Related Experiment Videos
End-stage periventricular leukomalacia: MR evaluation
L L Baker1, D K Stevenson, D R Enzmann
1Department of Diagnostic Radiology and Nuclear Medicine, Stanford University School of Medicine, CA 94305.
Insights
Magnetic resonance (MR) imaging effectively evaluates end-stage periventricular leukomalacia (PVL) in children. This advanced imaging technique identifies characteristic PVL abnormalities and correlates with neurologic impairment, even in subtle cases.
Area of Science:
- Pediatric neurology
- Neuroradiology
- Medical imaging
Background:
- Periventricular leukomalacia (PVL) is a significant cause of neurologic impairment in infants.
- Neonatal ultrasonography can document PVL, but its utility in assessing end-stage disease is limited.
- Advanced neuroimaging is crucial for characterizing long-term sequelae of neonatal brain injury.
Purpose of the Study:
- To evaluate the capabilities of magnetic resonance (MR) imaging in assessing end-stage periventricular leukomalacia (PVL).
- To identify characteristic MR imaging findings associated with established PVL.
- To correlate MR imaging findings with the degree of neurologic impairment in affected children.
Main Methods:
- Prospective study involving six children (31-54 months) with documented neonatal PVL.
- Comparison with eight age-matched healthy children serving as controls.
- Detailed analysis of MR imaging features, including signal intensity, white matter loss, and ventricular changes, using T2-weighted sequences.
Main Results:
- A characteristic triad of MR findings for PVL was identified: increased periventricular white matter signal intensity, marked white matter loss, and compensatory focal ventricular enlargement.
- These abnormalities were most commonly observed in the trigone regions of the lateral ventricles.
- A general correlation was found between the severity of MR abnormalities and the degree of neurologic impairment.
Conclusions:
- MR imaging is a valuable tool for evaluating end-stage periventricular leukomalacia in children.
- It can detect subtle forms of PVL and subclinical neurologic damage.
- The characteristic MR imaging triad aids in diagnosis and prognosis assessment.
Abstract:
A prospective study was performed to assess the capabilities of magnetic resonance (MR) imaging in evaluation of end-stage periventricular leukomalacia (PVL) in six children, aged 31-54 months, in whom PVL had been documented by neurologic ultrasonography during the neonatal period. Eight children of similar age (four premature infants and four full-term infants) with normal neurologic development served as controls. A characteristic triad of PVL abnormalities was seen on MR images: (a) abnormally increased periventricular white-matter signal intensity on the first and second echo images of a T2-weighted sequence (repetition time = 2,000-2,400 msec, echo times = 20 or 30 and 80 msec), most commonly observed in the trigone regions of the lateral ventricles bilaterally; (b) marked loss of periventricular white matter in these regions of abnormal signal intensity, predominantly in the periatrial regions; and (c) compensatory focal ventricular enlargement adjacent to regions of abnormal signal intensity. In patients with the classic periatrial distribution of PVL lesions, general correlation between the degree of neurologic impairment and the severity of MR abnormalities was demonstrated. MR imaging was useful in detecting subtle forms of PVL in cases in which neurologic damage was subclinical.