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[Sequential MRI in two cases with periventricular leukomalacia]
N Fujimoto1, K Sugita, H Niimi
1Department of Pediatrics, Chiba University School of Medicine.
Insights
Magnetic resonance imaging (MRI) effectively detected subtle cystic periventricular leukomalacia lesions in infants, complementing ultrasonography (US) findings and revealing delayed myelination and white matter abnormalities.
Area of Science:
- Neuroimaging
- Pediatric Neurology
- Neuroradiology
Background:
- Cystic periventricular leukomalacia (cPVL) is a significant cause of neurological impairment in premature infants.
- Early detection of cPVL is crucial for timely intervention and management.
- Ultrasonography (US) is commonly used for neonatal brain imaging, but may miss subtle lesions.
Observation:
- Two infants with cPVL, initially detected by US, underwent serial brain MRI at corrected ages of 4, 9, and 15-19 months.
- MRI utilized inversion-recovery (IR) and T2-weighted spin-echo (SE) sequences.
- Cysts were observed in the periventricular white matter adjacent to the frontal horns (Case 1) and posterior horns (Case 2).
Findings:
- Early MRI (4 months) showed ventricular wall irregularity and delayed myelination compared to controls.
- Subsequent MRIs (9 and 15-19 months) revealed progressively evident T2-weighted hyperintensities in the white matter.
- End-stage cPVL lesion locations on MRI correlated with US-identified cystic areas.
- Sagittal MRI views were particularly useful for identifying main cPVL lesions.
Implications:
- Serial MRI provides detailed characterization of cPVL progression and lesion evolution.
- MRI demonstrates superior sensitivity for detecting subtle cPVL lesions not visible on US.
- Advanced MRI techniques may enhance the early diagnosis and monitoring of cPVL, potentially improving neurodevelopmental outcomes.
Abstract:
We investigated two children with cystic periventricular leukomalacia, which we had detected by ultrasonography (US) during the neonatal period, with magnetic resonance imaging (MRI) of the brain at 4, 9, and 15 or 19 corrected months of age. Both inversion-recovery (IR) and T2-weighted spin-echo (SE) sequences were used for this study. We observed cysts involving the periventricular white matter at the region adjacent to bilateral frontal horns in case 1 and adjacent to the posterior horns of the lateral ventricles in case 2. MRI at 4 months showed the irregularity of the ventricular wall and delayed myelination, compared to that of an age-matched control. The T2-weighted SE and IR imaging at 9 months demonstrated abnormally increased signal in the white matter. These findings were more evident at the 3rd MRI examination. The location of end-stage periventricular leukomalacia lesions were consistent with the distribution of cystic lesions seen on US. MRI at sagittal sections was useful for the detection of main periventricular leukomalacia lesions. A possibility exists that MRI might be useful in detecting subtle lesions of periventricular leukomalacia in which we cannot find by US.