Cerebral palsy MRI

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:  Iqra Qamar M.D.[2]

## Overview

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MRI is the diagnostic neuroimaging study of choice especially for older children and is preferred over CT scan. The diagnostic yield of MRI depends upon the type of CP (mixed > quadriplegic > hemiplegic > diplegic > ataxic > dyskinetic) and the timing of birth. MRI findings in patients with CP may include hypoxic-ischemic lesions (eg, periventricular leukomalacia-PVL), cortical malformations and lesions of the basal ganglia.

## MRI

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* MRI is the diagnostic neuroimaging study of choice especially for older children.[1][2][3][4][5]
* MRI is preferred over CT due to
* Higher diagnostic yield
* Role in finding out the etiology and timing of insult
* The diagnostic yield of MRI depends upon:
* The type of CP (mixed > quadriplegic > hemiplegic > diplegic > ataxic > dyskinetic)
* Timing of birth (scans are more often abnormal in preterm compared with term infants)
* MRI findings in patients with CP include:
* Hypoxic-ischemic lesions (eg, periventricular leukomalacia-PVL)
* Cortical malformations
* Lesions of the basal ganglia (bilateral thalami)
* MRI may show:
* Myelination for a given age
* A tethered spinal cord
* MRI is found to be abnormal in 90% of children with cerebral palsy.[6]
* MRI has an important role in predicting neurodevelopmental outcomes in preterm infants.[7]
* MRI may be normal in cerebral palsy- does not exclude the diagnosis and require exclusion of metabolic and genetic etiologies

Hyperintense lesions of bilateral thalami Axial on T-1 MRI associated with hypoxic-ischemic encephelopathy- one of the most common causes of cerebral palsy in term neonates, source: Radiopedia.org

## References

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1. ↑ Ashwal S, Russman BS, Blasco PA, Miller G, Sandler A, Shevell M, Stevenson R (2004). "Practice parameter: diagnostic assessment of the child with cerebral palsy: report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society". Neurology. 62 (6): 851–63. PMID 15037681.
2. ↑ Truwit CL, Barkovich AJ, Koch TK, Ferriero DM (1992). "Cerebral palsy: MR findings in 40 patients". AJNR Am J Neuroradiol. 13 (1): 67–78. PMID 1595496.
3. ↑ Krägeloh-Mann I, Petersen D, Hagberg G, Vollmer B, Hagberg B, Michaelis R (1995). "Bilateral spastic cerebral palsy--MRI pathology and origin. Analysis from a representative series of 56 cases". Dev Med Child Neurol. 37 (5): 379–97. PMID 7768338.
4. ↑ Miller G, Cala LA (1989). "Ataxic cerebral palsy--clinico-radiologic correlations". Neuropediatrics. 20 (2): 84–9. doi:10.1055/s-2008-1071271. PMID 2739880.
5. ↑ "Bilateral lesions of thalamus and basal ganglia: origin and outcome - Krägeloh-Mann - 2007 - Developmental Medicine & Child Neurology - Wiley Online Library".
6. ↑ Bax M, Tydeman C, Flodmark O (2006). "Clinical and MRI correlates of cerebral palsy: the European Cerebral Palsy Study". JAMA. 296 (13): 1602–8. doi:10.1001/jama.296.13.1602. PMID 17018805.
7. ↑ Woodward LJ, Anderson PJ, Austin NC, Howard K, Inder TE (2006). "Neonatal MRI to predict neurodevelopmental outcomes in preterm infants". N. Engl. J. Med. 355 (7): 685–94. doi:10.1056/NEJMoa053792. PMID 16914704.

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