title: Echoplanar diffusion-weighted imaging in neonates and infants with suspected hypoxic-ischemic injury: correlation with patient outcome.
abstract: OBJECTIVE
  Our objective was to examine the effectiveness of echoplanar diffusion-weighted (DW) imaging in detecting CNS ischemia in neonates and infants and to determine how well the imaging findings using this technique correlate with short-term neurologic deficit.
  
  
  METHODS
  Echoplanar DW images, turbo T2-weighted images, and fluid-attenuated inversion recovery (FLAIR) sequences were obtained in a clinically defined cohort of 26 consecutive neonates and infants with suspected hypoxic-ischemic injury. Echoplanar DW imaging was performed with the diffusion gradient in the slice-select direction: b value, 1200 sec/mm2; matrix, 128 x 128, interpolated to 256 x 256. Four scans (4 sec per scan) were obtained and averaged to optimize the signal-to-noise ratio. Most patients were not sedated (n = 19). Abnormalities seen on DW imaging were correlated with clinical findings at short-term follow-up and compared with findings on FLAIR and turbo T2-weighted images.
  
  
  RESULTS
  Short-term clinical follow-up showed neurologic deficit in 10 (83%) of 12 patients with DW images with abnormal findings, and no neurologic sequelae in 12 (86%) of 14 patients with DW images with normal findings. Echoplanar DW images revealed a greater extent of and a larger number of abnormalities compared with FLAIR or turbo T2-weighted images in 11 (92%) of 12 patients with DW images with abnormal findings.
  
  
  CONCLUSIONS
  Echoplanar DW imaging reveals abnormalities poorly depicted on turbo T2-weighted and FLAIR images in neonates and infants with clinically suspected hypoxic-ischemic injury. DW imaging may be able to identify which patients are likely to develop at least short-term neurologic deficits and may afford the best early evaluation of short-term neurologic prognosis in these patients.
authors.affiliation: Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA.
authors.forename: A J
authors.initials: AJ
authors.lastname: Johnson
authors.forename: B C
authors.initials: BC
authors.lastname: Lee
authors.forename: W
authors.initials: W
authors.lastname: Lin
mesh_terms: D001921:Brain / Q000473:pathology; D002545:Brain Ischemia / Q000150:complications / Q000175:diagnosis*; D017352:Echo-Planar Imaging; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009422:Nervous System Diseases / Q000209:etiology; D011379:Prognosis; D012189:Retrospective Studies