Abstract:
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Purpose: To determine the imaging outcome of lesions identified on DWI in term infants presenting with seizures and to determine the corresponding clinical outcome.
Methods and Materials: Term infants presenting with seizures, lesions with increased DWI signal and decreased ADC in the first week of life and clinical follow-up of at least 12 months were included in this study. DWI patterns of abnormality were classified as 1) central (VL thalamus and lateral lentiform), 2) peripheral or 3) focal vascular territory lesions. Abnormalities on follow-up T1 and T2 weighted images were compared to initial area of involvement on the presenting DWI study. Standardized neurological assessments were performed at a minimum of 12 months of age.
Results: Eighteen patients met these criteria: one had a central pattern of DWI bright signal, 9 had peripheral patterns, 7 had vascular territory lesions, 1 was unusual and not classifiable. Imaging follow-up was obtained between 3 months and 2 years in 14/18 and showed that the outcome of bright DWI regions was variable ranging from no detectable abnormality, volume loss with no T2 abnormality, volume loss with increased T2 signal, to cystic encephalomalacia. In general, the final region of abnormality was usually smaller in size than the initial DWI abnormality. On neurological assessments at 12 -72 months, none had microcephaly or major motor disability and only 1 developed a seizure disorder.
Conclusion: In these selected cases, bright lesions on DWI were not predictive of the severity of structural injury or of the degree of neurological disability. Further neurological follow-up and neuropsychological assessments at school age are required to fully evaluate the consequence of these lesions.
Grant MD, MSc, P,
Imaging and Clinical Follow-up of Newborns with Seizures and Bright DWI/Decreased ADC Lesions. Radiological Society of North America 2003 Scientific Assembly and Annual Meeting, November 30 - December 5, 2003 ,Chicago IL.
http://archive.rsna.org/2003/3107263.html
