MRI of the Neonatal Brain新生儿脑磁共振成像.docx

MRI of the Neonatal BrainContributors6Preface9Acknowledgments10Dedication101Patient preparation, safety and hazards in imaging infants and children10Imaging team12Assessment of patients for imaging12Organizing the day13Preparation of the MR unit and scanning room13Clinical safety in the MR unit14Physiological monitoring devices15Prior to sedation15Sedation16Transfer to the MR unit18Monitoring18Immobilization18During the scan20Recovery from sedation20Technical considerations202Imaging the preterm infant: practical issues33The neonatal scanner34Transport of the baby36Ventilation37Immobilization37Temperature maintenance37Sedation38Monitoring38Pulse sequences and scanning parameters38Safety issues393Magnetic resonance imaging of the brain in preterm infants: 24 weeks gestation to term42Cortical folding44Ventricular system and extracerebral space53Germinal matrix564Magnetic resonance imaging of the normal infant brain: term to 2 years73Pulse sequences used by our own group for imaging neonates and young infants74Table 4.1 Pulse sequences. Term to 3 months74MR imaging of the brain in the term infant: conventional T1 and T2 weighted sequences76Part III Pathology1155 Basic cellular reactions of the immature human brain115Introduction115The postmortem examination116Cellular reactions of the human brain117Hemorrhages (see also Chapters 9 and 13121White matter damage124Gray matter damage127Malformations (see Chapter 11)128Infections (see Chapter 10)129Part IV Disorders in the newborn infant1316The asphyxiated term infant131Hypoxicischemic encephalopathy132Imaging132MRI pulse sequences133Patterns of injury134Early MRI findings135Pattern recognition, scoring systems and prediction of outcome in term infants with HIE153The preterm asphyxiated brain154Case histories155Summary167References1687Cerebral infarction in the full-term infant170Introduction171Arterial infarction171Borderzone infarcts180Neurodevelopmental outcome in arterial and borderzone infarcts: prognostic factors182Case histories183Summary193References1948Ischemic lesions in the preterm brain195Introduction196Periventricular leukomalacia (PVL)196Infarction208Case histories210Summary212References2129Hemorrhagic lesions of the newborn brain215MRI appearances of hemorrhage215Etiology217Sites of hemorrhage221Extracranial hemorrhage222Subdural hemorrhage223Subarachnoid hemorrhage228Thrombosis of sagittal sinus228Parenchymal hemorrhage233Arterio-venous malformations238Thalamic hemorrhage238Basal ganglia hemorrhage239Cerebellar hemorrhage239Intraventricular hemorrhage240Complications of GLH IVH242Ventricular dilation243Summary244References24410 Neonatal brain infection246Introduction246Imaging protocols247Neonatal CNS bacterial and fungal infections247Neuroimaging features of selected congenital infections (STORCH)261Summary273References27311Congenital malformations in the neonate278Introduction and embryology278Neural tube closure defects279Malformations of the lamina terminalis284Malformations of the cerebellum291Malformations of the cerebral cortex299Chiari I malformation307Malformations of the meninx primitiva308Summary310References31112Vascular malformations of the neonatal brain312Introduction312Prenatally diagnosed lesions317Familial lesions319Sporadic lesions319Clinical presentation and management of intracranial arteriovenous shunts320Conclusions324Summary325References32513Non-accidental injury in the young infant325Mechanism of injury326Primary injury327Secondary injury333Associated findings335Differential diagnosis336Summary337References33714The neonate with a neuromuscular disorder338Introduction339Obstetric history and clinical assessment339Congenital muscular dystrophies340Congenital myotonic dystrophy352Congenital myopathies353Motoneuron disorders355Mitochondrial encephalomyopathies358Summary360Acknowledgments360References36015Magnetic resonance imaging of the fetal brain363Introduction363Safety issues364Developments364MR sequences364Normal development365Fetal cerebral abnormalities366The present370The future370Summary371References37116Magnetic resonance spectroscopy of the neonatal brain373Technical aspects373Normal brain development in infants and children377Cerebral