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Magnetic resonance imaging spectrum of perinatal hypoxic-ischemic brain injury

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ABSTRACT

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.

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(A, B): Axial magnetic resonance imaging (MRI) of a 5 day old full-term neonate at the level of internal capsule. (A) T1 weighted image (WI) shows normally increased signal intensity (SI) of the posterior limb of internal capsule relative to the basal ganglia and thalamus; (B) Corresponding T2WI shows normal hypointense signal of the posterior limb of internal capsule; (C, D): Just above (A, B), shows normal variation in SI of the basal ganglia and thalamus. (C) T1WI shows normally increased SI of the posterior limb of internal capsule (large black arrow) and ventrolateral thalamus (small black arrows). Note the moderate hyperintensity of globus pallidus, which is a normal variation (small white arrow). (D) Corresponding T2WI shows normal hypointense signal of the posterior limb of internal capsule
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Figure 1: (A, B): Axial magnetic resonance imaging (MRI) of a 5 day old full-term neonate at the level of internal capsule. (A) T1 weighted image (WI) shows normally increased signal intensity (SI) of the posterior limb of internal capsule relative to the basal ganglia and thalamus; (B) Corresponding T2WI shows normal hypointense signal of the posterior limb of internal capsule; (C, D): Just above (A, B), shows normal variation in SI of the basal ganglia and thalamus. (C) T1WI shows normally increased SI of the posterior limb of internal capsule (large black arrow) and ventrolateral thalamus (small black arrows). Note the moderate hyperintensity of globus pallidus, which is a normal variation (small white arrow). (D) Corresponding T2WI shows normal hypointense signal of the posterior limb of internal capsule

Mentions: Our interest is specifically confined to the posterior limb of internal capsule and to a lesser degree to the ventrolateral nucleus of the thalamus. Increased T1 signal intensity of myelination is seen in the posterior half of the posterior limb of the internal capsule in normal neonates after 37 weeks of gestational age. This should be seen at least for one-third of the length of the posterior limb of the internal capsule [Figure 1A–D]. This and the corresponding T2 hypointensity can be seen usually during the first 24 hours of life.


Magnetic resonance imaging spectrum of perinatal hypoxic-ischemic brain injury
(A, B): Axial magnetic resonance imaging (MRI) of a 5 day old full-term neonate at the level of internal capsule. (A) T1 weighted image (WI) shows normally increased signal intensity (SI) of the posterior limb of internal capsule relative to the basal ganglia and thalamus; (B) Corresponding T2WI shows normal hypointense signal of the posterior limb of internal capsule; (C, D): Just above (A, B), shows normal variation in SI of the basal ganglia and thalamus. (C) T1WI shows normally increased SI of the posterior limb of internal capsule (large black arrow) and ventrolateral thalamus (small black arrows). Note the moderate hyperintensity of globus pallidus, which is a normal variation (small white arrow). (D) Corresponding T2WI shows normal hypointense signal of the posterior limb of internal capsule
© Copyright Policy - open-access
Related In: Results  -  Collection

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Show All Figures
getmorefigures.php?uid=PMC5036328&req=5

Figure 1: (A, B): Axial magnetic resonance imaging (MRI) of a 5 day old full-term neonate at the level of internal capsule. (A) T1 weighted image (WI) shows normally increased signal intensity (SI) of the posterior limb of internal capsule relative to the basal ganglia and thalamus; (B) Corresponding T2WI shows normal hypointense signal of the posterior limb of internal capsule; (C, D): Just above (A, B), shows normal variation in SI of the basal ganglia and thalamus. (C) T1WI shows normally increased SI of the posterior limb of internal capsule (large black arrow) and ventrolateral thalamus (small black arrows). Note the moderate hyperintensity of globus pallidus, which is a normal variation (small white arrow). (D) Corresponding T2WI shows normal hypointense signal of the posterior limb of internal capsule
Mentions: Our interest is specifically confined to the posterior limb of internal capsule and to a lesser degree to the ventrolateral nucleus of the thalamus. Increased T1 signal intensity of myelination is seen in the posterior half of the posterior limb of the internal capsule in normal neonates after 37 weeks of gestational age. This should be seen at least for one-third of the length of the posterior limb of the internal capsule [Figure 1A–D]. This and the corresponding T2 hypointensity can be seen usually during the first 24 hours of life.

View Article: PubMed Central - PubMed

ABSTRACT

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.

No MeSH data available.


Related in: MedlinePlus