Topics in Magnetic Resonance Imaging-Imaging of the Developing Brain

In this edition of Topics in Magnetic Resonance Imaging, we address some of the major challenges in imaging of the developing brain in the neonate, infant, and young child. The 4 articles contained in this edition include Advances in Magnetic Resonance Neuroimaging Techniques in the Evaluation of Neonatal Encephalopathy by Dr. Ashok Panigrahy of Children’s Hospital of Los Angeles; Macrocephaly, Increased Intracranial Pressure, and Hydrocephalus by Drs. Talia Vertinsky and Patrick Barnes of the Lucile Packard Children’s Hospital at Stanford; Imaging of the Central Nervous System in Suspected or Alleged Nonaccidental Injury Including the Mimics by Drs. Michael Krasnokutsky and Patrick Barnes of the Lucile Packard Children’s Hospital at Stanford; and Neuroimaging of the Child With Developmental Delay by Drs. Diana Rodriguez and Tina Poussaint of the Children’s Hospital, Boston. In the initial article, Dr. Panigrahy describes the use of conventional and advanced magnetic resonance imaging (MRI) devices and techniques to assist in the evaluation of brain injury in preterm and term infants. This includes the use of MRI-compatible incubators and special RF coils, diffusion tensor imaging, spectroscopy, perfusion imaging, and functional MRI. He also provides helpful guidelines for image interpretation and describes the important features of a number of conditions including perinatal white matter injury, hypoxia-ischemia, neonatal hemorrhage, metabolic disorders, infection, and parturitional trauma. In the next article, Drs. Vertinsky and Barnes systematically present and illustrate the clinical evaluation and imaging findings for many of the common and important conditions manifesting as macrocephaly, increased pressure, and hydrocephalus in early childhood. This article emphasizes the role of MRI in the diagnosis and management of hydrocephalus of childhood, including image guidance and follow-up of advanced neurosurgical techniques such as endoscopic ventriculostomy. Drs. Krasnokutsky and Barnes, in the third article, address the ongoing controversies regarding the medical diagnosis and forensic evaluation of central nervous system injury in suspected, or alleged, child abuse. This includes a presentation of the traditional diagnostic criteria as well as more recent evidence-based challenges that emphasize biomechanical and pathological foundations. The authors also discuss the role of imaging, including its limitations, and illustrate the findings that commonly overlap nonaccidental trauma, accidental trauma, and nontraumatic causes (ie, the mimics) of the Triad of infant encephalopathy with dural and retinal hemorrhages. In the final article, Drs. Rodriguez and Poussaint present the clinical indications and evidence base for using conventional and advanced MRI techniques in the often difficult evaluation of the child with delayed motor and cognitive development. Imaging guidelines are provided along with descriptions and illustrations of the common general abnormalities in developmental delay plus features that are characteristic of more specific entities. It is our goal that this edition of Topics in Magnetic Resonance Imaging will provide the reader with a better understanding of the issues and challenges in imaging of injury to the developing brain, as well as assist in the proper use of MRI in the evaluation and management of these children. EDITORIAL