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• Clinical Article •
DTI-ALPS reveals abnormal glymphatic system in full-term neonates with hypoxic-ischemic encephalopathy
CAO Weibin  CHEN Yonggang  QIAN Fangfang  RAN Qiying  XIE Jiazhi  TANG Shilong 

Cite this article as CAO W B, CHEN Y G, QIAN F F, et al. DTI-ALPS reveals abnormal glymphatic system in full-term neonates with hypoxic-ischemic encephalopathy[J]. Chin J Magn Reson Imaging, 2026, 17(6): 46-54. DOI:10.12015/issn.1674-8034.2026.06.006.


[Abstract] Objective To investigate the feasibility of applying the diffusion tensor imaging-analysis along the perivascular space (DTI-ALPS) technique in the brains of full-term neonates with hypoxic-ischemic encephalopathy (HIE).Materials and Methods A prospective study was conducted. Forty-three HIE full-term neonates aged 1 to 28 days were recruited as the study group, and 37 age- and sex-matched full-term neonates without brain abnormalities served as the control group. All neonates underwent conventional MRI sequences and diffusion tensor imaging (DTI) scans. The DTI-ALPS index, reflecting glymphatic system activity, was obtained through post-processing software. The DTI-ALPS values in relevant brain regions were compared and analyzed between the two groups to identify characteristics of the glymphatic system in HIE neonates.Results The DTI-ALPS index was significantly lower in HIE neonates compared to controls (t = 9.12, P < 0.05). Among HIE neonates, the DTI-ALPS index was lower in the 1 to 5 days subgroup than in the 6 to 10 days subgroup (t = 8.98, P < 0.05), while it was higher in the 11 to 20 days subgroup than in the 6 to 10 days subgroup (t = 8.28, P < 0.05). No significant difference was found between the 11 to 20 days and 21 to 28 days subgroups (t = 0.40, P = 0.70). Mild HIE patients exhibited a higher DTI-ALPS index than moderate/severe HIE patients (F = 36.5, P < 0.05), with no significant difference between moderate and severe HIE patients (t = 1.69, P = 0.114). HIE patients with brain injury had a lower DTI-ALPS index than those without (t = 4.08, P < 0.05). The DTI-ALPS index demonstrated good discriminatory ability for identifying HIE neonates (AUC = 0.922, P < 0.001).Conclusions The DTI-ALPS imaging technique reveals abnormalities in the glymphatic system of full-term neonates with hypoxic-ischemic encephalopathy.
[Keywords] hypoxic-ischemic encephalopathy；neonate；diffusion tensor imaging；analysis along the perivascular space；magnetic resonance imaging；glymphatic system

CAO Weibin1   CHEN Yonggang2   QIAN Fangfang3   RAN Qiying3   XIE Jiazhi3   TANG Shilong3*  

1 Department of Radiology, Bishan Maternal and Child Health Hospital, Chongqing 402760, China

2 Department of Pharmacy Children's Hospital of Chongqing Medical University, Chongqing 400014, China

3 Department of Radiology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Children and Adolescents' Health and Diseases, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, Chongqing 400014, China

Corresponding author: TANG S L, E-mail: tangshilong66@163.com

Conflicts of interest   None.

Received  2026-01-22
Accepted  2026-04-30
DOI: 10.12015/issn.1674-8034.2026.06.006
Cite this article as CAO W B, CHEN Y G, QIAN F F, et al. DTI-ALPS reveals abnormal glymphatic system in full-term neonates with hypoxic-ischemic encephalopathy[J]. Chin J Magn Reson Imaging, 2026, 17(6): 46-54. DOI:10.12015/issn.1674-8034.2026.06.006.

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