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Diffusion-weighted imaging in neonatal cerebral infarction: clinical utility and follow-up
K S Krishnamoorthy1, T B Soman, M Takeoka
1Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston 02114, USA.
Insights
Echo-planar diffusion-weighted imaging aids in diagnosing neonatal cerebral infarction and seizures. This advanced MRI technique offers superior lesion visualization compared to conventional methods, correlating with patient outcomes.
Area of Science:
- Neonatal neurology
- Diagnostic imaging
- Neuroscience
Background:
- Neonatal seizures require accurate diagnosis of brain injury.
- Conventional imaging like CT and MRI have limitations in detecting early ischemic changes.
Observation:
- Echo-planar diffusion-weighted imaging (DWI) was used in 8 neonates with seizures.
- Lesion contrast and extent were evaluated against T2-weighted MRI and CT scans.
- Follow-up imaging and neurodevelopmental assessments were performed.
Findings:
- DWI showed significantly higher lesion contrast than T2-weighted images.
- Five patients had lesions exclusively visualized by DWI.
- DWI provided better lesion conspicuity and definition compared to CT and conventional MRI.
- Initial DWI findings correlated with short-term neurodevelopmental outcomes.
Implications:
- DWI is a valuable tool for evaluating acute ischemic brain injury in neonates.
- It provides critical information beyond CT and conventional MRI in the acute setting.
- DWI findings correlate with clinical outcomes, aiding in prognosis and management.
Abstract:
We describe the clinical utility of echo-planar diffusion-weighted imaging in neonatal cerebral infarction. Eight full-term neonates aged 1 to 8 days referred for neonatal seizures were studied. Patients were followed for a mean of 17 months with detailed neurologic examinations at regular intervals. Head computed tomography (CT) and conventional magnetic resonance (MRI) and diffusion-weighted images were obtained. Percent lesion contrast was evaluated for 19 lesions on T2-weighted and diffusion-weighted images. Follow-up conventional MRIs were obtained in seven patients. The findings on diffusion-weighted imaging were correlated with CT and conventional MRI findings as well as with short-term neurodevelopmental outcome. Four patients had focal cerebral infarctions. Four patients had diffuse injury consistent with hypoxic-ischemic encephalopathy. Percent lesion contrast of all 19 lesions was significantly higher on diffusion-weighted images when compared with T2-weighted images. In five patients, there were lesions visualized only with diffusion-weighted imaging. In all patients, there was increased lesion conspicuity and better definition of lesion extent on the diffusion-weighted images compared with the CT and T2-weighted MR images. In seven of eight patients follow-up imaging confirmed prior infarctions. Short-term neurologic outcome correlated with the extent of injury seen on the initial diffusion-weighted imaging scans for all patients. Diffusion-weighted imaging is useful in the evaluation of acute ischemic brain injury and seizure etiology in neonates. In the acute setting, diffusion-weighted imaging provides information not available on CT and conventional MRI. This information correlates with short-term clinical outcome.