Published online November 13, 2006
PEDIATRICS Vol. 118 No. 6 December 2006, pp. e1812-e1821 (doi:10.1542/peds.2006-1499)
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ARTICLE

Magnetic Resonance Imaging of Neonatal Encephalopathy at 4.7 Tesla: Initial Experiences

Enrico De Vita, PhDa,b, Alan Bainbridge, PhDa, Jeanie L. Y. Cheong, FRACPc, Cornelia Hagmann, MDc, Rosarie Lombard, ANNP, MScd, Wui K. Chong, MD, FRCRe, John S. Wyatt, FRCPCHc, Ernest B. Cady, FInstP, BSca,b, Roger J. Ordidge, PhDb and Nicola J. Robertson, FRCPCH, PhDc

a Department of Medical Physics and Bio-Engineering
d Neonatal Intensive Care Unit, Elizabeth Garrett Anderson Hospital, University College London Hospitals National Health Service Foundation Trust, London, United Kingdom
b Department of Medical Physics and Bio-Engineering
c Centre for Perinatal Brain Research, Institute for Women's Health
e Radiology and Physics Unit, Institute of Child Health, University College London, London, United Kingdom

OBJECTIVES. The goals were to develop safe 4.7-T MRI examination protocols for newborn infants and to explore the advantages of this field strength in neonatal encephalopathy.

METHODS. Nine ventilated newborn infants with moderate or severe encephalopathy were studied at 4.7 T, with ethical approval and informed parental consent. The custom-made, 4.7-T-compatible, neonatal patient management system included acoustic noise protection and physiologic monitoring. An adult head coil was used. Acquisition parameters for T2-weighted fast spin echo MRI and a variety of T1-weighted methods were adapted for MRI of neonatal brain at 4.7 T. The pulse sequences used had a radiofrequency specific absorption rate of <2 W/kg.

RESULTS. Physiologic measures were normal throughout each scan. T2-weighted fast spin echo imaging provided better anatomic resolution and gray/white matter contrast than typically obtained at 1.5 T; T1-weighted images were less impressive.

CONCLUSIONS. With appropriate safety precautions, MRI of newborn infants undergoing intensive care is as feasible at 4.7 T as it is at 1.5 T; our initial studies produced T2-weighted fast spin echo images with more detail than commonly obtained at 1.5 T. Although T1-weighted images were not adequately informative, additional pulse sequence optimization may be advantageous. A smaller neonatal head coil should also permit greater flexibility in acquisition parameters and even more anatomic resolution and tissue contrast. In neonatal encephalopathy, interpretation of the T2-weighted pathologic detail in combination with comprehensive neurodevelopmental follow-up should improve prognostic accuracy and enable more patient-specific therapeutic interventions. In addition, more precise relationships between structural changes and functional impairment may be defined.

Key Words: magnetic resonance imaging • brain • neonatal encephalopathy • high-field MRI • developmental outcomes

Abbreviations: FOV—field of view • FSE—fast spin echo • GWMC—gray/white matter contrast • IR—inversion recovery • MDEFT—modified driven-equilibrium Fourier transform • NE—neonatal encephalopathy • SAR—specific absorption rate • SNR—signal/noise ratio • TE—echo time • TI—inversion time • TR—repetition time

Accepted Jul 18, 2006.


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