Ultrasonography and Magnetic Resonance Imaging of the Brain in Hypoxic Full-Term Newborns

The aim of this article was to review the studies on diagnostic and prognostic value of radiological investigations (cranial sonography, Doppler ultrasonography, and magnetic resonance imaging) in the detection of hypoxic-ischemic brain injuries in full-term newborns.
Materials and Methods. A systematic search of studies on the diagnostic and prognostic possibilities of radiological investigations for the detection of hypoxic-ischemic injuries in full-term newborns was performed.
Results. A total of 13 prospective and 4 retrospective studies that analyzed the incidence of hypoxic-ischemic cerebral injuries, determined by means of cranial sonography, Doppler sonography, and magnetic resonance imaging, and associations with the stages of hypoxic-ischemic encephalopathy and long-term neurodevelopmental outcomes were included in this systematic review.
Conclusions. Magnetic resonance imaging detects lesions in 75%–100% of cases. Magnetic resonance imaging performed at the age of 7–11 days demonstrated a high sensitivity (100%) and negative predictive value (100%) to predict unfavorable outcomes at 4 years of age. In newborns with hypoxic-ischemic encephalopathy, substantial cerebral hemodynamic alterations are detected after birth. The sensitivity and negative predictive value of cerebral blood flow velocities (peak systolic flow velocity, end-diastolic flow velocity) changes at 12±2 hours of age to predict the severity of hypoxic-ischemic encephalopathy and unfavorable outcomes at 18 months of age were found to be high (90% and 94%, respectively). A low resistive index (<0.56) at the age of 1–3 days had a specificity of 95% to predict unfavorable outcomes at 3 years of age. The data on the diagnostic and prognostic potential of cranial sonography are limited scarce and contrary.