Massaro</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">April 2017,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">38 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(4) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">820-826; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A5092 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-54048--61641556070" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">M.A. Wien </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Divisions of Diagnostic Imaging and Radiology (M.A.W., M.T.W., D.B.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=M.A.%2BWien%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Wien%20M&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AM.A.%2BWien%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0002-0634-4635" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for M.A. Wien</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">M.T. Whitehead </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Divisions of Diagnostic Imaging and Radiology (M.A.W., M.T.W., D.B.)</div><div class='author-affiliation'><span class='nlm-sup'>d</span>The George Washington University School of Medicine (M.T.W., D.B., L.M., A.N.M.), Washington, DC.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=M.T.%2BWhitehead%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Whitehead%20M&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AM.T.%2BWhitehead%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0001-5077-693X" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for M.T. Whitehead</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">D. Bulas </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Divisions of Diagnostic Imaging and Radiology (M.A.W., M.T.W., D.B.)</div><div class='author-affiliation'><span class='nlm-sup'>b</span>Neonatology (D.B., M.R., L.M., B.L.S., A.N.M.)</div><div class='author-affiliation'><span class='nlm-sup'>d</span>The George Washington University School of Medicine (M.T.W., D.B., L.M., A.N.M.), Washington, DC.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=D.%2BBulas%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Bulas%20D&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AD.%2BBulas%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0001-5003-2105" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for D. Bulas</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">M. Ridore </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Neonatology (D.B., M.R., L.M., B.L.S., A.N.M.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=M.%2BRidore%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Ridore%20M&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AM.%2BRidore%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0002-7163-4751" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for M. Ridore</a></li></ul></div><div class="author-tooltip-4"><div class="author-tooltip-name">L. Melbourne </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Neonatology (D.B., M.R., L.M., B.L.S., A.N.M.)</div><div class='author-affiliation'><span class='nlm-sup'>d</span>The George Washington University School of Medicine (M.T.W., D.B., L.M., A.N.M.), Washington, DC.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=L.%2BMelbourne%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Melbourne%20L&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AL.%2BMelbourne%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0002-7420-0377" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for L. Melbourne</a></li></ul></div><div class="author-tooltip-5"><div class="author-tooltip-name">G. Oldenburg </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>c</span>the ECMO Program (G.O.), Children's National Health System, Washington, DC</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=G.%2BOldenburg%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Oldenburg%20G&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AG.%2BOldenburg%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0003-1041-9625" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for G. Oldenburg</a></li></ul></div><div class="author-tooltip-6"><div class="author-tooltip-name">B.L. Short </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Neonatology (D.B., M.R., L.M., B.L.S., A.N.M.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=B.L.%2BShort%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Short%20B&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AB.L.%2BShort%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0002-6785-9069" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for B.L. Short</a></li></ul></div><div class="author-tooltip-7"><div class="author-tooltip-name">A.N. Massaro </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Neonatology (D.B., M.R., L.M., B.L.S., A.N.M.)</div><div class='author-affiliation'><span class='nlm-sup'>d</span>The George Washington University School of Medicine (M.T.W., D.B., L.M., A.N.M.), Washington, DC.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=A.N.%2BMassaro%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Massaro%20A&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AA.N.%2BMassaro%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0002-5543-6165" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for A.N. 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    <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" data-highwire-cite-ref-tooltip-instance="highwire_reflinks_tooltip" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div class="article abstract-view "><span class="highwire-journal-article-marker-start"></span><div class="section abstract" id="abstract-1"><h2>Abstract</h2><div id="sec-1" class="subsection"><p id="p-1"><strong>BACKGROUND AND PURPOSE:</strong> Neonates treated with extracorporeal membrane oxygenation are at risk for brain injury and subsequent neurodevelopmental compromise. Advances in MR imaging and improved accessibility have led to the increased use of routine MR imaging after extracorporeal membrane oxygenation. Our objective was to describe the frequency and patterns of extracorporeal membrane oxygenation–related brain injury based on MR imaging findings in a large contemporary cohort of neonates treated with extracorporeal membrane oxygenation.</p></div><div id="sec-2" class="subsection"><p id="p-2"><strong>MATERIALS AND METHODS:</strong> This was a retrospective study of neonatal patients treated with extracorporeal membrane oxygenation from 2005–2015 who underwent MR imaging before discharge. MR imaging and ultrasound studies were reviewed for location and type of parenchymal injury, ventricular abnormalities, and increased subarachnoid spaces. Parenchymal injury frequencies between patients treated with venoarterial and venovenous extracorporeal membrane oxygenation were compared by χ<sup>2</sup> tests.</p></div><div id="sec-3" class="subsection"><p id="p-3"><strong>RESULTS:</strong> Of 81 neonates studied, 46% demonstrated parenchymal injury; 6% showed infarction, mostly in vascular territories (5% anterior cerebral artery, 5% MCA, 1% posterior cerebral artery); and 20% had hemorrhagic lesions. The highest frequency of injury occurred in the frontal (right, 24%; left, 25%) and temporoparietal (right, 14%; left, 19%) white matter. Sonography had low sensitivity for these lesions. Other MR imaging findings included volume loss (35%), increased subarachnoid spaces (44%), and ventriculomegaly (17% mild, 5% moderate, 1% severe). There were more parenchymal injuries in neonates treated with venoarterial (49%) versus venovenous extracorporeal membrane oxygenation (29%, <em>P</em> = .13), but the pattern of injury was consistent between both modes.</p></div><div id="sec-4" class="subsection"><p id="p-4"><strong>CONCLUSIONS:</strong> MR imaging identifies brain injury in nearly half of neonates after treatment with extracorporeal membrane oxygenation. The frontal and temporoparietal white matter are most commonly affected, without statistically significant laterality. This pattern of injury is similar between venovenous and venoarterial extracorporeal membrane oxygenation, though the frequency of injury may be higher after venoarterial extracorporeal membrane oxygenation.</p></div></div><div class="section glossary" id="glossary-1"><h2 class="">ABBREVIATIONS:</h2><dl id="def-list-1"><dt id="def-item-1">CUS<span class="def-item-dt-sep"></span></dt><dd>cranial ultrasound<span class="def-item-dd-sep"></span></dd><dt id="def-item-2">ECMO<span class="def-item-dt-sep"></span></dt><dd>extracorporeal membrane oxygenation<span class="def-item-dd-sep"></span></dd><dt id="def-item-3">VA<span class="def-item-dt-sep"></span></dt><dd>venoarterial<span class="def-item-dd-sep"></span></dd><dt id="def-item-4">VV<span class="def-item-dt-sep"></span></dt><dd>venovenous</dd></dl></div><ul class="copyright-statement"><li class="fn" id="copyright-statement-1">© 2017 by American Journal of Neuroradiology</li></ul><span class="highwire-journal-article-marker-end"></span></div><span class="related-urls"></span></div><a href="http://ajnr-stage2.stage.highwire.org/content/38/4/820.full" class="hw-link hw-link-article-full-text" data-icon-position="" data-hide-link-title="0">View Full Text</a></div>  </div>

