Patterns and implications of MR contrast enhancement in perinatal asphyxia: a preliminary report.

PURPOSE To determine the presence and location of MR contrast enhancement in infants with perinatal asphyxia and to evaluate the utility of enhancement in assessing extent of brain damage. METHODS Precontrast and postcontrast MR examinations within the first 10 days of life were evaluated in 10 infants with suspected hypoxic-ischemic birth injury. Findings were correlated with clinical birth history and short-term neurologic follow-up. RESULTS All four infants with MR signal abnormalities and contrast enhancement in the basal ganglia and brain stem had early seizures and profound neurologic deficits at early follow-up. Two infants had abnormal scans but no contrast enhancement; one with MR signal abnormality within the basal ganglia is neurologically healthy at 10-month follow-up, whereas the other, in status epilepticus at the time of imaging at age 2 days, died. Two infants with minimal parasagittal subcortical white matter enhancement had no early seizure activity and only mild developmental delay at early follow-up. Two infants with normal precontrast and postcontrast MR had no early seizures and remain healthy at early follow-up, despite initial clinical parameters similar to more severely injured infants. CONCLUSION Although the number of patients is small, our results indicate that the presence of contrast enhancement in asphyxiated neonates may indicate more severe brain damage and, hence, a poorer prognosis.