A pictorial review of the pathophysiology and classification of the magnetic resonance imaging patterns of perinatal term hypoxic ischemic brain injury – What the radiologist needs to know… (original) (raw)
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Magnetic resonance imaging spectrum of perinatal hypoxic-ischemic brain injury
Indian Journal of Radiology and Imaging, 2016
Perinatal hypoxic-ischemic brain injury results in neonatal hypoxic-ischemic encephalopathy and serious long-term neurodevelopmental sequelae. Magnetic resonance imaging (MRI) of the brain is an ideal and safe imaging modality for suspected hypoxic-ischemic injury. The pattern of injury depends on brain maturity at the time of insult, severity of hypotension, and duration of insult. Time of imaging after the insult influences the imaging findings. Mild to moderate hypoperfusion results in germinal matrix hemorrhages and periventricular leukomalacia in preterm neonates and parasagittal watershed territory infarcts in full-term neonates. Severe insult preferentially damages the deep gray matter in both term and preterm infants. However, associated frequent perirolandic injury is seen in term neonates. MRI is useful in establishing the clinical diagnosis, assessing the severity of injury, and thereby prognosticating the outcome. Familiarity with imaging spectrum and insight into factors affecting the injury will enlighten the radiologist to provide an appropriate diagnosis.
MRI Brain in Perinatal Hypoxia – A Case Series
IOSR Journal of Dental and Medical Sciences, 2016
Background: HIE is one of the most common cause of neonatal deaths and morbidity in children. Due to limited facilities in India, many a times HIE goes undetected only to present in later stages of life as handicapped children. Objective: To study the Magnetic Resonance Imaging (MRI) brain findings in children having suffered perinatal hypoxia, to analyze MRI findings in brain based on time of perinatal hypoxia. Material and Methods: A prospective Study was conducted on 100 patients suffered with perinatal hypoxia on Siemens 1.5 Tesla MAGNATOM AVANTO machine. Patterns of hypoxic ischemic brain injury in preterm and term infants of were evaluated. Results: Out of 100 cases, 72% were abnormal and 28% were normal studies. 36 %patients were preterms and 64% had term delivery. In patients with term delivery, 28.1 % were normal and 71.8 % were abnormal. In patients with preterm delivery, 72.3% cases were found to be abnormal while 27.7 % cases did not show any significant abnormality. Conclusion: MRI was a definitive diagnostic modality in perinatal hypoxia. Patterns of brain injury were determined by nature, timing and severity of insult. Imaging appearances were influenced by sequences used and time from injury.
2021
Int J Med Students • 2021 | Vol 9 | Suppl 1 DOI 10.5195/ijms/2021.978 | ijms.info The International Journal of Medical Students S4 Abstracts of the International Medical Students' Congress Sarajevo (SaMED) 2021 01. THE ASSESSMENT OF HYPOXIC ISCHEMIC BRAIN INJURY IN NEWBORNS WITH HISTORY OF PERINATAL ASPHYXIA USING MAGNETIC RESONANCE IMAGING VIKTORIJA ALEKSEJEVA1, Natalija Merkla2 1 Riga Stradins University, Riga, LV-1007, Latvia 2 Children's Clinical University Hospital, Riga, LV-1004, Latvia BACKGROUND: HIE is a significant brain injury due to perinatal asphyxia. The diagnosis of HIE is based on neurological and radiological examinations. MRI can be utilized to evaluate extent of injury, while MRS is widely used to assess the level of metabolites in the brain. AIM: To select patients diagnosed with perinatal asphyxia and evaluate the frequency of MRI use, results, and associations with clinical symptoms and the neurologist's conclusion regarding HII. METHODS: This retro...
Cranial MRI Findings in Predicting the Severity of Hypoxic-Ischemic Encephalopathy in Term Neonates
Journal of Dr. Behcet Uz Children s Hospital, 2021
Objective: The aim of this study is to compare magnetic resonance imaging (MRI) findings with severity of hypoxic-ischemic encephalopathy (HIE) in term neonates. Methods: Sixty-three newborns with HIE in whom cranial MRIs were performed within the first 3 weeks of life between 2016 and 2020 were included in the study. Severity of HIE was graded using Sarnat & Sarnat staging. In statistical analysis, Stage 1 was considered as mild, Stage 2 or 3 as severe HIE. The signal intensities of perirolandic cortex, posterior limb of internal capsule (PLIC), globus pallidus, and cerebrospinal tract on T1- weighted imaging (T1WI), and of perirolandic cortex, PLIC, ventrolateral thalamus, lateral edge of putamen and tegmentum on T2WI, and brain diffusion weighted imaging (DWI) findings were evaluated with consensus by two radiologists blinded to clinical findings. Gestational age, birth weight and MRI signal intensities were compared with HIE groups using t test, and Fisher-Exact test. Results: T...
