Neonatal MRI

The neurological examination often falls short as a definitive test of central nervous system (CNS) integrity in newborn infants. In addition, neonatal brain injury often eludes diagnosis, especially in preterm infants, because obvious signs are not apparent or may be attributed to immaturity. However, the likelihood of CNS compromise increases dramatically with signs of perinatal distress such as low umbilical cord blood pH, low Apgar score, and seizures. The importance of early diagnosis becomes apparent in studies showing the efficacy of treating brain injury with pharmacologic and head- or body cooling therapies. These treatments may support the maturing brain in its early self-repair mechanisms and rescue neurons after the initial perinatal insult. The treatment’s success, however, hinges on early diagnosis. Magnetic resonance imaging (MRI) techniques are far superior to ultrasonography (US) or computed tomography (CT) in detecting early perinatal brain injury. MRI provides more specific anatomical localisation and more often reveals the underlying cause and timing of the initial insult. In addition, MRI is the only technique that can distinguish the presence or absence of myelin. Information such as the timing of the insult, its location, and myelination are crucial for assessing neurodevelopmental outcome. This paper reviews the basic principles of MRI as well as the benefits of imaging the neonatal brain. It also examines two pathological patterns of neonatal brain injury on MRI: intraventricular haemorrhage (IVH) and hypoxic-ischaemic encephalopathy (HIE).