MRI of brain with T1 weighted echo train spin echo, T2 weighted
echo train spin echo, fluid-attenuated inversion recovery echo
train spin echo, MR diffusion imaging, and without intravenous
gadolinium-enhancement; CT scan of brain with multiplanar
reconstruction, and without intravenous contrast:
1. BPD = 84mm; FOD = 98mm
Cephalic index = (84/98)*100 = 85.7 within normal range.
HC = (84+98)x1.57 = 285.7mm.
Estimated gestational age: 28.3-33.7 (31.0) weeks (less than
true gestational age 38+4 weeks from history), suggest small
Transcerebellar diameter (TCD): 44.0mm.
2. Relative smooth cerebral gyri and shallow sulci, predominant
over right frontal-parietal lobe, with the appearance about
33-34 weeks, delayed brain development can be suspected.
But pachygyria can not be excluded at this time.
3. A long T1 and T2 cystic lesion without mass effect in left
occipital lobe with adjacent left lateral ventricle occipital
horn focal dilatation, in favor of encephalomalacia from
previous brain insult.
4. Diffuse long T1 and T2 signals in bilateral cerebral white
matter with partial liquefaction, predominant in bilateral
anterior temporal lobes, white matter edema with necrosis
can not be excluded.
5. A small short T1 and T2 calcified spot in periventricular
white matter of right temporal lobe (fig1 and arrows in fig9)
(more obvious on CT scan than MRI). Susoicious a few of
faint calcified spots in periventricular white matter of
left parietal lobe.
6. Prominence of CSF space between two leaves of septum pellucidum,
suggesting cavum septi pellucidi.
Posterior extension of cavum septi pellucidi below corpus
callosum and above fornix, suggesting cavum vergae.
7. Persistent metopic suture in midline anterior frontal bone.
1. All of above findings (microcephaly, delayed brain development
with cortical malformation, white matter damage with
encephalomalacia and calcification) suggesting congenital
2. Smooth cerebral gyri and shallow sulci, may due to delayed brain
development, but pachygyria can not be excluded at this time.
3. Recommendation: Follow up with MRI of brain 3-6 months later,
if clinical necessary. Thank you!
Urine cytomegalovirus polymerase chain reaction (CMV-PCR): positive (not showed on above figures!).