The magnetic resonance revolution in brain imaging: impact on neonatal intensive care
- 1Department of Paediatrics, Faculty of Medicine, Imperial College London, Hammersmith Hospital, DuCane Road, London W12 0HS, UK
- 2Perinatal Brain Repair Group, Department of Paediatrics and Child Health, University College London, London WC1E 6JJ, UK
- Correspondence to:
Dr Robertson
Perinatal Brain Repair Group, Department of Obstetrics and Gynaecology, University College London, 86-96 Chenies Mews, London WC1E 6HX, UK; n.robertsonucl.ac.uk
- CT, computed tomography
- fMRI, functional MR imaging
- HI, hypoxia-ischaemia
- MR, magnetic resonance
- NE, neonatal encephalopathy
- NMR, nuclear magnetic resonance
- PVL, periventricular leucomalacia
- US, ultrasonography
- WMD, white matter damage
Magnetic resonance imaging and spectroscopy techniques have huge medical and scientific potential in neonatal brain imaging
The magnetic resonance (MR) phenomenon was first described in 19461,2 but it was not until 1981 that the first transverse image through the human head was reported.3 In the last 20 years, MR technology has revolutionised medical and scientific neuroimaging, providing the richest source of information about the living brain available from any imaging technology and without the use of ionising radiation. MR techniques most commonly used in the neonate have been conventional MR imaging and 31P and 1H MR spectroscopy. MR imaging has allowed the observation of brain development and response to perinatal brain injury in vivo with an unprecedented sensitivity for assessment of changes in grey and white matter and an ability to differentiate unmyelinated from myelinated white matter. MR spectroscopy has provided a metabolic fingerprint of the brain during normal development and after perinatal brain injury (fig 1). Conventional MR imaging and MR spectroscopy, however, are only part of an array of methods that comprise the MR diagnostic armamentarium, which includes diffusion weighted MR imaging, diffusion tensor imaging, MR angiography, functional MR imaging (fMRI), magnetisation transfer imaging, and chemical shift imaging. These newer techniques have huge medical and scientific potential.
(A) Representative T2 weighted magnetic resonance (MR) images, (B) 1H MR spectra, and (C) 31P MR spectra from healthy infants at 30 weeks gestation, term, 6 months, and 1 year of age. (A) The MR images show an increase in volume, surface area, and sulcation of cerebral cortex and in volume and microstructural organisation of cerebral white matter with development. (B) The series of 1H MR spectra show a steady increase in N-acetyl aspartate (NAA; a marker of neuronal and axonal density …
