Classification of MRI signs of hypoxic-ischemic encephalopathy

Magnetic resonance imaging is a sensitive method for visualizing changes in hypoxic-ischemic encephalopathy. Several classifications of the severity of such changes have been developed to date. Different classifications suggest different degrees of differentiation of the anatomical landmarks used, and in some cases, interpretation of MRI data is a problem for a general radiologist and a clinician. Objective. The aim of the work was to develop a classification accessible to a general radiologist and understandable to neonatologists, pediatricians, and neurologists.

Material and methods. The study group included 164 children with MRI signs of hypoxic-ischemic damage on MRI, regardless of the referring diagnosis, which made it possible to avoid the influence of anamnestic data on its formulation. The anamnestic and clinical data that were the most informative during the risk analysis were analyzed: complication of the mother’s anamnesis for somatic non-infectious and infectious pathology, complications of the obstetric-gynecological anamnesis, prolonged anhydrous interval, depression and seizures in the early postpartum period.

Results. Correlation of neuroimaging data, anamnesis and clinical picture allowed us to formulate a classification of MRI changes in newborns with hypoxic-ischemic brain damage: Grade I (mild) includes changes in the area of the external watershed and the posterior leg of the internal capsule; Grade II (moderate) — to those characteristic of the first degree are added those in the area of the internal watershed and the anterior leg of the internal capsule; At the III degree (severe) — to the changes in the area of the external and internal watersheds, the posterior and anterior legs of the internal capsule, a picture of selective neuronal necrosis is added, that is, damage to the basal ganglia and (or) thalamus; To the IV degree belong gross structural changes in the brain tissue with the formation of gliosis, cystic cavities, atrophy of the brain substance. We characterized them as gross. Phenomenological features of intraventricular hemorrhages do not allow them to be used as a market or a criterion for the severity of hypoxic-ischemic changes, and this sign can be used as an additional one, to clarify their nature.

Conclusion. The classification reflects the dynamics of the ischemic process and is available for use not only by doctors of radiation diagnostics, but also by clinicians — neonatologists, neurologists, pediatricians.

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