pathology391Conclusions399Summary400References40117Metabolic disorders in the neonate407Introduction408Clinical and biochemical aspects of inborn errors of metabolism410Conventional MR imaging in metabolic diseases in the neonate412Diffusion-weighted MRI in neurometabolic disorders414Single voxel proton MR spectroscopy in neonates with inborn errors of metabolism417Specific inherited metabolic disorders419Clinical management of inborn errors of metabolism in neonates454Conclusion455Summary455Acknowledgements456References45618Imaging of brain function during early human development459Structurefunction relationship460Imaging of brain function460Developmental neuroimaging462Mapping visual processing in neonates and infants with fMRI464Summary467References467Glossary of physics terms470Edited byMary A Rutherford, MD MRCPCHHonorary Senior Lecturer and Consultant in PaediatricsRobert Steiner Magnetic Resonance Unit and Department of Paediatrics and Neonatal Medicine,Imperial College School of Medicine, Hammersmith Hospital, London, UK ContentsContributors Foreword Preface Acknowledgments Dedication Part I Practical issuesChapter 1 Patient preparation, safety and hazards in imaging infants and children Chapter 2 Imaging the preterm infant: practical issues Part II Anatomy and development of the immature brainChapter 3 Magnetic resonance imaging of the brain in preterm infants: 24 weeks gestation to term Chapter 4 Magnetic resonance imaging of the normal infant brain: term to 2 years Part III PathologyChapter 5 Basic cellular reactions of the immature human brain Part IV Disorders in the newborn infantChapter 6 The asphyxiated term infant Chapter 7 Cerebral infarction in the full-term infant Chapter 8 Ischemic lesions in the preterm brain Chapter 9 Hemorrhagic lesions of the newborn brain Chapter 10 Neonatal brain infection Chapter 11 Congenital malformations in the neonate Chapter 12 Vascular malformations of the neonatal brain Chapter 13 Non-accidental injury in the young infant Chapter 14 The neonate with a neuromuscular disorder Chapter 15 Magnetic resonance imaging of the fetal brain Chapter 16 Magnetic resonance spectroscopy of the neonatal brain Chapter 17 Metabolic disorders in the neonate Chapter 18 Imaging of brain function during early human development Glossary of physics terms ContributorsHortensia Alvarez md Radiology Assistant, Service de Neuroradiologie Diagnostique et Thrapeutic, Bictre Hpital, Universit Paris-Sud, Le Kremlin Bictre, France Malcolm Battin mb chb mrcp(uk) frcpch fracp Senior Lecturer in Neonatology, Neonatal Unit, National Womens Hospital and University of Auckland, New Zealand Laurence E Becker md frcpc Professor, Departments of Laboratory Medicine, Pathology and Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada Susan Blaser md frcpc Assistant Professor, University of Toronto; Pediatric Neuroradiologist, Diagnostic Imaging, Hospital for Sick Children, Toronto, Ontario, Canada Serena Counsell bsc msc Superintendent Research Radiographer, Robert Steiner Magnetic Resonance Unit, Hammersmith Hospital, London, UK Frances M Cowan lrcp&si mbbs mrcp(uk) dch mrcgp phd mrcpch Senior Lecturer in Neonatal Neurology, Department of Paediatrics and Neonatal Medicine, Imperial College School of Medicine, Hammersmith Hospital, London, UK I Jane Cox ma Non-Clinical Lecturer, Imperial College School of Medicine, Hammersmith Hospital, London, UK Lilly Dubowitz Honorary Senior Lecturer, Department of Paediatrics and Neonatal Medicine, Hammersmith Hospital, London, UK E Lee Ford-Jones md frcpc Associate Professor of Pediatrics, University of Toronto; Division of Infectious Diseases, Hospital for Sick Children, Toronto, Ontario, Canada Floris Groenendaal md phd Consultant in Neonatology, Department of Neonatology, Wilhelmina Childrens Hospital, University Medical Center, Utrecht, The Netherlands Venita Jay mbbs frcpc Associate Professor, University of Toronto; Neuropathologist, Hospital for Sick Children, Toronto, Ontario, Canada Pierre Lasjaunias md phd Professor of Anatomy; Chairman of Neuroradiology, Service de Neuroradiologie Diagnostique et Thrapeutic, Bictre Hpital, Universit Paris-Sud, Le Kremlin Bictre, France Elia F Maalouf mbchb mrcp mrcpch md Consultant in Neonatal