Patterns of damage in the mature neonatal brain
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Neurobehavioral Assessments in a Mouse Model of Neonatal Hypoxic-ischemic Brain Injury
Published on: November 24, 2017
Fabio Triulzi1, Cecilia Parazzini, Andrea Righini
1Department of Radiology, Children's Hospital Vittore Buzzi, Via Castelvetro 32, 20154 Milan, Italy. ftriulzi@icp.mi.it
Insights
Hypoxic-ischaemic encephalopathy (HIE) is a major cause of brain damage in newborns. Advanced MRI techniques, including diffusion imaging, help identify HIE patterns and differentiate them from other conditions, improving diagnosis.
Area of Science:
- Neonatal Neurology
- Pediatric Radiology
- Neuroimaging
Background:
- Neonatal brain damage presents as focal, multifocal, or diffuse patterns.
- Hypoxic-ischaemic encephalopathy (HIE) is the primary cause of diffuse brain damage in term newborns, leading to significant neurological morbidity.
- Magnetic Resonance Imaging (MRI) is crucial for detecting acute anoxic brain injury in neonates.
Purpose of the Study:
- To outline the diagnostic capabilities of MRI, particularly diffusion techniques, in identifying and characterizing neonatal brain injury patterns.
- To differentiate HIE from other conditions that mimic its early MRI findings.
- To highlight the role of diffusion MRI in assessing focal injuries like arterial and venous infarctions.
Main Methods:
- Utilizing conventional MRI sequences and advanced diffusion-weighted imaging (DWI) techniques.
- Analyzing characteristic injury patterns associated with HIE.
- Comparing MRI findings with clinical presentations and differentiating from conditions like kernicterus, hypoglycemia, infections, and non-accidental injury.
- Evaluating arterial and venous infarctions using diffusion techniques and MR angiography.
Main Results:
- Conventional and diffusion MRI can identify typical HIE injury patterns, though they are not pathognomonic.
- Diffusion techniques aid in distinguishing various types of diffuse brain edema and precisely defining the extent of focal infarctions, even in the hyperacute phase.
- MRI, including MR angiography, is essential for evaluating venous structures in cases of unexplained neonatal cerebral hematoma.
Conclusions:
- MRI, especially with diffusion-weighted imaging, is highly sensitive for detecting neonatal brain injury.
- While suggestive, MRI patterns require differentiation from other conditions, with diffusion techniques offering valuable insights.
- Advanced MRI is critical for precise characterization of focal and diffuse brain injuries in newborns, guiding diagnosis and management.
Abstract:
Patterns of damage in the mature neonatal brain can be subdivided into focal, multifocal and diffuse. The main cause of diffuse brain damage in the term newborn is hypoxic-ischaemic encephalopathy (HIE). HIE is still the major recognized perinatal cause of neurological morbidity in full-term newborns. MRI offers today the highest sensitivity in detecting acute anoxic injury of the neonatal brain. Conventional acquisition techniques together with modern diffusion techniques can identify typical patterns of HIE injury, even in the early course of the disease. However, even though highly suggestive, these patterns cannot be considered as pathognomonic. Perinatal metabolic disease such as kernicterus and severe hypoglycaemia should be differentiated from classic HIE. Other conditions, such as infections, non-accidental injury and rarer metabolic diseases can be misinterpreted as HIE in their early course when diffuse brain swelling is still the predominant MRI feature. Diffusion techniques can help to differentiate different types of diffuse brain oedema. Typical examples of focal injuries are arterial or venous infarctions. In arterial infarction, diffusion techniques can define more precisely than conventional imaging the extent of focal infarction, even in the hyperacute phase. Moreover, diffusion techniques provide quantitative data of acute corticospinal tract injury, especially at the level of the cerebral peduncles. Venous infarction should be suspected in every case of unexplained cerebral haematoma in the full-term newborn. In the presence of spontaneous bleeding, venous structures should always be evaluated by MR angiography.
