Classification of Developmental Features and Cerebral Pathologic Lesions on Brain MRI Scans

Structure/LesionT1-Weighted ImagingT2-Weighted ImagingSiteComments
White matter detailsIncreased signal intensity, bands, “caps” and “arrowheads”16Periventricular white matterPresent from birth and still seen in some infants at term-equivalent age
Myelin within white matter tractsIncreased signal intensityDecreased signal intensityPLICProportion of myelination of PLIC recorded
Central sulcusMyelin noted as present or absent
Corona radiataMyelin noted as present or absent
HPICystic area: decreased signal intensity; hemorrhagic area: increased signal intensityCystic area: increased signal intensity; hemorrhagic area: decreased signal intensityAdjacent to/communicating with lateral ventricle; associated with GLH/IVHLaterality of lesion noted; signal intensity dependent on timing and extent20
Cystic periventricular leukomalaciaDecreased signal intensity, equivalent to CSFIncreased signal intensity, equivalent to CSFBilateral within periventricular white matter
GLHIncreased signal intensityDecreased signal intensityGerminal matrix, caudal/temporalLaterality of lesion noted; signal intensity dependent on timing and extent of lesion20
IVHIncreased signal intensityDecreased signal intensityWithin lateral ventricleLaterality of lesion noted; signal intensity dependent on timing and extent of lesion20
Extracerebral hemorrhageIncreased signal intensityDecreased signal intensityHemispheric or within posterior fossa
Punctate white matter lesions (Fig 1)Increased signal intensityDecreased signal intensityPeriventricular white matterNumber noted
DEHSIDecreased signal intensityIncreased signal intensityThroughout white matterSeverity graded by signal intensity and extent (Fig 3)
Ventricular dilationAxial diameter of >8 mm at GA of ≤25 wk; axial diameter of >10 mm at GA of >25 wk
Widened ECSAssessed on T2-weighted scans; >3 mm in width along cortical convexities
Cerebellar hemorrhagic lesions (Fig 2)Increased signal intensityDecreased signal intensityWithin cerebellar hemispheresLaterality of lesion noted; subsequent atrophy of cerebellum recorded
Basal ganglia and thalamic lesionsCysts: decreased signal intensity; hemorrhage: increased signal intensityCysts: increased signal intensity; hemorrhage: decreased signal intensityCaudate, lentiform or thalamusAtrophy on term scan recorded
  • CSF indicates cerebrospinal fluid; PLIC, posterior limb of the internal capsule.