To determine which magnetic resonance (MR) imaging sequence demonstrates the highest lesion conspicuity for lesion detection in neonates with hypoxic-ischemic encephalopathy (HIE).

In 30 neonates with HIE, lesion conspicuity in different brain structures was retrospectively compared on T1-weighted images, T2-weighted images, fluid-attenuated inversion recovery images, and diffusion-weighted images (DWI). The brain structures were categorized as follows: cerebral cortex; cerebral white matter; deep gray matter; posterior limb of the internal capsule (PLIC); brain stem; and cerebellum.

For the deep gray matter, T1-weighted imaging was superior to the other sequences in lesion detection of 9 of 14 patients (64.3%), whereas DWI was superior in only 4/14 patients (28.6%). For the cerebral cortex, T1- and DWI were similar in lesion conspicuity (5/13 patients and 6/13 patients, respectively). For the white matter, HIE lesions were most conspicuous on DWI in a majority of the study patients. Lesions were detected in the cerebral white matter in 16/20 patients (80.0%), lesions were detected in the PLIC in 11/12 patients (91.7%), lesions were detected in the corticospinal tract in the brain stem in 11/11 patients (100%) and lesions were detected in the cerebellar white matter in one patient (100%).

In neonates with HIE, white matter lesions are most conspicuous on DWI, whereas gray matter lesions tend to have greater conspicuity on T1-weighted images than on the other MR sequences.