title: Diffusion-weighted imaging in neonatal cerebral infarction: clinical utility and follow-up.
abstract: We describe the clinical utility of echo-planar diffusion-weighted imaging in neonatal cerebral infarction. Eight full-term neonates aged 1 to 8 days referred for neonatal seizures were studied. Patients were followed for a mean of 17 months with detailed neurologic examinations at regular intervals. Head computed tomography (CT) and conventional magnetic resonance (MRI) and diffusion-weighted images were obtained. Percent lesion contrast was evaluated for 19 lesions on T2-weighted and diffusion-weighted images. Follow-up conventional MRIs were obtained in seven patients. The findings on diffusion-weighted imaging were correlated with CT and conventional MRI findings as well as with short-term neurodevelopmental outcome. Four patients had focal cerebral infarctions. Four patients had diffuse injury consistent with hypoxic-ischemic encephalopathy. Percent lesion contrast of all 19 lesions was significantly higher on diffusion-weighted images when compared with T2-weighted images. In five patients, there were lesions visualized only with diffusion-weighted imaging. In all patients, there was increased lesion conspicuity and better definition of lesion extent on the diffusion-weighted images compared with the CT and T2-weighted MR images. In seven of eight patients follow-up imaging confirmed prior infarctions. Short-term neurologic outcome correlated with the extent of injury seen on the initial diffusion-weighted imaging scans for all patients. Diffusion-weighted imaging is useful in the evaluation of acute ischemic brain injury and seizure etiology in neonates. In the acute setting, diffusion-weighted imaging provides information not available on CT and conventional MRI. This information correlates with short-term clinical outcome.
authors.affiliation: Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston 02114, USA.
authors.forename: K S
authors.initials: KS
authors.lastname: Krishnamoorthy
authors.forename: T B
authors.initials: TB
authors.lastname: Soman
authors.forename: M
authors.initials: M
authors.lastname: Takeoka
authors.forename: P W
authors.initials: PW
authors.lastname: Schaefer
mesh_terms: D001921:Brain / Q000098:blood supply / Q000000981:diagnostic imaging / Q000473:pathology; D002544:Cerebral Infarction / Q000175:diagnosis*; D004058:Diffusion; D017352:Echo-Planar Imaging / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005625:Frontal Lobe / Q000098:blood supply / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D008297:Male; D009778:Occipital Lobe / Q000098:blood supply / Q000000981:diagnostic imaging / Q000473:pathology; D012640:Seizures / Q000209:etiology; D013702:Temporal Lobe / Q000098:blood supply / Q000000981:diagnostic imaging / Q000473:pathology; D013788:Thalamus / Q000098:blood supply / Q000000981:diagnostic imaging / Q000473:pathology; D014057:Tomography, X-Ray Computed