Comparing tract-based spatial statistics and manual region-of-Interest labeling as diffusion analysis methods to detect white matter abnormalities in infants with hypoxic- Ischemic encephalopathy

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Purpose—To compare manual region of interest (ROI) labeling and tract-based spatial statistics (TBSS) by their ability to detect group-wise differences in fractional anisotropy (FA) in the neonatal brain. Materials and Methods—Diffusion weighted data were obtained for nine infants with hypoxicischemic encephalopathy (HIE) (6 males, 3 females; gestational age (GA) range, 36–40 weeks; mean GA, 37.8 weeks) and eleven healthy-control infants (10 males, 1 female; GA range, 36–40 weeks; mean GA, 38.4 weeks) at 3T. For manual ROI labeling, ROIs were drawn freehand for each subject in eight, clinically relevant brain regions. For TBSS, all FA data underwent an optimized, automated protocol for neonates. Each method was evaluated for detection of decreased FA in HIE infants, sensitivity, specificity, and variability. Results—FA values from manual ROI and TBSS were strongly correlated (r=0.94, p