Original Research

Neuroquantification enhances the radiological evaluation of term neonatal hypoxic-ischaemic cerebral injuries

Shalendra K. Misser, Nobuhle Mchunu, Jan W. Lotz, Lisa Kjonigsen, Aziz Ulug, Moherndran Archary
South African Journal of Radiology | Vol 27, No 1 | a2728 | DOI: https://doi.org/10.4102/sajr.v27i1.2728 | © 2023 Shalendra K. Misser, Nobuhle Mchunu, Jan W. Lotz, Lisa Kjonigsen, Aziz Ulug, Moherndran Archary | This work is licensed under CC Attribution 4.0
Submitted: 02 June 2023 | Published: 26 December 2023

About the author(s)

Shalendra K. Misser, Department of Radiology, Lake Smit and Partners Inc., Durban, South Africa; and, Department of Radiology, Faculty of Health Sciences, University of KwaZulu-Natal, Duban, South Africa
Nobuhle Mchunu, Biostatistics Research Unit, South African Medical Research Council, Durban, South Africa; and, Department of Statistics, Faculty of Science, School of Mathematics, Statistics and Computer Sciences, University of KwaZulu-Natal, Pietermaritzburg, South Africa
Jan W. Lotz, Department of Radiodiagnosis, Faculty of Sciences, Stellenbosch University, Cape Town, South Africa
Lisa Kjonigsen, Medtech, Oslo, Sweden
Aziz Ulug, Cortechs Labs, San Diego, United States of America
Moherndran Archary, Department of Pediatrics, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa


Background: Injury patterns in hypoxic-ischaemic brain injury (HIBI) are well recognised but there are few studies evaluating cerebral injury using neuroquantification models.

Objectives: Quantification of brain volumes in a group of patients with clinically determined cerebral palsy.

Method: In this retrospective study, 297 children with cerebral palsy were imaged for suspected HIBI with analysis of various cerebral substrates. Of these, 96 children over the age of 3 years with a clinical diagnosis of cerebral palsy and abnormal MRI findings underwent volumetric analyses using the NeuroQuant® software solution. The spectrum of volumetric changes and the differences between the various subtypes (and individual subgroups) of HIBI were compared.

Results: Compared with the available normative NeuroQuant® database, the average intracranial volume was reduced to the 1st percentile in all patient groups (p < 0.001). Statistically significant differences were observed among the types and subgroups of HIBI. Further substrate volume reductions were identified and described involving the thalami, brainstem, hippocampi, putamina and amygdala. The combined volumes of five regions of interest (frontal pole, putamen, hippocampus, brainstem and paracentral lobule) were consistently reduced in the Rolandic basal ganglia-thalamus (RBGT) subtype.

Conclusion: This study determined a quantifiable reduction of intracranial volume in all subtypes of HIBI and predictable selective cerebral substrate volume reduction in subtypes and subgroups. In the RBGT subtype, a key combination of five substrate injuries was consistently noted, and thalamic, occipital lobe and brainstem volume reduction was also significant when compared to the watershed subtype.

Contribution: This study demonstrates the value of integrating an artificial intelligence programme into the radiologists’ armamentarium serving to quantify brain injuries more accurately in HIBI. Going forward this will be an inevitable evolution of daily radiology practice in many fields of medicine, and it would be beneficial for radiologists to embrace these technological innovations.


neuroquantification; hypoxic-ischaemic; cerebral; term neonatal; magnetic resonance; artificial intelligence; brain volumetry

Sustainable Development Goal

Goal 3: Good health and well-being


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