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Do we need a brain MRI once or twice in infants treated with hypothermia?

Pediatric Research volume 94, pages 870–872 (2023)Cite this article

Garvey et al. raise the question whether one magnetic resonance imaging (MRI) to assess brain injury in infants with neonatal encephalopathy (NE) receiving hypothermia is sufficient to demonstrate the full extent of injury.1 In their cohort of 94 infants, they argue that it is not, because 18 infants had a change in findings between the two scans including 7/18 whose lesion severity, using the Weeke score,2 changed the overall grade. They showed that 3/24 (13%) infants with a normal first MRI had abnormalities on the second MRI and 4/70 (6%) with lesions on the first MRI showed worsening of the lesions on the second MRI. Conversely in 11/70 (16%) infants, lesions seen on the first MRI were no longer seen on the second MRI performed between 9 and 43 days after birth, including 4 infants with diffusion restriction of the thalami and basal ganglia on the earlier scan.

Their data are in agreement with those reported by other groups performing sequential MRIs in infants with NE. O’Kane et al. also found some differences between the first (days 4–6) and second scan (days 10–12), with better prediction of outcome based on the first week MRI.3 This may be explained by pseudonormalization in the second week, so that areas of diffusion restriction were no longer seen but signal abnormalities on T1- and T2-weighted images were less apparent or not yet fully developed.

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Fig. 1: Evolution of PWML over time.

References

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Authors and Affiliations

  1. Department of Neonatology, Wilhelmina Children’s Hospital and Brain Center, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands

    Linda S. de Vries & Floris Groenendaal

  2. Department of Neonatology, Leiden University Medical Center, Leiden, the Netherlands

    Linda S. de Vries

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  1. Linda S. de Vries
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  2. Floris Groenendaal
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L.s.d.V. wrote the first draft and F.G. edited and approved the final version.

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Correspondence to Linda S. de Vries.

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de Vries, L.S., Groenendaal, F. Do we need a brain MRI once or twice in infants treated with hypothermia?. Pediatr Res 94, 870–872 (2023). https://doi.org/10.1038/s41390-023-02634-x

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