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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 24-day-old neonate born preterm (32 weeks) with germinal matrix intraventricular hemorrhage (GM-IVH) grade II. (A, B) Axial T2WI at the level of lateral ventricles show left germinal matrix hemorrhage (black arrow) with extension in to the occipital horn (white arrow) and mild ventricular dilatation. Coronal (C) and sagittal (D) T2WI show left germinal matrix hemorrhage (black arrow). (E) Axial TIWI at the level of lateral ventricles shows T1 hyperintensity at left germinal matrix hemorrhage (black arrow). (F) Axial gradient image shows corresponding subependymal blooming area (black arrow)
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Figure 9: A 24-day-old neonate born preterm (32 weeks) with germinal matrix intraventricular hemorrhage (GM-IVH) grade II. (A, B) Axial T2WI at the level of lateral ventricles show left germinal matrix hemorrhage (black arrow) with extension in to the occipital horn (white arrow) and mild ventricular dilatation. Coronal (C) and sagittal (D) T2WI show left germinal matrix hemorrhage (black arrow). (E) Axial TIWI at the level of lateral ventricles shows T1 hyperintensity at left germinal matrix hemorrhage (black arrow). (F) Axial gradient image shows corresponding subependymal blooming area (black arrow)

Mentions: Germinal matrix–intraventricular hemorrhage (GM-IVH) is unique to the immature brain and is never seen beyond the neonatal period. GM-IVH occurs approximately in one-fourth of the low birth weight preterm neonates. It is found in late antenatal or immediate postnatal period in at one-third of the cases.[13] The spectrum of GM-IVH [Figures 4, 9, and 10] is classically described in the literature as follows.


Magnetic resonance imaging spectrum of perinatal hypoxic-ischemic brain injury
A 24-day-old neonate born preterm (32 weeks) with germinal matrix intraventricular hemorrhage (GM-IVH) grade II. (A, B) Axial T2WI at the level of lateral ventricles show left germinal matrix hemorrhage (black arrow) with extension in to the occipital horn (white arrow) and mild ventricular dilatation. Coronal (C) and sagittal (D) T2WI show left germinal matrix hemorrhage (black arrow). (E) Axial TIWI at the level of lateral ventricles shows T1 hyperintensity at left germinal matrix hemorrhage (black arrow). (F) Axial gradient image shows corresponding subependymal blooming area (black arrow)
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 9: A 24-day-old neonate born preterm (32 weeks) with germinal matrix intraventricular hemorrhage (GM-IVH) grade II. (A, B) Axial T2WI at the level of lateral ventricles show left germinal matrix hemorrhage (black arrow) with extension in to the occipital horn (white arrow) and mild ventricular dilatation. Coronal (C) and sagittal (D) T2WI show left germinal matrix hemorrhage (black arrow). (E) Axial TIWI at the level of lateral ventricles shows T1 hyperintensity at left germinal matrix hemorrhage (black arrow). (F) Axial gradient image shows corresponding subependymal blooming area (black arrow)
Mentions: Germinal matrix–intraventricular hemorrhage (GM-IVH) is unique to the immature brain and is never seen beyond the neonatal period. GM-IVH occurs approximately in one-fourth of the low birth weight preterm neonates. It is found in late antenatal or immediate postnatal period in at one-third of the cases.[13] The spectrum of GM-IVH [Figures 4, 9, and 10] is classically described in the literature as follows.

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