The magnetic resonance revolution in brain imaging: impact on neonatal intensive care

Despite these advances, perinatal hypoxia-ischaemia (HI) is experienced by about 4/1000 live term births, and disability rates among very low birthweight (birth weight < 1500 g) infants remain high, with 5-15% showing major spastic abnormalities and an additional 25-50% or more having deficits in cognition and behaviour. 4- 6 Neuroimaging is needed in at risk infants, as clinical evaluation may not provide adequate diagnostic or prognostic information and has two principal functions: (a) early diagnosis of brain injury so that appropriate medical management can be provided; (b) detection of lesions associated with long term neurodevelopmental disability. [...]diffusion weighted imaging has not been proven to be effective as a prognostic tool in NE. 14 This is surprising, as diffusion weighted imaging in the adult brain 15 and experimental models 16 of stroke has revolutionised the possibility of early diagnosis and intervention, often revealing image abnormalities on water diffusion maps well before CT or conventional MR. 31P and 1H MR spectroscopy (giving quantitative information on brain energetics, intracellular pH (pHi) and lactate) can give early prognostic information on brain injury severity.