A Practical approach Dr Dr. Khorshid Moh ohammad, MD, MSc(Pedia - PowerPoint PPT Presentation

Neonatal Brain MRI: A Practical approach Dr Dr. Khorshid Moh ohammad, MD, MSc(Pedia iatrics), FABP, FR FRCP(Edin in) NIC ICU le lead ad, Neuro-Crit itical l Car are Program , , Univ iversity of of Calg algary ry

Disclosure • I have no conflict of interest to disclose

Objectives • MRI sequences • Brain MRI in HIE • MRI approach to large ventricles

Orientation

Sagittal

Axial

Coronal

Sequences

T1 • Chronic ischemic changes • Hemorrhage • Myelination • Brain malformation

Chronic ischemia

Hemorrhage

Myelination

Myelination

T2 • Myelination • Brain malformation • Hemorrhage • Chronic ischemic changes

Myelination

Myelination

Hemorrhage

Chronic ischemia

DWI/ADC

MRS

MRS

GRE/SWI

Brain MRI in HIE

MRI windows Post cooli ling (day 4-5) 5) Day 10-14 14 • DWI • T1 T1 • ADC • MRS • T2 T2

HIE IE brain in in inju jury ry patterns on MRI

MRS

b f h

Hypoglycemia

Big ventricles Normal or small head Big head Brain atrophy or Hydrocephalus malformation

Big ventricles and small/normal HC= Atrophy

Big ventricles and small/normal HC= Malformation • 1) Ventriculomegaly dysmorphic • 2) Sylvian Fissures simple, vertically oriented • 3) G/W interface normal vs. too simple • 4) Cortical thickness: too thick > 3mm • 5) # Sulci/Gyri too many or too few • 6) Heterotopias radial review of images

1.Ventricles

Ventricles

Lateral ventricles corpus callosum Septum pellucidum Head of caudate Anterior horn of the lateral ventricles Fornix

Third ventricle Fornix Thalamus Thalamus Third Ventricle Midbrain

Fourth ventricle Pons Cerebellar peduncle Cerebellar peduncle Fourth ventricle Vermis

CC Agenesis

Vermis agenesis

2.Sylvian fissure

Sylvian fissure

Sylvian fissure

3. G/W interface

G/W interface

4.Cortical thickness

Cortical thickness

5. Number of Sulci/Gyri

Lissencephaly pachygyria Polymicrogyria

Lissencephaly

Hemimegalencephaly

Polymicrogyria

Polymicrogyria

6.Heterotopias

CSF-WM-GM

Heterotopia

subependymal heterotopia

Large ventricles with macrocephaly =Hydrocephalus

CSF flow

Aqueductal stenosis

PHVD

PHVD

PHVD

A CKNOWLEDGEMENTS Pediatric-NCC ◦ Michael Esser ◦ Luis Bello-Espinoza ◦ Jeffrey Buchhalter ◦ JP Appendino ◦ Aleksandra Mineyko ◦ Jong Rho ◦ Adam Kirton ◦ Harvey Sarnat ◦ Alice Ho ◦ Kim Smyth ◦ Xing-Chang Wei ◦ James Scott ◦ Megan Crone NICU-NCC ◦ Alixe Howlett ◦ Hussein Zein ◦ Prashanth Murthy ◦ Thierry Lacaze ◦ Leonora Hendson ◦ Elsa Fiedrich ◦ Ayman Abou Mehrem ◦ Ipsita Goswami ◦ Jan Lind ◦ Cathy Metcalf ◦ Leigh Irvine ◦ Norma Oliver SANTS outreach program team ◦ Sumesh Thomas ◦ Renee Paul ◦ NTNs and TRTs

THANK YOU!