Magnetic resonance imaging spectrum of perinatal hypoxic–ischemic brain injury

Abstract

Perinatal hypoxic–ischemic brain injury results in neonatal hypoxic–ischemic encephalopathy and serious long-term neurodevelopmental sequelae. Magnetic resonance imaging (MRI) of the brain is an ideal and safe imaging modality for suspected hypoxic–ischemic injury. The pattern of injury depends on brain maturity at the time of insult, severity of hypotension, and duration of insult. Time of imaging after the insult influences the imaging findings. Mild to moderate hypoperfusion results in germinal mazatrix hemorrhages and periventricular leukomalacia in preterm neonates and parasagittal watershed territory infarcts in full-term neonates. Severe insult preferentially damages the deep gray matter in both term and preterm infants. However, associated frequent perirolandic injury is seen in term neonates. MRI is useful in establishing the clinical diagnosis, assessing the severity of injury, and thereby prognosticating the outcome. Familiarity with imaging spectrum and insight into factors affecting the injury will enlighten the radiologist to provide an appropriate diagnosis.

Keywords

Cortical highlighting - germinal matrix hemorrhage - hypoxic ischemic encephalopathy - hypoxic ischemic injury - periventricular leukomalacia

Conflict of Interest

There are no conflicts of interest.

• References

• 1 Graham EM, Ruis KA, Hartman AL, Northington FJ, Fox HE. A systematic review of the role of intrapartum hypoxia-ischemia in the causation of neonatal encephalopathy. Am J Obstet Gynecol 2008;199:587-95.
• 2 Chalak LF, Rollins N, Morriss MC, Brion LP, Heyne R, Sánchez PJ. Perinatal Acidosis and Hypoxic-Ischemic Encephalopathy in Preterm Infants of 33 to 35 Weeks' Gestation. J Pediatr 2012;160:388-94.
• 3 Lawn JE, Cousens S, Zupan J. 4 million neonatal deaths: When? Where? Why? Lancet 2005;365:891-900.
• 4 Vannucci RC, Perlman JM. Interventions for Perinatal Hypoxic-Ischemic Encephalopathy. Pediatrics 1997;100:1004-114.
• 5 Barkovich AJ. The encephalopathic neonate: Choosing the proper imaging technique. Am J Neuroradiol 1997;18:1816-20.
• 6 Shroff MM, Soares-Fernandes JP, Whyte H, Raybaud C. MR Imaging for Diagnostic Evaluation of Encephalopathy in the Newborn. Radiographics 2010;30:763-80.
• 7 Huang BY, Castillo M. Hypoxic-Ischemic Brain Injury: Imaging Findings from Birth to Adulthood. Radiographics 2008;28:417-39.
• 8 Rutherford MA. The asphyxiated term infant. MRI of the neonatal brain. London: Saunders; 2002. p. 99-128.
• 9 Boichot C, Walker PM, Durand C, Grimaldi M, Chapuis S, Brunotte F. Term neonate prognoses after perinatal asphyxia: Contributions of MR imaging, MR spectroscopy, relaxation times, and apparent diffusion coefficients. Radiology 2006;239:839-48.
• 10 Heinz ER, Provenzale JM. Imaging findings in neonatal hypoxia: A practical review. Am J Roentgenol 2009;192:41-7.
• 11 Volpe JJ. Brain injury in premature infants: A complex amalgam of destructive and developmental disturbances. Lancet Neurol 2009;8:110-24.
• 12 Welker KM, Patton A. Assessment of normal myelination with magnetic resonance imaging. Semin Neurol 2012;32:15-28.
• 13 Paneth N, Pinto-Martin J, Gardiner J, Wallenstein S, Katsikiotis V, Hegyi T, et al. Incidence and timing of germinal matrix/intraventricular hemorrhage in low birth weight infants. Am J Epidemiol 1993;137:1167-76.
• 14 Roze E, Kerstjens JM, Maathuis CG, ter Horst HJ, Bos AF. Risk factors for adverse outcome in preterm infants with periventricular hemorrhagic infarction. Pediatrics 2008;122:e46-e52.
• 15 Barkovich A J, Sargent S K. Profound asphyxia in the premature infant: Imaging findings. Am J Neuroradiol 1995;16:1837-46.
• 16 Cabaj A, Bekiesińska-Figatowska M, Mądzik J. MRI patterns of hypoxic-ischemic brain injury in preterm and full term infants – Classical and less common MR findings. Pol J Radiol 2012;77:71-6.
• 17 Lynch JK, Hirtz DG, DeVeber G, Nelson KB. Report of the National Institute of Neurological Disorders and Stroke Workshop on Perinatal and Childhood Stroke. Pediatrics 2002;109:116-23.
• 18 Schulzke S, Weber P, Luetschg J, Fahnenstich H. Incidence and diagnosis of unilateral arterial cerebral infarction in newborn infants. J Perinat Med 2005;33:170-5.
• 19 Armstrong-Wells J, Johnston SC, Wu YW, Sidney S, Fullerton HJ. Prevalence and predictors of perinatal hemorrhagic stroke: Results from the Kaiser Pediatric Stroke Study. Pediatrics 2009;123:823-8.
• 20 Berfelo FJ, Kersbergen KJ, van Ommen CH, Govaert P, van Straaten HL, Poll-The BT, et al. Neonatal cerebral sinovenous thrombosis from symptom to outcome. Stroke 2010;41:1382-8.
• 21 Wu YW, Miller SP, Chin K, Collins AE, Lomeli SC, Chuang NA, et al. Multiple risk factors in neonatal sinovenous thrombosis. Neurology 2002;59:438-40.
• 22 Burns CM, Rutherford MA, Boardman JP, Cowan F M. Patterns of cerebral injury and neurodevelopmental outcomes after symptomatic neonatal hypoglycaemia. Pediatrics 2008;122:65-74.
• 23 Rutherford MA, Pennock JM, Counsell SJ, Mercuri E, Cowan FM, Dubowitz LM, et al. Abnormal Magnetic Resonance Signal in the Internal Capsule Predicts Poor Neurodevelopmental Outcome in Infants with Hypoxic-Ischemic Encephalopathy. Pediatrics 1998;102:323-8.
• 24 Miller SP, Ramaswamy V, Michelson D, Barkovich AJ, Holshouser B, Wycliffe N, et al. Patterns of brain injury in term neonatal encephalopathy. J Pediatr 2005;146:453-60.
• 25 Martinez-Biarge M, Bregant T, Wusthoff CJ, Chew AT, Diez-Sebastian J, Rutherford MA, et al. White Matter and Cortical Injury in Hypoxic-Ischemic Encephalopathy: Antecedent Factors and 2-Year Outcome. J Pediatr 2012;161:799-807.
• 26 Resić B, Tomasović M, Kuzmanić-Samija R, Lozić M, Resić J, Solak M. Neurodevelopmental outcome in children with periventricular leukomalacia. Coll Antropol 2008;32(Suppl 1):143-7.

Publikationsverlauf

Artikel online veröffentlicht:
30. Juli 2021