Perfusion-weighted magnetic resonance imaging patterns of hypoxic-ischemic encephalopathy in term neonates.
OBJECTIVE
To determine whether an early magnetic resonance imaging (MRI) study using perfusion-weighted imaging (PWI) may define the pattern of brain injury in term neonatal hypoxic-ischemic (HI) encephalopathy.


METHODS
Five newborns with HI encephalopathy or a marker of perinatal depression, and 2 controls underwent an early MRI (at 2 to 4 days), including PWI. Relative cerebral blood flow (rCBF) values were measured.


RESULTS
On early (<or=4 days) PWI-MRI, marked hyperperfusion was seen in areas of HI brain damage, allowing the classification of the children into different patterns according to the predominant site of injury: 1 with a "normal pattern"; 1 with a "watershed pattern" with increased rCBF ratios in white matter; 1 with a "basal ganglia pattern" with increased rCBF ratios in basal ganglia; and 2 with a "total cortical pattern" with increased rCBF ratios in cortical gray matter, white matter, and basal ganglia. These patterns were confirmed in all infants on late (9 to 11 days) conventional MRI (T2-weighted images) (4 of 5 patients) or on postmortem examination (1 of 5 patients).


CONCLUSIONS
PWI is technically feasible in neonates with HI encephalopathy in a reproducible way, permitting comparisons between children. It provides a practical means to identify early after birth the future definitive ischemic areas that may be shown on conventional MRI only later.
Wintermark
Pia
P
Division of Neonatology, Department of Pediatrics, Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland. pia.wintermark@bluemail.ch
Moessinger
Adrien C
AC
Gudinchet
François
F
Meuli
Reto
R
D016022:Case-Control Studies; D002560:Cerebrovascular Circulation; D003287:Contrast Media; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D020925:Hypoxia-Ischemia, Brain / Q000175:diagnosis* / Q000473:pathology; D007231:Infant, Newborn; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D011446:Prospective Studies
D003287:Contrast Media; C064925:gadodiamide; D019786:Gadolinium DTPA