MRI Pattern Analysis and MRI Severity Score in the Assessment of Acute Global Hypoxia in Adults and Its Prognostic Value: A Prospective Study

Background: The study aims to evaluate the MRI patterns and severity scores of adult patients with acute global hypoxic-ischaemic encephalopathy (HIE). It also evaluates the predictive value of advanced MRI sequences, such as arterial spin labelling (ASL), susceptibility-weighted imaging (SWI), MR angiography (MRA), and MR venography (MRV). Methods: A prospective observational study was conducted at a tertiary care facility between December 2023 and December 2024. Forty-three adult individuals with clinical suspicions of HIE were studied. MRI sequences such as DWI, FLAIR, ASL, SWI, MRA, and MRV were examined to identify specific hypoxic injury patterns and also to generate an imaging severity score. Clinical outcomes were assessed using the cerebral performance category (CPC) scale. Results: The majority of cases (97.7%) showed diffuse cortical involvement with deep grey matter and perirolandic areas. Patterns of bilateral medial occipital lobes, perirolandic region, diffuse cortical, diffuse cortical with deep grey matter, deep white matter, brain stem, cerebellum, and hippocampus involvement were strongly related to poor outcomes (CPC-5). On ASL, diffuse hypoperfusion and bilateral medial occipital hyperperfusion, medullary vein prominence on SWI, were associated with poor outcomes. The imaging severity score from all sequences significantly correlated with prognosis ( P < .05). Conclusion: This prospective study found that MRI, when standard sequences like DWI and FLAIR are paired with advanced sequences like ASL, SWI, MRA, and MRV, is an excellent approach for evaluating the quantity and pattern of acute global hypoxic-ischaemic brain injury (HIBI) in adults. The imaging severity score is a structured approach to stratifying patients by prognosis and guiding management.