Prospective evaluation of term neonate brain damage following preceding hypoxic sentinel events using enhanced T₂* weighted angiography (eSWAN).

Purpose: To evaluate the brain damage of term neonates with evidence of a preceding hypoxic sentinel event using eSWAN prospectively.

Methods: The study was approved by the institutional research ethics committee. Among the neonates who were examined during the first 8 days after birth with conventional magnetic resonance imaging (MRI), diffusion-weighted imaging (DWI) and eSWAN, 39 neonates with a preceding acute hypoxic sentinel event were divided into two groups: the hypoxic ischaemic encephalopathy (HIE) group and the high-risk group. Twenty-five neonates were normal control subjects. Conventional MRI, DWI, and T₂* and R₂* maps from eSWAN were assessed. T₂* and R₂* values from T₂* and R₂* maps were calculated in predefined regions in the HIE and high-risk groups and then compared with those in control subjects.

Results: The neonates in the HIE and high-risk groups showed a high percentage of cerebral oedema and periventricular white-matter (PWM) lesions. Cerebral oedema and haemorrhagic lesions of PWM were more highly visible on the T₂* map compared with conventional MRI: cerebral oedema was illustrated as a high T₂* area and haemorrhagic lesions had a significantly lower T₂* on the T₂* map. Lower R₂* values of lentiform nuclei (LN) and a higher T₂* and lower R₂* of frontal white matter (FWM) were found in neonates in the HIE group relative to those of normal controls. The T₂* value of LN in the high-risk group was higher than that of the normal controls.

Conclusions: The T₂* map from eSWAN is useful in detecting cerebral oedema and haemorrhagic lesions of PWM in neonates. The measurement of T₂* and R₂* values is helpful in assessing the LN and FWM damage in neonates following a hypoxic sentinel event.