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Published on: September 25, 2019
Differentiation between peritrigonal terminal zones and hypoxic-ischemic white matter injury on MRI
Lishya Liauw1, Jeroen van der Grond, Valerie Slooff
1Department of Radiology, C3Q, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands. l.liauw@rad.umcn.nl
Abstract:
The differentiation between terminal zones and pathological signal intensity changes on MRI of children and young adults is of diagnostic importance. We assessed the diagnostic value of several morphological features on MRI to differentiate between terminal zones and hypoxic-ischemic white matter injury. We selected all brain MRI examinations performed in subjects up to 20 years of age showing increased signal intensity on T2-weighted images in the peritrigonal areas. 75 individuals were assigned to a patient group (n=28) if there was evidence of hypoxia-ischemia during the perinatal period or a control group (n=47). Aspect, location, extent, shape, and borders of signal intensity changes in the peritrigonal areas were studied. Signal intensity of the peritrigonal areas was related to signal intensity of surrounding white matter. Presence of Virchow Robin spaces, hypoxic-ischemic abnormalities, and local atrophy were also recorded. Chi-squared tests assessed whether presence or absence of morphological characteristics differed between patients and controls. Logistic regression analysis studied which characteristics were best to discriminate between the two groups. Very high signal intensity of the peritrigonal areas on FLAIR (Odds Ratio 25) and presence of local atrophy (Odds Ratio 14.3) were best predictors to discriminate between the two groups.
Insights
Distinguishing terminal zones from hypoxic-ischemic white matter injury in children and young adults using MRI is crucial. Very high FLAIR signal intensity and local atrophy are key indicators for diagnosing white matter injury.
Area of Science:
- Pediatric neuroradiology
- Neuroimaging in children and young adults
Background:
- Differentiating normal white matter variations (terminal zones) from pathological findings like hypoxic-ischemic injury on MRI is critical for accurate diagnosis in pediatric populations.
- Peritrigonal white matter signal abnormalities on MRI in children and young adults require careful evaluation to determine their etiology.
Purpose of the Study:
- To evaluate the diagnostic value of specific MRI morphological features in distinguishing terminal zones from hypoxic-ischemic white matter injury in individuals up to 20 years of age.
- To identify MRI characteristics that best discriminate between normal peritrigonal signal variations and pathological hypoxic-ischemic changes.
Main Methods:
- Retrospective analysis of brain MRI examinations in 75 individuals (up to 20 years old) with increased T2-weighted signal intensity in peritrigonal areas.
- Categorization into a patient group (n=28) with perinatal hypoxia-ischemia and a control group (n=47).
- Assessment of signal intensity, aspect, location, extent, shape, borders, relationship to surrounding white matter, presence of Virchow Robin spaces, other hypoxic-ischemic abnormalities, and local atrophy; statistical analysis using Chi-squared tests and logistic regression.
Main Results:
- Very high signal intensity on FLAIR sequences (Odds Ratio 25) and the presence of local atrophy (Odds Ratio 14.3) were identified as the strongest predictors for differentiating hypoxic-ischemic white matter injury from terminal zones.
- Morphological characteristics of signal intensity changes in peritrigonal areas were analyzed for their discriminatory power.
Conclusions:
- Very high FLAIR signal intensity and local atrophy are highly significant indicators for diagnosing hypoxic-ischemic white matter injury in the peritrigonal regions of children and young adults.
- These findings aid in the accurate differentiation of pathological changes from normal variations on pediatric brain MRI, improving diagnostic precision.