Paediatrics, Neonatal Unit, Homerton Hospital, London, UK Claude Manelfe Chef de Service, Service de Neuroradiologie Pediatrique, Purpan Hospital, Toulouse, France Ernst Martin md Professor of Paediatric Neuroradiology and MR Research, Department of DiagnosticImaging, University Childrens Hospital Zurich, Switzerland Maeve McPhillips Consultant Paediatric Radiologist, Department of Radiology, Royal Hospital for Sick Children, Edinburgh, Scotland, UK Linda C Meiners md phd Neuroradiologist, Department of Radiology, University Hospital Groningen, Utrecht, The Netherlands Eugenio Mercuri md phd Lecturer in Paediatric Neurology, Department of Paediatrics and Neonatal Medicine, Hammersmith Hospital, London, UK Francesco Muntoni md Professor in Paediatric Neurology, Department of Paediatrics, Hammersmith Hospital, London, UK Zoltan Patay md phd Consultant Neuroradiologist, Department of Radiology, King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia Jacqueline M Pennock m phil Senior Scientific Officer (Retired), Enniskillen, County Fermanagh, Northern Ireland Nicola Robertson mb chb Consultant Neonatologist, Imperial College School of Medicine, Robert Steiner Magnetic Resonance Unit, Hammersmith Hospital, London, UK Georges Rodesch md Radiology Assistant, Service de Neuroradiologie Diagnostique et Thrapeutic, Bictre Hpital, Universit Paris-Sud, LeKremlin Bictre, France Andrea Rossi md Staff Neuroradiologist, Department of Pediatric Neuroradiology, G Gaslini Childrens Research Hospital, Genoa, Italy Mary A Rutherford md mrcpch Honorary Senior Lecturer and Consultant in Paediatrics, Robert Steiner Magnetic Resonance Unit and Department of Paediatrics and Neonatal Medicine, Imperial College School of Medicine, Hammersmith Hospital, London, UK Annick Svely md Radiologist, Department of Neuroradiology, Purpan Hospital, Toulouse, France Waney Squier bsc mbchb mrcp frcpath Consultant Neuropathologist and Honorary Clinical Lecturer, Department of Neuropathology, Radcliffe Infirmary, Oxford, UK Paolo Tortori-Donati md Professor of Neuropathology; Head of Pediatric Neuroradiology, G Gaslini Childrens Research Hospital, Genoa, Italy Linda S de Vries md phd Professor in Neonatal Neurology, Department of Neonatology, Wilhelmina Childrens Hospital, University Medical Center, Utrecht, The Netherlands PrefaceIt is a pleasure to introduce this volume, which collects together experience from specialists and clinicians working in many of the leading childrens hospitals of the world. The field of neonatal and infant magnetic resonance is now expanding rapidly. The technical problems in providing magnetic-compatible equipment for life support and monitoring have now been overcome, and we are now seeing images and spectra from infants of 24 weeks of gestation and upwards. But more than that, there have also been rapid advances in fetal imaging and it is now possible to see a full continuum of normal development. Much is owed to the early pioneers in this field, such as Jaap Valk and Marjo van der Knaap (Amsterdam), Charles Raybaud (Marseille), Robert Zimmerman (Philadelphia), James Barkovich (San Francisco), Rosalind Dietrich (UCL), Ernst Martin (Zurich), Ossie Reynolds (London) and Britton Chance (Philadelphia), who took a long-term view and recognised the possibilities of magnetic resonance even before the technical capabilities were developed. There is a shift in diagnosis from adults to children and almost as big a shift from children to neonates. The normal brain undergoes a quite remarkable series of changes, which can be observed in detail with magnetic resonance, and these present a background for the wide spectrum of pathology in the newborn. Twenty years on, since the advent of clinical MR, there are few areas presenting such new and interesting opportunities as neonatal MR and it is a pleasure to commend Mary Rutherfords book, which provides a platform and a basic foundation for all those practising and performing research in this field. A David EdwardsProfessor of Paediatrics and Neonatal Medicine,Hammersmith Hospital, London Part I Practical issues1Patient preparation, safetyand hazards in imaginginfants and childrenJacqueline M Pennock1Chapter ContentsIntroduction Imaging team Assessment of