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Hypoxic Ischemic Encephalopathy MRI Findings and Patterns Review, Revisited

Hazar Abdulbasset Tabban MD, FRCR, Islam Ahmed Hassan MBBS, ABHS-R, Khaled Y. Salem MD, Tahiya Ahmed Salem MD, Sulafa Ibrahim MD, Ashley Maya Ezeldin, Ezat El-Said

Hypoxic ischemic encephalopathy, HIE, despite advances in healthcare and imaging modalities, is still a major cause of death and a leading cause of neonatal encephalopathy, neurodevelopmental disabilities, and seizures. It is associated with a high incidence of morbidity and mortality, which is significantly higher in developing countries. Early diagnosis and detection of the pattern and severity of brain injury aid to predict prognosis, select for appropriate therapy options like hypothermia therapy, and, therefore, improving the clinical outcome and prognosis. MRI brain with DWI is the investigation of choice for diagnosis, MRI is considered a predictor factor in addition to clinical findings and biomarkers. The four patterns of MRI findings in HIE are: the basal ganglia, thalamus, and posterior limb of internal capsule pattern, the watershed predominant pattern affecting the white matter in the cortex and subcortical zones, the minimal focal/multifocal injury of white matter, and the extensive injury of the entire brain. These patterns are determined by many factors combined including brain maturation, time, duration, and strength of the cerebral blood flow impairment. This mini review will discuss the pathophysiology of HIE and MRI findings patterns in premature and term neonates.