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Neuropediatrics 2003; 34(2): 72-76
DOI: 10.1055/s-2003-39599
Original Article

Georg Thieme Verlag Stuttgart · New York

Diffusion-Weighted MRI in Severe Neonatal Hypoxic Ischaemia: The White Cerebrum

R. J. Vermeulen 1 , W. P. F. Fetter 2 , L. Hendrikx 1 , P. E. M. Van Schie 3 , M. S. van der Knaap 1 , F. Barkhof 4
  • 1Department of Child Neurology, VUMC, Amsterdam, The Netherlands
  • 2Department of Neonatology, VUMC, Amsterdam, The Netherlands
  • 3Department of Rehabilitation, VUMC, Amsterdam, The Netherlands
  • 4Department of Radiology, VUMC, Amsterdam, The Netherlands
Further Information

Publication History

Received: May 10, 2002

Accepted after Revision: January 23, 2003

Publication Date:
30 May 2003 (online)

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Abstract

Presently, prognosis of infants with perinatal hypoxia-ischaemia is estimated using the Sarnat scale, which combines clinical evaluation and electroencephalography, in combination with magnetic resonance imaging (MRI) and or evoked potentials. While the value of conventional MRI is limited during the first week of life, diffusion-weighted MRI demonstrates effects of acute cerebral ischaemia within hours of onset. However, the exact value of diffusion MRI in the prognosis of infants with hypoxia-ischaemia has to be established in larger follow-up studies. In this report we describe 5 term (post-conceptional age 40 1/7 to 41 2/7 week) neonates with severe hypoxia-ischaemia and a characteristic pattern of diffusion changes. T1-weighted images showed a hyperintense cortical signal in only one case and extensive hyperintensity in the basal nuclei in all 5 cases. T2-weighted images showed nearly complete loss of cortical delineation in three cases. Increased signal on diffusion-weighted images was seen throughout all cortical and subcortical areas while the cerebellum remained normal. This pattern, which we refer to as the “white cerebrum”, is most readily apparent on coronal images. The apparent diffusion coefficient (ADC) was calculated and compared to that of four control infants. In the cortex ADC values were lowered (0.70 ± 0.17 µm2/msec [mean ± standard deviation (SD)]; controls [n = 4]: 1.18 ± 0.02 µm2/msec) as compared to values of ADC in the cerebellum (1.31 ± 0.06 µm2/msec [mean ± SD]; controls [n = 4]: 1.25 ± 0.06 µm2/msec). All infants died in the perinatal period. In summary, the “white cerebrum” on diffusion-weighted MRI indicates severe neonatal hypoxia-ischaemia and is the counterpart of the white cerebellum on CT.

