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Normal myelination of the pediatric brain imaged with fluid-attenuated inversion-recovery (FLAIR) MR imaging
J W Murakami1, E Weinberger, D W Shaw
1Department of Radiology, CH-69, Children's Hospital and Regional Medical Center, Seattle, WA 98105, USA.
Background And Purpose:
As in adult imaging, FLAIR can be applied to pediatric brain imaging, and this requires an appreciation of the normal pediatric brain appearance by FLAIR imaging. The purpose of this study was to describe the MR appearance of the brain in normal infants and young children as demonstrated by fluid-attenuated inversion-recovery (FLAIR) MR imaging.
Methods:
We retrospectively examined MR brain studies, interpreted as normal by pediatric radiologists, from 29 patients (aged 1 to 42 months) to catalog the appearance of myelination in multiple brain areas.
Results:
On T2-weighted images, white matter progressed from hyperintense to hypointense relative to adjacent gray matter over the first 2 years of life. An analogous, although slightly delayed sequence was observed on FLAIR images with the exception of the deep cerebral hemispheric white matter, which followed a triphasic sequence of development. On FLAIR images, the deep cerebral white matter was heterogeneously hypointense relative to gray matter in the young infant, became hyperintense early in the first few months of life, and then reverted to hypointense during the second year of life.
Conclusion:
The normal appearance and development of brain white matter must be taken into account when interpreting FLAIR images of infants and young children.
Insights
Fluid-attenuated inversion-recovery (FLAIR) imaging reveals normal white matter development in infants and young children. Understanding these FLAIR imaging patterns is crucial for accurate pediatric brain interpretation.
Area of Science:
- Pediatric Radiology
- Neuroimaging
- Brain Development
Background:
- Fluid-attenuated inversion-recovery (FLAIR) MRI is applicable to pediatric brain imaging.
- Accurate interpretation requires knowledge of normal pediatric brain appearance on FLAIR.
Purpose of the Study:
- To describe the MR appearance of the normal pediatric brain using FLAIR imaging.
- To catalog myelination patterns in infants and young children.
Main Methods:
- Retrospective analysis of 29 normal pediatric brain MRI studies.
- Patients aged 1 to 42 months.
- Focus on myelination appearance in multiple brain areas.
Main Results:
- White matter signal intensity on T2-weighted images changes over the first 2 years.
- FLAIR imaging shows a similar, delayed myelination sequence.
- Deep cerebral white matter exhibits a unique triphasic FLAIR signal development.
Conclusions:
- Normal white matter appearance and development are essential for interpreting pediatric FLAIR images.
- Awareness of these developmental patterns aids in diagnosing abnormalities.