Aim: Magnetic resonance imaging (MRI) is increasingly being used in high-risk preterm
neonates. Cranial ultrasound (US) was compared with MRI in preterm patients with parenchymal
injury and related to neurodevelopmental outcome.
Patients and Methods: Studies were performed in 61 patients. Twelve infants with normal US (Group 1) had
an MRI within the first 4 weeks of life (early MRI), and 10 also at term age (late
MRI). Eight out of 20 infants with intraventricular haemorrhage with parenchymal involvement
(IVH + PI) (Group 2) had an early as well as a late MRI and 12 a late MRI. Of the
20 patients with cystic-periventricular leukomalacia (c-PVL) (Group 3), 7 had an early
MRI, 1 had an MRI on both occasions and 12 had a late MRI. All 9 children with focal
infarction (FI) (Group 4) had a late MRI. Results: MRI was conform with cranial US in Group 1. Early MRI in Group 2 showed contralateral
c-PVL in one infant and an additional contralateral occipital parenchymal haemorrhage
and blood in the posterior fossa in another infant. Late MRI showed an asymmetrical
posterior limb of the internal capsule (PLIC) (n = 6), which predicted later hemiplegia.
Early MRI in Group 3 showed more cysts (n = 5), punctate white matter lesions (n =
6), lesions in the basal ganglia (n = 1) and once involvement of the cerebellum. Late
MRI showed involvement of the centrum semiovale (n = 2) lesions in the basal ganglia
(n = 2) and bilateral abnormal signal intensity of the PLIC in 7 infants who all went
on to develop cerebral palsy. In Group 4 MRI showed signal intensity changes suggestive
of cystic lesions compared to persisting echogenicity on US (n = 3) and an asymmetrical
PLIC (n = 5), which predicted hemiplegia in 4. Conclusion: Early MRI especially provided additional information in those with c-PVL. MRI at
term age could assess the PLIC, which was useful in children with unilateral parenchymal
involvement, for prediction of subsequent hemiplegia and, to a lesser degree, in bilateral
c-PVL for prediction of diplegia or quadriplegia.
Key words
Cranial ultrasound - Periventricular leukomalacia - Intraventricular haemorrhage -
Magnetic resonance imaging - Preterm infants - Neurodevelopmental outcome
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Prof. Dr. L. S. de Vries
Department of Neonatology KE.04.123.1
P.O. Box 85090
3508 AB Utrecht
The Netherlands
Email: L.devries@wkz.azu.nl
