Periventricular low intensities on fluid attenuated inversion recovery imaging in the newborn infant: relationships to the clinical data and long-term outcome.

BACKGROUND

The author's previous study showed that it is possible to predict the severity of white matter injury in early infancy by using fluid attenuated inversion recovery (FLAIR) imaging. A follow-up study was performed in order to assess the correlation between the incidence of periventricular low intensities on FLAIR imaging (F-PVLI) and the clinical data including the physiological variables at birth and the long-term outcome of the infant.

METHODS

The authors reviewed MRI of 328 newborn infants, which were obtained before 2 months corrected age. Abnormal findings in the periventricular white matter and other part of the brain were recorded. Periventricular abnormal intensities were sorted into four groups according to the FLAIR grade, which comprised normal, F-PVLI 1 (focal), F-PVLI 2 (extensive), cystic periventricular leukomalacia (C-PVL), and diffused leukomalacia.

RESULTS

Significantly more periventricular abnormal intensities were detected by FLAIR imaging than by conventional T1 and T2 weighted imaging. In the groups of F-PVLI 2 and C-PVL, the birth weight (BW), gestational age (GA), blood pH and base excess at birth were significantly lower than in the normal group. However, when the study population was defined into very low birth weight infants, F-PVLI 2 had significantly larger BW and GA than normal. The FLAIR grade had a strong correlation with the developmental outcome at 12 and 36 months corrected age.

CONCLUSIONS

F-PVLI is a silent but very important white matter injury, which has many features in common with C-PVL. FLAIR imaging could be a strong tool in screening newborn infants at high risk of neurological impairment.