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Evidence-Based Imaging in Pediatrics pp 71–83Cite as

Imaging of Hypoxic-Ischemic Encephalopathy in the Full-Term Neonate

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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).

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Author information

Authors and Affiliations

  1. Department of Pediatrics/Newborn Medicine, Washington University School of Medicine, St. Louis Children’s Hospital, 63110, St. Louis, MO, USA

    Amit M. Mathur

  2. Department of Pediatric Radiology, St. Louis Children’s Hospital,Washington University, 63017, St. Louis, MO, USA

    Robert C. McKinstry MD, PhD (Associate Professor)

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  1. Amit M. Mathur
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  2. Robert C. McKinstry MD, PhD
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Correspondence to Amit M. Mathur .

Editor information

Editors and Affiliations

  1. Dept. Radiology, Miami Children's Hospital, SW 114 Street 7420, Miami , 33156, U.S.A.

    L. Santiago Medina

  2. Dept. Radiology, Riley Children's Hospital, Barnhill Drive 702 , Indianapolis, 46202-5200, U.S.A.

    Kimberly E. Applegate

  3. Harborview Medical Center, University of Washington, Ninth Avenue 325, Seattle, 98104-2499, U.S.A.

    C. Craig Blackmore

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Mathur, A.M., McKinstry, R.C. (2010). Imaging of Hypoxic-Ischemic Encephalopathy in the Full-Term Neonate. In: Medina, L., Applegate, K., Blackmore, C. (eds) Evidence-Based Imaging in Pediatrics. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-0922-0_6

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  • DOI: https://doi.org/10.1007/978-1-4419-0922-0_6

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