Key Points: □ Clinical neurological evaluation of the neonate with depression and/or encephalopathy is nonspecific. The neonatal course may suggest hypoxic-ischemic insult but the clinical examination cannot fully evaluate the extent or severity of the brain injury (moderate evidence). □ The role of ultrasound (US) and computed tomography (CT) in the evaluation of hypoxic-ischemic brain injury at term is limited. Ultrasound could be used to evaluate neonates in the neonatal ICU if the patient is too sick to travel to the MR scanner. CT can be used to assess for traumatic brain injury if there is a history of complicated delivery. CT also plays a role in the acute management of suspected acute intracranial hemorrhage. However, CT and US fall short of MR imaging in the evaluation of the parenchymal changes of hypoxic-ischemic injury (moderate evidence). □ Conventional MR imaging with T1-weighted, T2-weighted and T2*-weighted imaging is more sensitive than US and at least as sensitive as CT for HIE (moderate evidence). □ Diffusion-weighted imaging (DWI) is complementary to conventional MR imaging, improving sensitivity to ischemic injuries during the first week after the ischemic insult (moderate to strong evidence). □ MR spectroscopy (MRS) may detect injuries in the first week after the insult that are otherwise occult. Elevated lactate and decreased NAA predict a poor clinical outcome (moderate to strong evidence). □ FLAIR and contrast-enhanced imaging sequences do not improve sensitivity of the MR exam beyond the other conventional sequences, DWI and MRS (moderate evidence). □ MR imaging holds promise for evaluating prognosis, triaging patients for neuroprotective therapies, and serving as early predication of therapeutic efficacy (limited to moderate evidence).
|Title of host publication||Evidence-Based Imaging in Pediatrics|
|Subtitle of host publication||Optimizing Imaging in Pediatric Patient Care|
|Publisher||Springer New York|
|Number of pages||13|
|State||Published - Dec 1 2010|