# Characterization of Acute Pediatric Anoxic Brain Injury in Non-fatal Drowning Using MRI

> **NIH NIH R03** · UNIVERSITY OF TEXAS HLTH SCIENCE CENTER · 2020 · $77,000

## Abstract

Project Summary/Abstract
This is a pilot study to confirm localized lesions in acute pediatric anoxic brain injury (ABI) secondary to
nonfatal drowning using magnetic resonance imaging (MRI). Drowning is the third leading cause of death due
to unintentional injury worldwide, with the highest incidence in young children (ages 1-4 years). Although
drowning (i.e. submersion/immersion in liquid) results in multi-organ damage, the most devastating disability
results from brain injury.
Current diagnostic neuroimaging findings (largely via qualitative visual inspection) are nonspecific and offer
little value for prognosis or for directing therapeutic interventions in the acute injury phase of pediatric ABI post-
drowning. Our preliminary MRI studies show that chronic ABI displays lesions limited to the lenticulostriate
distribution, which is an end-arterial watershed zone, similar to focal ischemia seen in stroke. We found that
this localized pattern of injury exhibits gray matter atrophy and also white matter microstructural abnormalities
on diffusion-tensor images (DTI), by using fully automated quantitative imaging analysis. Interestingly, lesion
burden limited to the lenticulostriate distribution has not been reported in adults with nonfatal drowning and
may be observed only in children.
Acute ABI due to different ischemic neuropathologies can be detected sooner on diffusion-weighted images as
compared to other structural MRI modalities (i.e. T1 and T2-weighted images) according to evidence provided
in the literature. For example, detection of lesions occurs by 30 minutes after occlusion of vasculature in animal
stroke models on diffusion-weighted images. Further, focal microstructural compromise can be detected by 16
hours in perinatal asphyxia on diffusion-weighted images—which demonstrates a similar injury pattern in the
lenticulostriate distribution.
The overall goal of the proposal is to identify and validate acute-imaging markers for ABI in nonfatal drowning.
To this end, we seek to test 3 aims using structural MRI. Based on current literature and results from our
preliminary work, we expect an injury pattern that is localized to the lenticulostriate vascular distribution
affecting both gray and white matter. In the acute phase of injury, we will seek to demonstrate focal
abnormalities on DTI (Aim 1) and T2-weighted images (Aim 2). Additionally, we will correlate abnormalities on
DTI with duration of hospital stay (Aim 3), which promises to validate diagnostic and prognostic imaging
markers. Future testing of neuroprotective agents in the acute injury phase would leverage conclusions from
this feasibility study.

## Key facts

- **NIH application ID:** 9982115
- **Project number:** 5R03HD099783-02
- **Recipient organization:** UNIVERSITY OF TEXAS HLTH SCIENCE CENTER
- **Principal Investigator:** FLORENCE CHIANG
- **Activity code:** R03 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $77,000
- **Award type:** 5
- **Project period:** 2019-07-20 → 2022-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9982115

## Citation

> US National Institutes of Health, RePORTER application 9982115, Characterization of Acute Pediatric Anoxic Brain Injury in Non-fatal Drowning Using MRI (5R03HD099783-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/9982115. Licensed CC0.

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