Key words

Neonates - hypoxia-ischaemic - brain injury - MRI - diffusion

References

  • 1 D'Arceuil H E, Crespgny de A J, Röther J, Moseley M, Rhine W. Serial magnetic resonance diffusion and hemodynamic imaging in a rabbit model of hypoxic-ischaemic encephalopathy.  NMR in Biomedicine. 1999;  12 505-514
    CrossrefPubMedGoogle Scholar
  • 2 Baenziger O, Martin E, Steinlin M, Good M, Largo R, Burger R, Fanconi S, Duc G, Buchli R, Rumpel H. et al . Early pattern recognition in severe perinatal asphyxia: a prospective MRI study.  Neuroradiology. 1993;  35 437-442
    CrossrefPubMedGoogle Scholar
  • 3 Barkovich A J, Westmark K D, Bedi H S, Partridge J C, Ferriero D M, Vignero D B. Proton spectroscopy and diffusion imaging on the first day of life after perinatal asphyxia: Preliminary report.  AJNR. 2001;  22 1786-1794
    PubMedGoogle Scholar
  • 4 Cowan F M, Pennock J M, Manji K P, Edwards A D. Early detection of cerebral infarction and hypoxic ischemic encephalopathy in neonates using diffusion-weighted magnetic resonance imaging.  Neuropediatrics. 1994;  25 172-175
    Article in Thieme ConnectPubMedGoogle Scholar
  • 5 Piper M C, Darrah J. Motor Assessment of the Developing Infant. Philadelphia; W. B. Saunders Company 1994
    Google Scholar
  • 6 Duyn J H, Gillen J, Sobering G, van Zijl P C, Moonen C T. Multisection proton MR spectroscopic imaging of the brain.  Radiology. 1993;  188 277-282
    PubMedGoogle Scholar
  • 7 Gray P H, Tudehope D I, Masel J P, Burns Y R, Mohay H A, O'Callaghan M J, Williams G M. Perinatal hypoxic-ischaemic brain injury: prediction of outcome.  Dev Med Child Neurol. 1993;  35 965-973
    PubMedGoogle Scholar
  • 8 Johnson M A, Pennock J M, Bydder G M, Dubowitz L MS, Thomas D J, Young I R. Serial MR imaging in neonatal cerebral injury.  AJNR. 1987;  8 83-92
    PubMedGoogle Scholar
  • 9 Levene M I, Fenton A C, Evans D H, Archer L N, Shortland D B, Gibson N A. Severe birth asphyxia and abnormal cerebral blood-flow velocity.  Dev Med Child Neurol. 1989;  31 427-434
    PubMedGoogle Scholar
  • 10 Lövblad K O, Baird A E, Schaug G, Benfield A. et al . Ischaemic lesion volumes in acute stroke by diffusion-weighted magnetic resonance imaging correlate with clinical outcome.  Ann Neurol. 1997;  42 164-170
    CrossrefPubMedGoogle Scholar
  • 11 Lövblad K O, Bassetti C. Diffusion-weighted magnetic resonance imaging in brain death.  Stroke. 2000;  31 539-542
    PubMedGoogle Scholar
  • 12 Lutsep H L, Albers G W, DeCrespigny A, Kamat G N. et al . Clinical utility of diffusion-weighted magnetic resonance imaging in the assessment of ischaemic stroke.  Ann Neurol. 1997;  41 574-580
    CrossrefPubMedGoogle Scholar
  • 13 Mader I, Schöning M, Klose U, Küker W. Neonatal cerebral infarction diagnosed by diffusion-weighted MR. Pseudonormalization occurs early.  Stroke. 2002;  33 1142-1145
    CrossrefPubMedGoogle Scholar
  • 14 Pasternak J F, Gorey M T. The syndrome of acute near-total intrauterine asphyxia in the term infant.  Pediatr Neurol. 1998;  18 391-398
    Google Scholar
  • 15 Robertson R L, Ben-Sira L, Barnes P D, Mulkern R V, Robson C D, Maier S E, Rivkin M J, du Plessis A. MR line-scan diffusion-weighted imaging of term neonates with perinatal brain ischemia.  AJNR Am J Neuroradiol. 1999;  20 1658-1670
    PubMedGoogle Scholar
  • 16 Roelants-van Rijn P G, Nikkels P G, Groenendaal F, van der Grond J. et al . Neonatal diffusion-weighted MR imaging: relation with histopathology or follow-up MR examination.  Neuropediatrics. 2001;  32 286-294
    Article in Thieme ConnectPubMedGoogle Scholar
  • 17 Rutherford M A, Pennock J M, Schwieso J E, Cowan F M, Dubowitz L MS. Hypoxic ischaemic encephalopathy: Early magnetic resonance imaging findings and their evolution.  Neuropediatrics. 1995;  126 183-191
    PubMedGoogle Scholar
  • 18 Rutherford M A, Pennock J M, Counsell S J, Mercuri E, Cowan F M, Dubowitz L M, Edwards A D. Abnormal magnetic resonance signal in the internal capsule predicts poor neurodevelopmental outcome in infants with hypoxic-ischemic encephalopathy.  Pediatrics. 1998;  102 323-328
    CrossrefPubMedGoogle Scholar
  • 19 Sarnat H B, Sarnat M S. Neonatal encephalopathy following fetal distress: A clinical and encephalographic study.  Arch Neurol. 1976;  33 696-705
    CrossrefPubMedGoogle Scholar
  • 20 Schaefer P W, Grant P E, Gonzales R G. Diffusion-weighted MR imaging of the brain.  Radiology. 2000;  217 331-345
    CrossrefPubMedGoogle Scholar
  • 21 Volpe J J. Neurology of the Newborn. 4th ed. Philadelphia; W. B. Saunders Company 2001
    Google Scholar
  • 22 Wolf R L, Zimmerman R A, Clancy R, Haselgrove J H. Quantitative apparent diffusion coefficient measurements in term neonates for early detection of hypoxic-ischaemic brain injury: initial experience.  Radiology. 2001;  218 825-833
    CrossrefPubMedGoogle Scholar

Dr. R. J. Vermeulen

Department of Pediatric Neurology
Vrije Universiteit Medisch Centrum

De Boelelaan 1117, Postbox 7057

1007 MB Amsterdam

The Netherlands

Email: rj.vermeulen@vumc.nl

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