Early pattern recognition in severe perinatal asphyxia: a prospective MRI study.
On the basis of MRI examinations in 88 neonates and infants with perinatal asphyxia, we defined 6 different patterns on T2-weighted images: pattern A--scattered hyperintensity of both hemispheres of the telencephalon with blurred border zones between cortex and white matter, indicating diffuse brain injury; pattern B--parasagittal hyperintensity extending into the corona radiata, corresponding to the watershed zones; pattern C--hyper- and hypointense lesions in thalamus and basal ganglia, which relate to haemorrhagic necrosis or iron deposition in these areas; pattern D--periventricular hyperintensity, mainly along the lateral ventricles, i.e. periventricular leukomalacia (PVL), originating from the matrix zone; pattern E--small multifocal lesions varying from hyper--to hypointense, interpreted as necrosis and haemorrhage; pattern F--periventricular centrifugal hypointense stripes in the centrum semiovale and deep white matter of the frontal and occipital lobes. Contrast was effectively inverted on T1-weighted images. Patterns A, B and C were found in 17%, 25% and 37% of patients, and patterns D, E and F in 19%, 17% and 35%, respectively. In 49 patients a combination of patterns was observed, but 30% of the initial images were normal. At follow-up, persistent abnormalities were seen in all children with patterns A and D, but in only 52% of those with pattern C. Myelination was retarded most often in patients with diffuse brain injury and PVL (patterns A and D).
University Children's Hospital, Zürich, Switzerland.
O
O
Baenziger
E
E
Martin
M
M
Steinlin
M
M
Good
R
R
Largo
R
R
Burger
S
S
Fanconi
G
G
Duc
R
R
Buchli
H
H
Rumpel
D001238:Asphyxia Neonatorum / Q000175:diagnosis*; D001921:Brain / Q000473:pathology; D001925:Brain Damage, Chronic / Q000175:diagnosis*; D002543:Cerebral Hemorrhage / Q000175:diagnosis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002534:Hypoxia, Brain / Q000175:diagnosis*; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000175:diagnosis*; D007969:Leukomalacia, Periventricular / Q000175:diagnosis; D008279:Magnetic Resonance Imaging; D008297:Male; D011247:Pregnancy; D011446:Prospective Studies