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Neonatal diffusion-weighted MR imaging: relation with histopathology or follow-up MR examination
A M Roelants-van Rijn1, P G Nikkels, F Groenendaal
1Department of Neonatology, University Medical Center, Utrecht, The Netherlands.
Purpose:
Diffusion-weighted imaging (DWI) has become a standard method for early evaluation of stroke in adults, but its value in neonates is less well established. In this study neonatal DWI was compared with histopathology in those patients who died, or with sequelae seen on a second MR in the surviving neonates.
Patients And Methods:
DWI was performed in 2 groups. Group 1: seven neonates who died and had a post-mortem ex-amination (perinatal asphyxia [n=5], symptomatic hypoglycemia [n= 11, periventricular leukomalacia [n= 1]). Group 2: six surviving neonates with a second MR examination at three months of age (perinatal asphyxia [n= 21, neonatal stroke[n= 3], meningo-encephalitis [n= 1]).
Results:
In group l neonatal DWI showed more extensive involvement than conventional MRI in 6 out of 7 patients. These changes were less extensive,however, than seen post-mortem by histopathology in 5 out of 7. In group 2 neonatal DWI showed more extensive involvement than conventional MRI in 2 out of 6; 4 out of 6, however, showed less extensive cystic evolution on follow-up MRI at 3 months than expected from neonatal imaging.
Conclusion:
There was a good relation between hyperintense areas on DWI and areas of cytotoxic edema and neuronal damage on histopathology. In the survivors a second MRI showed cystic evolution in all, but the volume of the cysts was smaller than expected on the basis of the neonatal DWI findings.
Insights
Neonatal diffusion-weighted imaging (DWI) shows more extensive brain injury than conventional MRI. Follow-up MRI in survivors revealed smaller cystic lesions than initially suggested by neonatal DWI findings.
Area of Science:
- Neonatal Neurology
- Neuroimaging
- Pediatric Radiology
Background:
- Diffusion-weighted imaging (DWI) is standard for adult stroke evaluation.
- Its utility in neonates requires further establishment.
Purpose of the Study:
- To compare neonatal DWI with histopathology in deceased neonates.
- To compare neonatal DWI with follow-up MRI in surviving neonates.
Main Methods:
- Two groups of neonates were studied.
- Group 1: Seven neonates who died underwent post-mortem examination.
- Group 2: Six surviving neonates had follow-up MRI at three months.
Main Results:
- Neonatal DWI revealed more extensive involvement than conventional MRI in most patients.
- In deceased neonates, DWI findings were less extensive than histopathology.
- In survivors, follow-up MRI showed less cystic evolution than predicted by neonatal DWI.
Conclusions:
- Neonatal DWI correlates well with cytotoxic edema and neuronal damage on histopathology.
- Neonatal DWI may overestimate the extent of eventual cystic lesions in surviving neonates.