BMC Pediatrics, 2014
Background: Despite therapeutic hypothermia 30-70% of newborns with moderate or severe hypoxic ischemic encephalopathy will die or survive with significant long-term impairments. Magnetic resonance imaging (MRI) in the first days of life is being used for early identification of these infants and end of life decisions are relying more and more on it. The purpose of this study was to evaluate how MRI performed around day 4 of life correlates with the ones obtained in the second week of life in infants with hypoxic-ischemic encephalopathy (HIE) treated with hypothermia. Methods: Prospective observational cohort study between April 2009 and July 2011. Consecutive newborns with HIE evaluated for therapeutic hypothermia were included. Two sequential MR studies were performed: an 'early' study around the 4th day of life and a 'late' study during the second week of life. MRI were assessed and scored by two neuroradiologists who were blinded to the clinical condition of the infants. Results: Forty-eight MRI scans were obtained in the 40 newborns. Fifteen infants underwent two sequential MR scans. The localization, extension and severity of hypoxic-ischemic injury in early and late scans were highly correlated. Hypoxic-ischemic injury scores from conventional sequences (T1/T2) in the early MRI correlated with the scores of the late MRI (Spearman ρ = 0.940; p < .001) as did the scores between diffusion-weighted images in early scans and conventional images in late MR studies (Spearman ρ = 0.866; p < .001). There were no significant differences in MR images between the two sequential scans. Conclusions: MRI in the first days of life may be a useful prognostic tool for clinicians and can help parents and neonatologist in medical decisions, as it highly depicts hypoxic-ischemic brain injury seen in scans performed around the second week of life.
Magnetic resonance imaging in perinatal brain injury: clinical presentation, lesions and outcome
Pediatric Radiology, 2006
Neonatal MR imaging is invaluable in assessing the term born neonate who presents with an encephalopathy. Successful imaging requires adaptations to both the hardware and the sequences used for adults. The perinatal and postnatal details often predict the pattern of lesions sustained and are essential for correct interpretation of the imaging findings, but additional or alternative diagnoses in infants with apparent hypoxic ischaemic encephalopathy should always be considered. Perinatally acquired lesions are usually at their most obvious between 1 and 2 weeks of age. Very early imaging (<3 days) may be useful to make management decisions in ventilated neonates, but abnormalities may be subtle at that stage. Diffusion-weighted imaging is clinically useful for the early identification of ischaemic white matter in the neonatal brain but is less reliable in detecting lesions within the basal ganglia and thalami. The pattern of lesions seen on MRI can predict neurodevelopmental outcome. Additional useful information may be obtained by advanced techniques such as MR angiography, venography and perfusion-weighted imaging. Serial imaging with quantification of both structure size and tissue damage provides invaluable insights into perinatal brain injury.
Magnetic Resonance Imaging in (Near-)Term Infants with Hypoxic-Ischemic Encephalopathy
Diagnostics, 2022
Hypoxic-ischemic encephalopathy (HIE) is a major cause of neurological sequelae in (near-)term newborns. Despite the use of therapeutic hypothermia, a significant number of newborns still experience impaired neurodevelopment. Neuroimaging is the standard of care in infants with HIE to determine the timing and nature of the injury, guide further treatment decisions, and predict neurodevelopmental outcomes. Cranial ultrasonography is a helpful noninvasive tool to assess the brain before initiation of hypothermia to look for abnormalities suggestive of HIE mimics or antenatal onset of injury. Magnetic resonance imaging (MRI) which includes diffusion-weighted imaging has, however, become the gold standard to assess brain injury in infants with HIE, and has an excellent prognostic utility. Magnetic resonance spectroscopy provides complementary metabolic information and has also been shown to be a reliable prognostic biomarker. Advanced imaging modalities, including diffusion tensor imagi...
State of the art of magnetic resonance (MR) in neonatal hypoxic-ischemic encephalopathy
Child's Nervous System, 1989
Magnetic resonance (MR) has begun to play an important role in neonatal neurology. Several M R I techniques have been applied to the diagnosis of hypoxic ischemic encephalopathy. Cerebral perfusion examined by intravoxel incoherent motion, a non-invasive tool, seems to be opening new inroads for detecting variations (neurophysiological modifications) in cerebral flows during hypoxic ischemic encephalopathy. MR spectroscopy allows identification of specific biochemical alteration of spectra patterns at various moments of hypoxic ischemic distress, including:
Evaluation of Neonatal Hypoxic-Ischemic Encephalopathy by MRI and Ultrasound
Journal of Diagnostic Medical Sonography, 2013
Hypoxic-ischemic encephalopathy (HIE) is a major cause of brain damage and neurodevelopmental abnormalities in full-term newborn infants. We are reporting the results of a study comparing cranial magnetic resonance imaging (MRI) and cranial sonography (US) in 150 neonates with suspected HIE. Magnetic resonance imaging findings were normal in 44 patients (29%); 18% of patients showed only basal ganglia (BG) brightness, 10.6% showed brightness of the BG with intracerebral hemorrhage, and 63% of patients showed additional diagnostic details. Cranial US was normal in 75 patients (50%) and showed increased periventricular echogenicity in 32%, intraventricular hemorrhage in 9%, and additional diagnostic details in 13%. There was a positive correlation between MRI studies and US ( P = .013). These data suggest that US is a worthwhile modality for the diagnosis of HIE but that early MRI findings will provide additional information in many cases in the detection of cerebral intraventricular ...