Skip to main content
SpringerLink
Log in

Diffusion-weighted MR imaging in the early diagnosis of periventricular leukomalacia

  • Neuro
  • Published:
European Radiology Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1a, b.
Fig. 2a–e.
Fig. 3a–e.

Similar content being viewed by others

References

  1. van Everdingen KJ, van der Grond J, Kappelle LJ, Ramos LM, Mali WP (1998) Diffusion-weighted magnetic resonance imaging in acute stroke. Stroke 29:1783–1790

    Article  Google Scholar 

  2. Moseley ME, Kucharczyk J, Mintorovitch J et al. (1990) Diffusion-weighted MR imaging of acute stroke: correlation with T2-weighted and magnetic susceptibility-enhanced MR imaging in cats. Am J Neuroradiol 11:423–429

    CAS  PubMed  Google Scholar 

  3. Baird AE, Benfield A, Schlaug G et al. (1997) Enlargement of human cerebral ischemic lesion volumes measured by diffusion-weighted magnetic resonance imaging. Ann Neurol 41:581–589

    Article  CAS  PubMed  Google Scholar 

  4. Warach S, Chien D, Li W, Ronthal M, Edelman RR (1992) Fast magnetic resonance diffusion-weighted imaging of acute human stroke. Neurology 42:1717–1723

    Article  CAS  PubMed  Google Scholar 

  5. Warach S, Gaa J, Siewert B, Wielopolski P, Edelman RR (1995) Acute human stroke studied by whole brain echo planar diffusion-weighted magnetic resonance imaging. Ann Neurol 37:231–241

    Article  CAS  PubMed  Google Scholar 

  6. Burdette JH, Ricci PE, Petitti N, Elster AD (1998) Cerebral infarction: time course of signal intensity changes on diffusion-weighted MR images. Am J Roentgenol 171:791–795

    Article  CAS  Google Scholar 

  7. Lovblad KO, Laubach HJ, Baird AE et al. (1998) Clinical experience with diffusion-weighted MR in patients with acute stroke. Am J Neuroradiol 19:1061–1066

    CAS  PubMed  Google Scholar 

  8. Grunwald I, Reith W (2002) Non-traumatic neurological emergencies: imaging of cerebral ischemia. Eur Radiol 7:1632–1647

    Article  Google Scholar 

  9. Cowan FM, Pennock JM, Hanrahan JD, Manji KP, Edwards AD (1994) Early detection of cerebral infarction and hypoxic ischemic encephalopathy in neonates using diffusion-weighted magnetic resonance imaging. Neuropediatrics 25:172–175

    Article  CAS  PubMed  Google Scholar 

  10. Robertson RL, Ben-Sira L, Barnes PD et al. (1999) MR line-scan diffusion-weighted imaging of term neonates with perinatal brain ischemia. Am J Neuroradiol 20:1658–1670

    CAS  PubMed  Google Scholar 

  11. Johnson AJ, Lee BC, Lin W (1999) Echoplanar diffusion-weighted imaging in neonates and infants with suspected hypoxic-ischemic injury: correlation with patient outcome. Am J Roentgenol 172:219–226

    Article  CAS  Google Scholar 

  12. Azzarelli B, Caldemeyer KS, Phillips JP, DeMyer WE (1996) Hypoxic–ischemic encephalopathy in areas of primary myelination: a neuroimaging and PET study. Pediatr Neurol 14:108–116

    Article  CAS  PubMed  Google Scholar 

  13. Tuor UI, Kozlowski P, Del Bigio MR et al. (1998) Diffusion- and T2-weighted increases in magnetic resonance images of immature brain during hypoxia–ischemia: transient reversal posthypoxia. Exp Neurol 150:321–328

    Article  CAS  PubMed  Google Scholar 

  14. Maalouf EF, Duggan PJ, Counsell SJ, Rutherford MA, Cowan F, Azzopardi D, Edwards AD (2001) Comparison of findings on cranial ultrasound and magnetic resonance imaging in preterm infants. Pediatrics 107:719–727

    Article  CAS  PubMed  Google Scholar 

  15. Volpe JJ (1991) Brain injury in the premature infant. Neuropathology, clinical aspects, pathogenesis, and prevention. Clin Perinatol 24:567–587

    Google Scholar 

  16. Inder T, Huppi PS, Zientara GP, Maier SE, Jolesz FA, Salvo D di, Robertson R, Barnes PD, Volpe JJ (1999) Early detection of periventricular leukomalacia by diffusion-weighted magnetic resonance imaging techniques. J Pediatr 134:631–634

    Article  CAS  PubMed  Google Scholar 

  17. Gelal FM, Grant PE, Fischbein NJ, Henry RG, Vigneron DB, Barkovich AJ (2001) The role of isotropic diffusion MRI in children under 2 years of age. Eur Radiol 11:1006–1114

