Published online December 29, 2008
PEDIATRICS Vol. 123 No. 1 January 2009, pp. 319-326 (doi:10.1542/peds.2008-0283)

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ARTICLE

Comparison of Computer Tomography and Magnetic Resonance Imaging Scans on the Third Day of Life in Term Newborns With Neonatal Encephalopathy

Vann Chau, MD^a, Kenneth John Poskitt, MDCM^b, Michael Andrew Sargent, MD^b, Brian Alexander Lupton, MB^a, Alan Hill, MD, PhD^a, Elke Roland, MD^a and Steven Paul Miller, MAS, MDCM^a

Departments of ^a Pediatrics
^b Radiology, University of British Columbia, Vancouver, British Columbia, Canada

OBJECTIVE. Our goal was to compare the patterns of brain injury detected by computed tomography, conventional MRI (T1- and T2-weighted sequences), and diffusion-weighted MRI in a cohort of term newborns with neonatal encephalopathy studied uniformly with all 3 modalities on the third day of life.

METHODS. Term newborns (36 weeks' gestation) admitted to our center with neonatal encephalopathy were scanned with computed tomography, MRI, and diffusion-weighted MRI at 72 (±12) hours of life (n = 48). Each modality was scored independently of the other with previously validated scoring systems. The predominant pattern of brain injury was classified as: normal, watershed, basal nuclei, total (maximal basal nuclei and watershed), and focal-multifocal (presence of strokes and/or white matter injury alone).

RESULTS. The agreement for the predominant pattern of injury was excellent between MRI and diffusion-weighted MRI (77% agreement). The agreement for the pattern of injury was also good for computed tomography and diffusion-weighted MRI (67% agreement). The extent of cortical injury and focal-multifocal lesions, such as strokes and white matter injury, were less apparent on computed tomography than diffusion-weighted MRI. In 19 newborns with a repeat MRI in the second week of life, the predominant pattern seen on the day 3 diffusion-weighted MRI was confirmed.

CONCLUSIONS. Diffusion-weighted MRI is the most sensitive technique with which to assess brain injury on day 3 of life in term newborns with neonatal encephalopathy, particularly for cortical injury and focal-multifocal lesions such as stroke and white matter injury. All 3 modalities identify the most serious patterns of brain injury similarly.

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Key Words: brain imaging • diffusion-weighted MRI • hypoxic-ischemic encephalopathy • magnetic resonance • neonatal, hypoglycemia

Abbreviations: NE—neonatal encephalopathy • CT—computed tomography • DW—diffusion-weighted • BN—basal nuclei • WMI—white matter injury • ADC—apparent diffusion coefficient • RS—resuscitation score

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Accepted Apr 22, 2008.

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