Newborns with brain bleeds, including those related to fetal and neonatal alloimmune thrombocytopenia (FNAIT), may benefit from a specialized type of MRI that goes beyond standard scans, according to a study published recently.
In preterm infants with hydrocephalus after intraventricular hemorrhage, a phase-contrast MRI (PCMRI) was able to detect abnormal patterns in blood and cerebrospinal fluid (CSF) movement that traditional imaging missed. This added detail could help tailor treatment for a vulnerable population where early intervention is key.
“In an acquisition lasting less than 5 min, PCMRI can quantify CSF and blood flow dynamics over the cardiac cycle in newborns,” the study authors wrote.
In this study of 15 infants who underwent MRI between three weeks and six years of age, researchers found that PCMRI identified disrupted CSF pulsatility, which is how fluid rhythmically moves, in several areas of the brain and spine. These findings often conflicted with what standard MRIs showed, revealing that structural imaging alone may not be enough to explain a child’s symptoms or guide decisions about surgery or shunting.
Read more about testing and diagnosis for FNAIT
Many of the infants showed no CSF pulsatility in critical regions such as the aqueduct of Sylvius or the cervical spine, even when those areas appeared normal on standard MRI. Others had excessive pulsatility, suggesting high pressure or poor drainage. Importantly, 10 of the 15 patients had CSF flow findings that did not match the apparent structure of their ventricles or subarachnoid spaces, which are the cavities and pathways through which CSF circulates.
Patients with obstructive hydrocephalus, which is where fluid is blocked, had flow patterns consistent with non-communicating hydrocephalus in 100% of cases, even when structural issues were subtle or absent. Conversely, among those with supposedly communicating hydrocephalus, 60% had CSF abnormalities on PCMRI that standard imaging missed.
Because FNAIT and other causes of brain bleeding in newborns can lead to long-term complications from fluid buildup, understanding both the structure and dynamics of CSF is critical. This study suggests that PCMRI may reveal important differences between patients that could influence diagnosis, timing of interventions and selection of treatment.
Ultimately, incorporating PCMRI alongside conventional scans may offer a clearer picture of how CSF behaves in the context of brain injury and bleeding. For families navigating the aftermath of FNAIT-related hemorrhage, this added clarity could lead to more precise and effective care.
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