patients for imaging Organizing the day Preparation of the MR unit and scanning room Clinical safety in the MR unit Physiological monitoring devices Prior to sedation Sedation Transfer to the MR unit MonitoringImmobilizationDuring the scanRecovery from sedationTechnical considerations SummaryAcknowledgmentsReferences IntroductionThe two greatest obstacles we face in imaging infants and children are the proper preparation of the subject and the selection of the right combination of imaging parameters to achieve the desired result3. Magnetic resonance (MR) systems are designed to accommodate the adult population; however, with a little effort and careful planning they can be successfully used to scan infants and children. This chapter offers advice about patient preparation and imaging protocols for those faced with the prospect of scanning infants up to 2 years of age in scanners used mainly for adults. Examples of the documentation we use for each pediatric examination are included as a guide for the reader with only occasional access to a scanner. We find this information extremely useful for follow-up studies, quality assurance in our sedation program, and dealing with potential medico-legal problems. Imaging teamFig.1.1 the Duchess was sitting on a three-legged stool in the middle, nursing a baby; the cook was leaning over the fire, stirring a large cauldron which seemed to be full of soup. Care and understanding are required for preparing an anxious mother and child for imaging. Examining a sick infant is a team effort and involves close co-operation between clinical and imaging staff as well as the mother and infant. A highly motivated and unified clinical team helps make a potentially distressing event easier for the mother and child (Fig.1.1). Our current core team consists of two pediatricians, a radiologist, pediatric nursing staff in the childrens out-patients and a radiographer with training in pediatric imaging. Our team members are involved in all aspects of patient care including setting up new imaging protocols and reporting images. Assessment of patients for imagingBefore an MR appointment is made the infant is seen by a pediatrician who takes a medical history including details of previous operations and possible implants. If, for example, a ventriculo-peritoneal shunt or a patent ductus arteriosus clip is present then its magnetic compatibility is checked before an appointment is given. The book by Shellock and Kanal lists many items, which have been tested for attraction/ deflection forces during exposure to static magnetic fields. These authors are also accessible through the world wide web and provide a quick reply to questions and problems concerned with safety14. At this initial assessment the pediatrician explains the MR procedure, the sedation protocol and gives instructions on feeding and or fasting before the scan. We recommend that the infant has no food for 4h and no drink for 2h before sedation. The parents are asked to prevent their infant from falling asleep for at least 2h before the scan. If possible we schedule appointments to coincide with the natural sleeping pattern of the infant. Organizing the dayFig.1.2 the Rabbit actually took a watch out of its waistcoat-pocket, and looked at it and then hurried on.It is not possible or desirable to rush mothers and babies through a scanning day. Scheduling naturally sleeping and sedated infants can be difficult and requires a degree of flexibility. It is much easier to have exclusively pediatric scanning sessions. Studying babies even when sedated takes more time than adults and they cannot be rushed (Fig.1.2). Patients coming from home are given appointment times and admitted to a childrens day care ward whereas in-patients are booked at times convenient to the ward.We offer the parents the opportunity to be with their child throughout the preparation for the scan and encourage them to accompany the baby to the imaging unit so that they can see their child is asleep and comfortable in the scanner. They can stay beside their infant in the scanner if they wish; however, they are often happy to have some time to themselves while we look after their child. Parents going into the scanner room need to be careful