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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 3½-year-old child with cerebral palsy, born preterm with low birth weight, shows features of periventricular leukomalacia as sequelae to hypoxic ischemic brain injury. (A, B) Axial T2WI at the level of lateral ventricles shows significant reduction in volume and gliosis of the periventricular white matter. Also note mild dilatation and wavy margins of the lateral ventricle (black arrows)
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Figure 5: A 3½-year-old child with cerebral palsy, born preterm with low birth weight, shows features of periventricular leukomalacia as sequelae to hypoxic ischemic brain injury. (A, B) Axial T2WI at the level of lateral ventricles shows significant reduction in volume and gliosis of the periventricular white matter. Also note mild dilatation and wavy margins of the lateral ventricle (black arrows)

Mentions: End-stage PVL shows a characteristic appearance due to gliosis and loss of volume of the periventricular white matter and centrum semiovale [Figures 5 and 6]. This results in ventriculomegaly with dilatation of the trigones and occipital horns, as well as wavy ventricular contour. Thinning of the corpus callosum is a characteristic late feature and is particularly noted posteriorly [Figure 6] (involving the posterior body and splenium). PVL is most commonly seen as white matter hyperintensity adjacent to lateral ventricle at peritrigonal and foramen of Monro region [Figure 6].[6] PVL may also present as scattered punctate white matter abnormalities. Approximately two-third of PVL cases are associated with hemorrhage. If PVL is seen as isolated white matter hyperintensity at peritritrigonal region [Figure 7], then it should be differentiated from the terminal zones of myelination (TZM). TZM show a thin band of low signal between the ependymal margin of ventricle and high intensity zone in coronal T2 weighted and FLAIR images [Figure 8]. However, in PVL, the high intensity zone generally extends to the ventricular ependyma [Figures 6 and 7]. TZM also show a triangular shape with superior orientation of apex in coronal images.[12]


Magnetic resonance imaging spectrum of perinatal hypoxic-ischemic brain injury
A 3½-year-old child with cerebral palsy, born preterm with low birth weight, shows features of periventricular leukomalacia as sequelae to hypoxic ischemic brain injury. (A, B) Axial T2WI at the level of lateral ventricles shows significant reduction in volume and gliosis of the periventricular white matter. Also note mild dilatation and wavy margins of the lateral ventricle (black arrows)
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 5: A 3½-year-old child with cerebral palsy, born preterm with low birth weight, shows features of periventricular leukomalacia as sequelae to hypoxic ischemic brain injury. (A, B) Axial T2WI at the level of lateral ventricles shows significant reduction in volume and gliosis of the periventricular white matter. Also note mild dilatation and wavy margins of the lateral ventricle (black arrows)
Mentions: End-stage PVL shows a characteristic appearance due to gliosis and loss of volume of the periventricular white matter and centrum semiovale [Figures 5 and 6]. This results in ventriculomegaly with dilatation of the trigones and occipital horns, as well as wavy ventricular contour. Thinning of the corpus callosum is a characteristic late feature and is particularly noted posteriorly [Figure 6] (involving the posterior body and splenium). PVL is most commonly seen as white matter hyperintensity adjacent to lateral ventricle at peritrigonal and foramen of Monro region [Figure 6].[6] PVL may also present as scattered punctate white matter abnormalities. Approximately two-third of PVL cases are associated with hemorrhage. If PVL is seen as isolated white matter hyperintensity at peritritrigonal region [Figure 7], then it should be differentiated from the terminal zones of myelination (TZM). TZM show a thin band of low signal between the ependymal margin of ventricle and high intensity zone in coronal T2 weighted and FLAIR images [Figure 8]. However, in PVL, the high intensity zone generally extends to the ventricular ependyma [Figures 6 and 7]. TZM also show a triangular shape with superior orientation of apex in coronal images.[12]

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