The Role of MRI in Perinatal Anoxic Ischaemic Brain Injury ANDREA BOGHI SSD Neuroradiology Department of Radiology S. CROCE Hospital, Cuneo, Italy

Hypoxia-ischaemia is the most common cause of perinatally acquired brain injury The introduction of treatment with hypothermia has changed the natural hystory of this disease In this clinical context MR imaging of the brain has become a very important diagnostic tool in neonatology

Neonatal brain: Higher water content Unmielinated

T1 T2 Term newborn adult

To maximize SNR it is recommended to: Technique To maximize SNR it is recommended to: Use dedicated neonatal head coil or adult knee coil Adapted sequences

Protocol (20-30 min) T1 SE sagittal T2 TSE coronal T1 SE axial T1 IR axial T2 TSE axial DWI axial MR sinus venogram H-MRS: (still) limited clinical role

Timing Using conventional sequences, lesions become evident between 1 and 2 week from birth Earlier imaging: DWI is useful but has reduced sensitivity, above all in basal ganglia and thalami

Pattern of lesions: basal ganglia, thalami and posteior limb of internal capsule (PLIC) HIE Normal Severe hypoxic-ischaemic injury is usually associated with BGT lesions and PLIC signal abnormalities PLIC: predictor of abnormal motor outcome BGT: motor impairment (cerebral palsy) T1 T2

Pattern of lesions: brainstem Brainstem lesions are usually found in the most severe form of hypoxic-ischaemic encephalopathy Often associated with early death

Pattern of lesions: white matter Multicystic Encephalopathy T1 T2 T2 FLAIR BGT + WM: worse cognitive deficit

Pattern of lesions: white matter DWI ADC WM alone: more severe WM damage, worse cognitive outcome and possible motor impairment

Pattern of lesions: cortical lesions Cortical highlighting (T1 hyperintensity) out of the primary motor cortex Loss of spontaneous T1 hyperintensity) of the primary motor cortex T1 T2 Normal T2 DWI HIE

Pattern of lesions: overt infarction DWI ADC T1 Usually involved the middle cerebral artery territory; more often of the left hemisphere

MRI can Identify suspected brain lesions Define their topography and extension in order to explain neurological symptoms and predict clinical outcome Characterize brain lesions according to aetiology and timing

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