Background: Early neonatal hypoxic-ischemic encephalopathy (HIE) diagnosis is crucial for prompt neuroprotective intervention. However, current diagnostic methods are restricted by suboptimal sensitivity and delays in prompt identification. Therefore, this study evaluates the impact of combining magnetic resonance imaging (MRI) with color Doppler ultrasound (CDU) on the diagnostic accuracy of early-stage neonatal HIE.

Methods: This retrospective cohort study included 56 neonates with HIE and 47 healthy controls. All study participants underwent both MRI and CDU examinations. MRI provided diffusion-weighted imaging sequences and apparent diffusion coefficient (ADC) values, while CDU assessed cerebral hemodynamics in the middle cerebral artery (MCA) and anterior cerebral artery (ACA). Furthermore, the diagnostic performance of this multimodal approach was evaluated using receiver operating characteristic (ROC) analysis.

Results: MRI showed significantly higher ADC values in the HIE group (14.44 ± 4.43) compared to controls (9.43 ± 3.42, p < 0.001). However, CDU findings revealed significantly lower peak systolic velocity (Vs) and end-diastolic velocity (Vd) values, along with higher resistance index in both MCA and ACA among the HIE group (p < 0.001). The combined MRI and CDU approach demonstrated significantly higher diagnostic accuracy for HIE (area under the curve (AUC): 0.918) compared to MRI alone (AUC: 0.797).

Conclusion: Integrating MRI and CDU significantly enhances early detection of neonatal HIE, enabling the prompt initiation of neuroprotective therapies and improving prognostic assessment. This multimodal strategy may bridge critical gaps in early HIE diagnosis.