Institution: | (1) Department of Neuroradiology, University "La Sapienza", Via di Grottarossa, 1035 Rome, Italy;(2) Department of Neonatology, University of Rome "Tor Vergata", 1035 Rome, Italy;(3) Department of Radiology, University of Rome "Tor Vergata", 1035 Rome, Italy;(4) IRCCS Neuromed, Pozzilli Isernia, Italy |
Abstract: | Diffusion-weighted imaging (DWI) has been shown to be highly sensitive in detecting acute cerebral infarction, but its use
in detecting hypoxic–ischemic encephalopathy (HIE) in neonates is still controversial. Moreover, few reports concern pre-term
infants with possible periventricular leukomalacia (PVL). We examined the ability of this technique to detect cerebral changes
in the acute phase of PVL. Fifteen MR examinations were performed in 11 pre-term infants (mean age 3.4 days, range 2–6 days).
Conventional DWI sequences, apparent diffusion coefficient (ADC) maps, and US obtained in the acute phase were compared. All
the neonates underwent US follow-up up to 4 months after delivery; those with suspected PVL also underwent MRI follow-up for
up to 2 months. Qualitative and quantitative evaluations were performed to assess the presence of DW changes compatible with
PVL. Diffusion-weighted MRI showed signal hyperintensity associated with decreased ADC values in 3 subjects (27%). In these
patients conventional MRI sequences were interpreted as normal and US (performed at the same time) as doubtful in 2 and compatible
with PVL in 1 subject. The MRI and US follow-up confirmed severe damage in all these patients. In 1 neonate hemorrhages involving
the germinative matrix were identified. In 8 neonates MRI was considered normal. In these subjects US follow-up (up to 4 months)
confirmed no signs of PVL. Diffusion-weighted imaging may have a higher correlation with later evidence of PVL than does conventional
MR imaging and US when performed in the acute phase of the disease. |