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SSD Neuroradiology Department of Radiology S. CROCE Hospital, Cuneo, Italy

The Role of MRI in Perinatal Anoxic Ischaemic Brain Injury. ANDREA BOGHI. SSD Neuroradiology Department of Radiology S. CROCE Hospital, Cuneo, Italy. Hypoxia-ischaemia is the most common cause of perinatally acquired brain injury

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SSD Neuroradiology Department of Radiology S. CROCE Hospital, Cuneo, Italy

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  1. The Roleof MRI in PerinatalAnoxicIschaemicBrainInjury ANDREA BOGHI SSD Neuroradiology DepartmentofRadiology S. CROCE Hospital, Cuneo, Italy

  2. Hypoxia-ischaemiais the most common cause ofperinatallyacquiredbraininjury The introductionof treatment withhypothermiahaschanged the naturalhystoryofthisdisease In thisclinicalcontext MR imagingof the brainhasbecome a veryimportantdiagnostictool in neonatology

  3. Neonatalbrain: • Higher water content • Unmielinated

  4. T1 T2 T2 T1 T2 T2 Term newborn adult

  5. Technique • Tomaximize SNR itisrecommendedto: • Usededicatedneonatal head coil or adultkneecoil • Adaptedsequences

  6. Protocol(20-30 min) • T1 SE sagittal • T2 TSE coronal • T1 SE axial • T1 IR axial • T2 TSE axial • DWI axial • MR sinusvenogram • H-MRS: (still) limitedclinicalrole

  7. Timing Usingconventionalsequences, lesionsbecomeevidentbetween 1 and 2 week from birth Earlierimaging: DWI isusefulbuthasreducedsensitivity, aboveall in basalganglia and thalami

  8. T1 T2 Pattern oflesions: basalganglia, thalami and posteiorlimbofinternal capsule (PLIC) Normal HIE Severe hypoxic-ischaemicinjuryisusuallyassociatedwith BGT lesions and PLIC signalabnormalities PLIC: predictorofabnormal motor outcome BGT: motor impairment (cerebralpalsy) T1 T2

  9. Pattern oflesions: brainstem Brainstemlesions are usuallyfound in the most severe formofhypoxic-ischaemicencephalopathy Oftenassociatedwithearlydeath

  10. T1 T2 T2 FLAIR T1 T2 T2 FLAIR Pattern oflesions: whitematter Multicystic Encephalopathy BGT + WM: worse cognitive deficit

  11. T1 DWI ADC T1 DWI ADC Pattern oflesions: whitematter WM alone: more severe WM damage, worse cognitive outcome and possible motor impairment

  12. HIE Normal T2 DWI T1 T2 Pattern oflesions: corticallesions Cortical highlighting (T1 hyperintensity) out of the primary motor cortex Loss of spontaneous T1 hyperintensity) of the primary motor cortex

  13. Pattern oflesions: overtinfarction T1 Usuallyinvolved the middle cerebralarteryterritory; more oftenof the lefthemisphere DWI ADC

  14. MRI can • Identifysuspectedbrainlesions • Definetheirtopography and extension in ordertoexplainneurologicalsymptoms and predictclinicaloutcome • Characterizebrainlesionsaccordingtoaetiology and timing

  15. Thankyouforyourattention

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