Imaging of pediatric and congenital brain disease

The etiology of hemiplegic cerebral palsy has been elucidated by surveys of affected children using CT. MR imaging has contributed to the more exact diagnosis of the nature and extent of hypoxic ischemic damage and allows the accurate estimation of the time of the insult. Serial MR imaging and MR spectroscopy may be useful for predicting the prognosis for cerebral palsy and neurodevelopmental delay. The damage caused by intrauterine infection is best appreciated on MR imaging, though CT is important in showing calcification. Similar considerations apply to tuberous sclerosis, and new observations may facilitate MR imaging diagnosis. Gadolinium-enhanced MR imaging is the most accurate modality for detection of tumor recurrence and metastatic spread. Enhancement due to reactions to and complications of surgery can usually be distinguished. The reliability of MR imaging in showing many congenital anomalies provides evidence of the incidence of these lesions and contributes to understanding the disordered embryology. Most of the changes described in inherited metabolic disorders are nonspecific, but they may suggest a particular diagnosis, and MR imaging is the most sensitive modality for monitoring progress. Lifesaving intervention for arteriovenous malformations involving the vein of Galen requires detailed noninvasive imaging for selecting the most effective approach. Technical developments in diffusion and in flow imaging promise to further increase our diagnostic capabilities and to limit the application of invasive techniques.