Keywords:
Paediatric, Neuroradiology brain, MR, Diagnostic procedure, Cerebral palsy, Developmental disease
Authors:
M. Alonso, C. Sales Fernandez, M. Hernandez Herrero, M. Fajardo Puentes, V. Alvarez-Guisasola Blanco, T. Escudero Caro, S. G. Rizzo, M. Diez Blanco; Valladolid/ES
DOI:
10.26044/ecr2019/C-2636
Results
A total of 26 newborn infants 35 or more weeks of gestation were identified.
On MRI 13 patients had no evidence of brain injury and 13 patients had evidence of perinatally acquired lesions,
some of them overlapping patterns of brain injury.
Different patterns of brain injury we observed:
- Increased signal intensity of basal ganglia and thalamus (6 patients)
- Abscence of the normal increased signal intensity in the posterior limb of the internal capsule (5 patients)
- Cortical abnormalities (7 patients)
- Abnormal signal intensity of white matter (6 patients).
Increased signal intensity of basal ganglia and thalamus
This findings reflects the fact that the Deep gray matter structures (i.e.,
the basal ganglia and thalamus) are the most metabolically active in the brain.
An important sign is the T1-flair hyperintensity in the cental grey nuclei (posterior putamina and ventrolateral thalami).
Abscence of the normal increased signal intensity in the posterior limb of the internal capsule (PLIC)
It is the nonvisualization of the normal increased signal intensity of the PLIC on T1WI in a term neonate (after 37 weeks of gestational age).
Although the inversion of the signal within the PLIC is usually evident in the first 24 hours of life,
it attains aceptable specificity only by the end of the first week.
That is why MRI is performed between days 7 and 14 after birth.
Even though is a valuable sign,
these findings should not be interpreted in isolation because of some overlap between MRI findings of normal and hypoxic neonates.
Cortical abnormalities
The vascular parasagittal watershed zones (anterior-middle cerebral artery and posterior-middle cerebral artery) are involved,
affecting white matter and in more severely affected infants,
also the cortex and underlying subcortical white matter.
Although these findings can be seen in conventional MRI (T1WI),
DWI and ADC highlight the abnormalities.
Abnormal signal intensity of white matter
Severe involvement of the subcortical white matter can be seen with relative sparing of the immediate periventricular white matter and central grey matter,
referred to as the "white cerebrum".