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

2. 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

3. Neonatal brain:
Higher water content
Unmielinated

4. T1 T2
Term
newborn
adult

5. 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

6. 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

7. 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

8. 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

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

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

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

12. 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

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

14. 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

15. Thank you for your attention