  
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      <div class="highwire-cite-highlight"><a href="/content/38/4"  class="highlight-image-linked"><img class="highlight-image" src="http://ajnr-stage2.stage.highwire.org/sites/default/files/styles/medium/public/highwire/ajnr/38/4.cover-source.jpg?itok=D4eF0nE6" alt="American Journal of Neuroradiology: 38 (4)" /></a></div>
  
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        	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-volume highwire-cite-metadata">Vol. 38</span>, <span  class="highwire-cite-metadata-issue highwire-cite-metadata">Issue 4 </span><div  class="highwire-cite-metadata-pubdate highwire-cite-metadata">1 Apr 2017 </div></div>
      
      
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    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">M.A.</span> <span class="nlm-surname">Wien</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">M.T.</span> <span class="nlm-surname">Whitehead</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">D.</span> <span class="nlm-surname">Bulas</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">M.</span> <span class="nlm-surname">Ridore</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">L.</span> <span class="nlm-surname">Melbourne</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">G.</span> <span class="nlm-surname">Oldenburg</span></span>, <span class="highwire-citation-author" data-delta="6"><span class="nlm-given-names">B.L.</span> <span class="nlm-surname">Short</span></span>, <span class="highwire-citation-author" data-delta="7"><span class="nlm-given-names">A.N.</span> <span class="nlm-surname">Massaro</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Apr 2017, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">38 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(4) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">820-826; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A5092 </span></div>
  
  
  
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    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">M.A.</span> <span class="nlm-surname">Wien</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">M.T.</span> <span class="nlm-surname">Whitehead</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">D.</span> <span class="nlm-surname">Bulas</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">M.</span> <span class="nlm-surname">Ridore</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">L.</span> <span class="nlm-surname">Melbourne</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">G.</span> <span class="nlm-surname">Oldenburg</span></span>, <span class="highwire-citation-author" data-delta="6"><span class="nlm-given-names">B.L.</span> <span class="nlm-surname">Short</span></span>, <span class="highwire-citation-author" data-delta="7"><span class="nlm-given-names">A.N.</span> <span class="nlm-surname">Massaro</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Apr 2017, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">38 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(4) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">820-826; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A5092 </span></div>
  
  
  
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