A proposed magnetic resonance imaging grading system for the spectrum of central neonatal parasagittal hypoxic–ischaemic brain injury
Abstract Aim To describe the spectrum of parasagittal injury on MRI studies performed on children following severe perinatal term hypoxia–ischaemia, using a novel MRI grading system, and propose a new central pattern correlated with neuropathologic features. Methods MR scans of 297 patients with per...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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SpringerOpen
2022-01-01
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| Series: | Insights into Imaging |
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| Online Access: | https://doi.org/10.1186/s13244-021-01139-7 |
| _version_ | 1819349822450171904 |
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| author | Shalendra Kumar Misser Jan Willem Lotz Stefan-Dan Zaharie Nobuhle Mchunu Moherndran Archary Anthony James Barkovich |
| author_facet | Shalendra Kumar Misser Jan Willem Lotz Stefan-Dan Zaharie Nobuhle Mchunu Moherndran Archary Anthony James Barkovich |
| author_sort | Shalendra Kumar Misser |
| collection | DOAJ |
| description | Abstract Aim To describe the spectrum of parasagittal injury on MRI studies performed on children following severe perinatal term hypoxia–ischaemia, using a novel MRI grading system, and propose a new central pattern correlated with neuropathologic features. Methods MR scans of 297 patients with perinatal term hypoxia–ischaemia were evaluated for typical patterns of brain injury. A total of 83 patients that demonstrated the central/basal ganglia–thalamus and perirolandic pattern of injury were categorised according to the degree of severity. The perirolandic injury was graded by the degree of interhemispheric widening, paracentral lobule involvement and perirolandic cortex destruction leading to a tiered categorisation. Of these 83 patients, 19 had the most severe subtype of injury. A detailed analysis of the clinical data of a subset of 11 of these 19 patients was conducted. Results We demonstrated the mild subtype in 21/83(25%), the moderate subtype in 22/83(27%) and the severe subtype in 21/83(25%). A fourth pattern was identified in 19/83(23%) patients with a diamond-shaped expansion of the interhemispheric fissure, concomitant thalamic, putaminal, hippocampal and other smaller substrate involvement indicative of the most destructive subtype. Conclusions We propose a new MR grading system of injury at the parasagittal perirolandic region related to severe, sustained central perinatal term hypoxia–ischaemia. We also introduce a previously undescribed pattern of injury, the most severe form of this spectrum, seen especially after prolongation of the second stage of labour. This constellation of high metabolic substrate, targeted tissue destruction is consistently demonstrated by MRI, termed the massive paramedian injury pattern. |
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| format | Article |
| id | doaj.art-8d22be3abebd47d087dc3540e879a3b7 |
| institution | Directory Open Access Journal |
| issn | 1869-4101 |
| language | English |
| last_indexed | 2024-12-24T19:06:38Z |
| publishDate | 2022-01-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Insights into Imaging |
| spelling | doaj.art-8d22be3abebd47d087dc3540e879a3b72022-12-21T16:43:05ZengSpringerOpenInsights into Imaging1869-41012022-01-0113111910.1186/s13244-021-01139-7A proposed magnetic resonance imaging grading system for the spectrum of central neonatal parasagittal hypoxic–ischaemic brain injuryShalendra Kumar Misser0Jan Willem Lotz1Stefan-Dan Zaharie2Nobuhle Mchunu3Moherndran Archary4Anthony James Barkovich5Lake Smit and Partners Inc.Department of Radiodiagnosis, Faculty of Medicine and Health Sciences, Stellenbosch UniversityDepartment of Anatomical Pathology, Faculty of Medicine and Health Sciences, Stellenbosch UniversityBiostatistics Unit, South African Medical Research CouncilDepartment of Pediatrics, University of Kwa-Zulu Natal, Faculty of Health Sciences, Nelson R Mandela School of MedicineSchool of Medicine, University of CaliforniaAbstract Aim To describe the spectrum of parasagittal injury on MRI studies performed on children following severe perinatal term hypoxia–ischaemia, using a novel MRI grading system, and propose a new central pattern correlated with neuropathologic features. Methods MR scans of 297 patients with perinatal term hypoxia–ischaemia were evaluated for typical patterns of brain injury. A total of 83 patients that demonstrated the central/basal ganglia–thalamus and perirolandic pattern of injury were categorised according to the degree of severity. The perirolandic injury was graded by the degree of interhemispheric widening, paracentral lobule involvement and perirolandic cortex destruction leading to a tiered categorisation. Of these 83 patients, 19 had the most severe subtype of injury. A detailed analysis of the clinical data of a subset of 11 of these 19 patients was conducted. Results We demonstrated the mild subtype in 21/83(25%), the moderate subtype in 22/83(27%) and the severe subtype in 21/83(25%). A fourth pattern was identified in 19/83(23%) patients with a diamond-shaped expansion of the interhemispheric fissure, concomitant thalamic, putaminal, hippocampal and other smaller substrate involvement indicative of the most destructive subtype. Conclusions We propose a new MR grading system of injury at the parasagittal perirolandic region related to severe, sustained central perinatal term hypoxia–ischaemia. We also introduce a previously undescribed pattern of injury, the most severe form of this spectrum, seen especially after prolongation of the second stage of labour. This constellation of high metabolic substrate, targeted tissue destruction is consistently demonstrated by MRI, termed the massive paramedian injury pattern.https://doi.org/10.1186/s13244-021-01139-7Hypoxia–ischaemia in term neonatesBrainMagnetic resonance imagingMassive paramedian injury |
| spellingShingle | Shalendra Kumar Misser Jan Willem Lotz Stefan-Dan Zaharie Nobuhle Mchunu Moherndran Archary Anthony James Barkovich A proposed magnetic resonance imaging grading system for the spectrum of central neonatal parasagittal hypoxic–ischaemic brain injury Insights into Imaging Hypoxia–ischaemia in term neonates Brain Magnetic resonance imaging Massive paramedian injury |
| title | A proposed magnetic resonance imaging grading system for the spectrum of central neonatal parasagittal hypoxic–ischaemic brain injury |
| title_full | A proposed magnetic resonance imaging grading system for the spectrum of central neonatal parasagittal hypoxic–ischaemic brain injury |
| title_fullStr | A proposed magnetic resonance imaging grading system for the spectrum of central neonatal parasagittal hypoxic–ischaemic brain injury |
| title_full_unstemmed | A proposed magnetic resonance imaging grading system for the spectrum of central neonatal parasagittal hypoxic–ischaemic brain injury |
| title_short | A proposed magnetic resonance imaging grading system for the spectrum of central neonatal parasagittal hypoxic–ischaemic brain injury |
| title_sort | proposed magnetic resonance imaging grading system for the spectrum of central neonatal parasagittal hypoxic ischaemic brain injury |
| topic | Hypoxia–ischaemia in term neonates Brain Magnetic resonance imaging Massive paramedian injury |
| url | https://doi.org/10.1186/s13244-021-01139-7 |
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