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Diffusion-Weighted Imaging in Neonatal Cerebral Infarction: Clinical Utility and Follow-Up

Pediatric Neurology Unit, Departments of Neurology and Pediatrics, Massachusetts General Hospital and Harvard Medical School, Boston, MA

Teesta B. Soman, MD

Pediatric Neurology Unit, Departments of Neurology and Pediatrics, Massachusetts General Hospital and Harvard Medical School, Boston, MA

Masanori Takeoka, MD

Pediatric Neurology Unit, Departments of Neurology and Pediatrics, Massachusetts General Hospital and Harvard Medical School, Boston, MA

Pamela W. Schaefer, MD

Department of Radiology (Neuroradiology Division) Massachusetts General Hospital and Harvard Medical School, Boston, MA

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 mean of 17 months with detailed neurologic examinations at regular intervals. Head computed tomography (CT) and conventional magnetic resonance (MRI) and diffusion-weighted images were obtained. Percent lesion contrast was evaluated for 19 lesions on T ₂-weighted and diffusion-weighted images. Follow-up conventional MRIs were obtained in seven patients. The findings on diffusion-weighted imaging were correlated with CT and conventional MRI findings as well as with short-term neuro-developmental outcome. Four patients had focal cerebral infarctions. Four patients had diffuse injury consistent with hypoxic-ischemic encephalopathy. Percent lesion contrast of all 19 lesions was significantly higher on diffusion-weighted images when compared with T₂-weighted images. In five patients, there were lesions visualized only with diffusion-weighted imaging. In all patients, there was increased lesion conspicuity and better definition of lesion extent on the diffusion-weighted images compared with the CT and T ₂-weighted MR images. In seven of eight patients follow-up imaging confirmed prior infarctions. Short-term neurologic outcome correlated with the extent of injury seen on the initial diffusion-weighted imaging scans for all patients. Diffusion-weighted imaging is useful in the evaluation of acute ischemic brain injury and seizure etiology in neonates. In the acute setting, diffusion-weighted imaging provides information not available on CT and conventional MRI. This information correlates with short-term clinical outcome. (J Child Neurol 2000;15:592-602).

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