    Article  CAS  PubMed  Google Scholar 

  18. Hill A (1997) Current concepts of hypoxic–ischemic cerebral injury in the term newborn. Pediatr Neurol 7:317–325

    Article  Google Scholar 

  19. Forbes KPN, Pipe JG, Bird R (2000) Neonatal hypoxic–ischemic encephalopathy: detection with diffusion-weighted MR imaging. Am J Neuroradiol 21:1490–1496

    CAS  PubMed  Google Scholar 

  20. Wolf RL, Zimmerman RA, Clancy R, Haselgrove JH (2001) Quantitative apparent diffusion coefficient measurements in term neonates for early detection of hypoxic–ischemic brain injury: initial experience. Radiology 218:825–833

    Article  CAS  PubMed  Google Scholar 

  21. Huppi PS, Murphy B, Maier SE, Zientara GP, Inder TE, Barnes PD, Kikinis R, Jolesz FA, Volpe JJ (2001) Microstructural brain development after perinatal cerebral white matter injury assessed by diffusion tensor magnetic resonance imaging. Pediatrics 107:

  22. Roelants-van Rijn AM, Nikkels PG, Groenendaal F, van Der Grond J, Barth PG, Snoeck I, Beek FJ, de Vries LS (2001) Neonatal diffusion-weighted MR imaging: relation with histopathology or follow-up MR examination Neuropediatrics. 32:286–294

  23. Carson SC, Hertzberg BS, Bowie JD, Burger PC (1990) Value of sonography in the diagnosis of intracranial hemorrhage and periventricular leukomalacia: a post-mortem study of 35 cases. Am J Neuroradiol 11:677–683

    CAS  PubMed  Google Scholar 

  24. Maalouf EF, Duggan PJ, Counsell SJ, Rutherford MA, Cowan F, Azzopardi D, Edwards AD (2001) Comparison of findings on cranial ultrasound and magnetic resonance imaging in preterm infants. Pediatrics 107:719–727

    Article  CAS  PubMed  Google Scholar 

  25. Volpe JJ (2000) Neurology of the newborn, 4th edn. Saunders, Philadelphia

  26. Rorke LB (1992) Anatomical features of the developing brain implicated in pathogenesis of hypoxic–ischemic injury. Brain Pathol 2:211–221

    Article  CAS  PubMed  Google Scholar 

  27. Inder TE, Volpe JJ (2000) Mechanisms of perinatal brain injury. Semin Neonatol 5:3–16

    Article  CAS  PubMed  Google Scholar 

  28. Chuang NA, Barkovich AJ, Henry RG, Miller SP, Vigneron DB (2001) Diffusion-weighted imaging for evaluation of brain injury in asphyxiated term neonates. Presentation number 33. Proc ASNR, Boston

  29. Rumpel H, Nedelcu J, Aguzzi A, Martin E (1997) Late glial swelling after acute cerebral hypoxia–ischemia in the neonatal rat: a combined magnetic resonance and histochemical study. Pediatr Res 42:54–59

    Article  CAS  PubMed  Google Scholar 

  30. Myers RE (1975) Four patterns of perinatal brain damage and their conditions of occurrence in primates. Adv Neurol 10:223–234

    CAS  PubMed  Google Scholar 

  31. Barkovich AJ (1992) MR and CT evaluation of profound neonatal and infantile asphyxia. Am J Neuroradiol 13:959–972

    CAS  PubMed  Google Scholar 

  32. Barkovich AJ, Westmark KD, Bedi HS, Partridge JC, Ferriero DM, Vigneron DB (2001) Proton spectroscopy and diffusion imaging on the first day of life after perinatal asphyxia: preliminary report. Am J Neuroradiol 22:1786–1794

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neuroradiology, University "La Sapienza", Via di Grottarossa, 1035 , Rome, Italy

    Alessandro Bozzao & Luigi Maria Fantozzi

  2. Department of Neonatology, University of Rome "Tor Vergata", 1035 , Rome, Italy

    Ambrogio Di Paolo & Alessandra Simonetti

  3. Department of Radiology, University of Rome "Tor Vergata", 1035, Rome, Italy

    Clarissa Mazzoleni, Fabrizio Fasoli & Roberto Floris

  4. IRCCS Neuromed, Pozzilli Isernia, Italy

    Luigi Maria Fantozzi

Authors
  1. Alessandro Bozzao
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ambrogio Di Paolo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Clarissa Mazzoleni
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Fabrizio Fasoli
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Alessandra Simonetti
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Luigi Maria Fantozzi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Roberto Floris
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alessandro Bozzao.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bozzao, A., Di Paolo, A., Mazzoleni, C. et al. Diffusion-weighted MR imaging in the early diagnosis of periventricular leukomalacia. Eur Radiol 13, 1571–1576 (2003). https://doi.org/10.1007/s00330-002-1815-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-002-1815-2

Keywords

Search

Navigation