Magnetic Resonance Imaging in Evaluation of Periventricular Leukomalacia.

BACKGROUND: Improvements in perinatal care have resulted in increased survival of infants born prematurely, however neurological damage due to ischaemic infarction of the periventricular white matter is a problem of enormous medical, social and economic importance. Such vascular insult leads to destruction of the periventricular white matter, termed periventricular leukomalacia (PVL). This abnormality is the leading cause of significant morbidity in the survivors of premature birth. Magnetic Resonance Imaging (MRI) is perhaps the only imaging modality, which can accurately detect and quantify periventricular leukomalacia.
METHODS: Magnetic Resonance Imaging was carried out in 45 children in the age group of 4 weeks to 8 years, with history of premature birth and perinatal hypoxia. These children had neurological deficits ranging from cortical blindness, spastic diplegia, spastic quadriplegia to severe mental retardation. The procedure was carried out on a 1.5 Tesla (Siemens Magnetom Avanto) MR system using available protocols for imaging the paediatric brain. RESULT: The study revealed that MR imaging could accurately identify areas of ischaemic infarction of the periventricular white matter both in the early as well as in the late stages. The pattern of abnormalities detected on MRI of the brain in these patients can be considered specific for PVL in the clinical background of premature birth and perinatal hypoxia.
CONCLUSION: MRI is the ideal imaging modality to detect, quantify and accurately map the areas of brain affected by this hypoxic-ischaemic process. It is presently the gold standard for evaluating the neuroparenchyma in those with perinatal hypoxia. Advanced MR techniques like Diffusion Weighted Imaging (DWI), Proton MR Spectroscopy and DTI have shown great promise in our understanding of the pathophysiology and anatomic considerations of this disease process.