Objectives: Central gray matter damage, the hallmark of term acute perinatal hypoxia-ischemia, frequently leads to severe cerebral palsy and sometimes death. The precision with which these outcomes can be determined from neonatal imaging has not been fully explored. We evaluated the accuracy of early brain MRI for predicting death, the presence and severity of motor impairment, and ability to walk at 2 years in term infants with hypoxic-ischemic encephalopathy (HIE) and basal ganglia-thalamic (BGT) lesions. From 1993From to 2007 term infants with evidence of perinatal asphyxia, HIE, and BGT injury seen on early MRI scans were studied. BGT, white matter, posterior limb of the internal capsule (PLIC), and cortex and brainstem abnormality were classified by severity. Motor impairment was staged using the Gross Motor Function Classification System. Methods: Results:The severity of BGT lesions was strongly associated with the severity of motor impairment (Spearman rank correlation 0.77; p Ͻ 0.001). The association between white matter, cortical, and brainstem injury and motor impairment was less strong and only BGT injury correlated significantly in a logistic regression model. The predictive accuracy of severe BGT lesions for severe motor impairment was 0.89 (95% confidence interval 0.83-0.96). Abnormal PLIC signal intensity predicted the inability to walk independently by 2 years (sensitivity 0.92, specificity 0.77, positive predictive value 0.88, negative predictive value 0.85). Brainstem injury was the only factor with an independent association with death. Conclusion:We have shown that in term newborns with HIE and BGT injury, early MRI can be used to predict death and specific motor outcomes. Neurology ® 2011;76:2055-2061 GLOSSARY BFMF ϭ Bimanual Fine Motor Function; BGT ϭ basal ganglia and thalami; CI ϭ confidence interval; CP ϭ cerebral palsy; GMFCS ϭ Gross Motor Function Classification System; HIE ϭ hypoxic-ischemic encephalopathy; LRM ϭ logistic regression model; NE ϭ neonatal encephalopathy; NPV ϭ negative predictive value; PLIC ϭ posterior limb of the internal capsule; PPV ϭ positive predictive value; SCPE ϭ Surveillance of Cerebral Palsy in Europe; SI ϭ signal intensity; WM ϭ white matter.Central gray matter damage, the hallmark of acute perinatal hypoxia-ischemia in term infants, 1 is an important cause of death and cerebral palsy (CP). CP is a lifelong condition affecting not only motor function, but the child's global development. Commonly associated impairments include learning, visual, feeding, and communication difficulties and epilepsy that all place a heavy burden on the children and their families. Coping with the birth of a severely asphyxiated baby is extremely distressing for parents. Apart from the initial concern that their infant may die, parents have to deal with uncertainty about their child's future. They usually want to know not only if their child will have a motor problem, but its severity and whether their child will be able to walk 3 ; unfortunately, these questions can b...

The fetal brain shows accelerated growth in the latter half of gestation, and these changes can be captured by 2D and 3D biometry measurements. The aim of this study was to quantify brain growth in normal fetuses using Magnetic Resonance Imaging (MRI) and to produce reference biometry data and a freely available centile calculator (https://www.developingbrain.co.uk/fetalcentiles/). A total of 127 MRI examinations (1.5 T) of fetuses with a normal brain appearance (21–38 gestational weeks) were included in this study. 2D and 3D biometric parameters were measured from slice-to-volume reconstructed images, including 3D measurements of supratentorial brain tissue, lateral ventricles, cortex, cerebellum and extra-cerebral CSF and 2D measurements of brain biparietal diameter and fronto-occipital length, skull biparietal diameter and occipitofrontal diameter, head circumference, transverse cerebellar diameter, extra-cerebral CSF, ventricular atrial diameter, and vermis height, width, and area. Centiles were constructed for each measurement. All participants were invited for developmental follow-up. All 2D and 3D measurements, except for atrial diameter, showed a significant positive correlation with gestational age. There was a sex effect on left and total lateral ventricular volumes and the degree of ventricular asymmetry. The 5th, 50th, and 95th centiles and a centile calculator were produced. Developmental follow-up was available for 73.1% of cases [mean chronological age 27.4 (±10.2) months]. We present normative reference charts for fetal brain MRI biometry at 21–38 gestational weeks. Developing growth trajectories will aid in the better understanding of normal fetal brain growth and subsequently of deviations from typical development in high-risk pregnancies or following premature delivery.Electronic supplementary materialThe online version of this article (doi:10.1007/s00429-016-1342-6) contains supplementary material, which is available to authorized users.