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Magnetic resonance imaging of the infant brain: anatomical characteristics and clinical significance of punctate lesions

¹ Department of Paediatrics and Child Health, Leeds General Infirmary, Leeds, UK
² Department of Medical Physics and Centre of Medical Imaging Research, University of Leeds and Leeds General Infirmary
³ Department of Paediatric Radiology, Leeds General Infirmary

Correspondence to:
Correspondence to:
Dr Cornette, Peter Congdon Neonatal Intensive Care Unit, Clarendon Wing C Floor, Leeds General Infirmary, Leeds LS2 9NS, UK;
luc.cornette{at}leedsth.nhs.uk

Objective: To describe the magnetic resonance imaging (MRI) characteristics of punctate brain lesions in neonates (number, appearance, distribution, and association with other brain abnormalities) and to relate them to neurodevelopmental outcome.

Methods: A retrospective analysis was performed of 110 MRI brain scans from 92 infants admitted in 1998 to the neonatal intensive care unit. Results of routine neurodevelopmental follow up (1998–2001) in those infants with punctate brain lesions were analysed.

Results: Punctate lesions were observed in 15/50 preterm and 2/42 term infants. In the preterm group, the number of lesions was < 3 in 20%, 3–10 in 27%, and > 10 in 53%. In 14/15 the lesions were linearly organised and located in the centrum semiovale. Other brain abnormalities were absent or minor—that is, "isolated" punctate lesions—in 8/15 and major in 7/15. In the term group, punctate lesions were organised in clusters and no other brain abnormalities were observed. Isolated punctate lesions were observed in 10/17 infants, and a normal neurodevelopmental outcome was seen in 9/10 (mean follow up 29.5 months). One infant showed a slight delay in language development. In the infants with associated brain lesions (7/17, mean follow up 27.5 months), outcome was normal in only two subjects.

Conclusions: Punctate lesions are predominantly seen in preterm infants, are usually linearly organised, and border the lateral ventricles. Isolated punctate lesions may imply a good prognosis, because most of these subjects have a normal neurodevelopmental outcome so far.

Keywords: magnetic resonance imaging; brain; punctate lesion; prognosis

Abbreviations: MRI, magnetic resonance imaging; CUS, cranial ultrasound; PVL, periventricular leucomalacia; SI, signal intensity; GA, gestational age

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