Ks. Krishnamoorthy et al., Diffusion-weighted imaging in neonatal cerebral infarction: Clinical utility and follow-up, J CHILD NEU, 15(9), 2000, pp. 592-602
We describe the clinical utility of echo-planar diffusion-weighted imaging
in neonatal cerebral infarction. Eight full-term neonates aged 1 to 8 days
referred for neonatal seizures were studied. Patients were followed for a m
ean of 17 months with detailed neurologic examinations at regular intervals
. Head computed tomography (CT) and conventional magnetic resonance (MRI) a
nd diffusion-weighted images were obtained. Percent lesion contrast was eva
luated for 19 lesions on T-2-weighted and diffusion-weighted images. Follow
-up conventional MRIs were obtained in seven patients. The findings on diff
usion-weighted imaging were correlated with CT and conventional MRI finding
s as well as with short-term neurodevelopmental outcome. Four patients had
focal cerebral infarctions, Four patients had diffuse injury consistent wit
h hypoxic-ischemic encephalopathy. Percent lesion contrast of all 19 lesion
s was significantly higher on diffusion-weighted images when compared with
T-2-weighted images. In five patients, there were lesions visualized only w
ith diffusion-weighted imaging. In all patients, there was increased lesion
conspicuity and better definition of lesion extent on the diffusion-weight
ed images compared with the CT and T-2-weighted MR images. In seven of eigh
t patients follow-up imaging confirmed prior infarctions. Short-term neurol
ogic outcome correlated with the extent of injury seen on the initial diffu
sion-weighted imaging scans for all patients. Diffusion-weighted imaging is
useful in the evaluation of acute ischemic brain injury and seizure etiolo
gy in neonates. In the acute setting, diffusion-weighted imaging provides i
nformation not available on CT and conventional MRI. This information corre
lates with short-term clinical outcome.