Imaging the term neonatal brain

Question 1

What is neonatal encephalopathy?

Answer 1

clinically defined syndrome of disturbed neurological function in the earliest day of life in the term infant

Question 2

Patterns of injury in HIE?

Answer 2

1. Watershed
   * affects areas between brain’s major arterial supplies deep in sulci
   * best seen DOL 3-5 as restricted diffusion on DWI
   * Maximal injury day 10-14 on T1 and T2 images
   * Predicts language outcomes
2. Basal ganglia/thalamic
   * in acute, profound hypoxia-ischemia

Question 3

Most common area for neonatal stroke?

How does it present?

Answer 3

L MCA
Usually presents with seizures
MRI is most sensitive

Note: more common in neonatal period than any other time in childhood

Question 4

When should CT be done as first line in the term neonatal brain?

Answer 4

• urgent situations when MRI not available
• infant too unstable for MRI
• trauma or skull fracture suspected
• If done, ideally within 72 +/- 12 hours of suspected insult. Subsequent MRI recommended.

Question 5

What is the best imaging modality for IEM in neonates?

Answer 5

• MRI is optimal modality

* DWI and MRSI helpful for MSUD, nonketotic hyperglycinemia, creatinine deficiency

Question 6

What is the best head imaging modality for congenital infection in neonates?

Answer 6

• MRI preferred but may miss calcifications evident on CT

* MRI for all infants with symptomatic congenital CMV and infants with abnormal US

Question 7

What is the preferred imaging technique in neonates with bilirubin encephalopathy?

Answer 7

MRI

DO NOT do MRI in neonates with severe hyperbili in absence of encephalopathy

Question 8

What does a normal MRI in HIE suggest?

Answer 8

likelihood of severe neurodevelopmental impariment is low

Question 9

What imaging modalities are used for neonatal traumatic brain injury?

Answer 9

• MRI - modality of choice for parenchymal injury

* CT- modality of choice in trauma (detection of bone fracture is priorty)

Question 10

What is the best imaging modality for cerebral dysgenesis/structural abnormality?

Answer 10

MRI

Question 11

What imaging is done for HIE that is cooled?

Answer 11

• MRI DOL 3-5 or after rewarming
• repeat at 10-14 DOL when imaging and clinical features discordant or when diagnostic ambiguity persists
• consistent timing important to facilitate recognition of injury patterns on specific sequences
• Important for diagnosis, counselling about infant’s prognosis and potential outcomes, and for guiding decisions about care