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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.

No MeSH data available.


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Diagrammatic illustration shows usual patterns of hypoxic ischemic brain injury in mild-to-moderate hypoperfusion in preterm and term neonates. Premature neonatal brain (left half) shows a periventricular border zone (black arrows) of white matter injury due to ventriculopetal vasculature The term neonate (right half) shows a more peripheral border zone (black stars) injury involving subcortical white matter and parasagittal cortex due to a ventriculofugal vasculature
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Figure 2: Diagrammatic illustration shows usual patterns of hypoxic ischemic brain injury in mild-to-moderate hypoperfusion in preterm and term neonates. Premature neonatal brain (left half) shows a periventricular border zone (black arrows) of white matter injury due to ventriculopetal vasculature The term neonate (right half) shows a more peripheral border zone (black stars) injury involving subcortical white matter and parasagittal cortex due to a ventriculofugal vasculature

Mentions: During mild-to-moderate hypoperfusion, autoregulation causes redistribution of blood flow to the hypermetabolically active deep gray matter structures. This results in injury predominantly to the watershed zones of the cerebrum. The vascular supply of the brain changes with brain maturation. In the preterm brain, ventriculopetal penetrating arteries supply the periventricular regions by extending inward from the surface of the brain. Thus, hypoperfusion results in a periventricular border zone of white matter injury [Figure 2]. In the full-term, ventriculofugal vessels also extend into the brain from the lateral ventricles and the intervascular border zone moves peripherally to a parasagittal location [Figure 2]. This results in subcortical white matter and parasagittal cortical injury during hypotension.


Magnetic resonance imaging spectrum of perinatal hypoxic-ischemic brain injury
Diagrammatic illustration shows usual patterns of hypoxic ischemic brain injury in mild-to-moderate hypoperfusion in preterm and term neonates. Premature neonatal brain (left half) shows a periventricular border zone (black arrows) of white matter injury due to ventriculopetal vasculature The term neonate (right half) shows a more peripheral border zone (black stars) injury involving subcortical white matter and parasagittal cortex due to a ventriculofugal vasculature
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: Diagrammatic illustration shows usual patterns of hypoxic ischemic brain injury in mild-to-moderate hypoperfusion in preterm and term neonates. Premature neonatal brain (left half) shows a periventricular border zone (black arrows) of white matter injury due to ventriculopetal vasculature The term neonate (right half) shows a more peripheral border zone (black stars) injury involving subcortical white matter and parasagittal cortex due to a ventriculofugal vasculature
Mentions: During mild-to-moderate hypoperfusion, autoregulation causes redistribution of blood flow to the hypermetabolically active deep gray matter structures. This results in injury predominantly to the watershed zones of the cerebrum. The vascular supply of the brain changes with brain maturation. In the preterm brain, ventriculopetal penetrating arteries supply the periventricular regions by extending inward from the surface of the brain. Thus, hypoperfusion results in a periventricular border zone of white matter injury [Figure 2]. In the full-term, ventriculofugal vessels also extend into the brain from the lateral ventricles and the intervascular border zone moves peripherally to a parasagittal location [Figure 2]. This results in subcortical white matter and parasagittal cortical injury during hypotension.

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