Evaluating Tissue Contrast and Detecting White Matter Injury in the Infant Brain: A Comparison Study of Synthetic Phase-Sensitive Inversion Recovery

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Fig 1.
Representative synthetic PSIR image showing the drawn ROI along with cortical GM (A), uWM (B), and mWM (C).
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Fig 2.
A 30-day-old neonate. There is limited myelination at the posterior limb of the internal capsule (arrow), showing higher signal intensity on the FSPGR (A), synthetic T1WI (B), and synthetic PSIR (C) images compared with the uWM regions. D, On the T2WI, the myelinated posterior limb of internal capsule (arrow) shows lower signal intensity compared with the uWM regions.
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Fig 3.
A 7-day-old neonate who underwent brain imaging due to an apnea event. There are multifocal high signal intensity lesions in the WM, which are readily detectable on both the FSPGR (A) and synthetic PSIR (B) images (short arrows). However, some of the lesions only appear on the FSPGR (long arrow) and not on the synthetic PSIR image.

Table 1:

Contrast comparison of the FSPGR, synthetic T1WI, and synthetic PSIR sequences (n = 91)^{^a}

	FSPGR	T1WI^{^b}	PSIR^{^b}	P Value	FSPGR vs T1WI^{^b} (P Values)	T1WI^{^b} vs PSIR^{^b} (P Values)	FSPGR vs PSIR^{^b} (P Values)
uWM-mWM	0.249 (0.101)	0.182 (0.062)	0.506 (0.211)	<.001	<.001	<.001	<.001
uWM-GM	0.124 (0.117)	0.099 (0.067)	0.393 (0.309)	<.001	.454	<.001	<.001

Table 3:

Image quality and myelination degree assessment by the 2 radiologists^{^a}

Note:—ALIC indicates anterior limb of the internal capsule; PLIC, posterior limb of the internal capsule.
↵a Number of cases graded in 3-point scale are presented in order: Image quality, 1 = poor, 2 = moderate, and 3 = good; myelination, 1 = unmyelinated, 2 = intermediate, and 3 = fully myelinated.
↵b Synthetic image.

Table 4:

Number of punctate WM lesions detected on FSPGR, synthetic T1WI, and synthetic PSIR in the 10 patients

	FSPGR		T1WI^{^a}		PSIR^{^a}
	Rt Lobe	Lt Lobe	Rt Lobe	Lt Lobe	Rt Lobe	Lt Lobe
Patients
1	12	13	12	6	12	9
2	2	1	0	0	0	0
3	1	0	0	0	0	0
4	2	0	0	0	0	0
5	2	3	0	0	0	0
6	4	6	0	1	0	0
7	5	5	1	2	0	1
8	3	0	0	0	0	0
9	4	3	1	1	1	1
10	0	1	0	0	0	0
Total	67		24		24
Mean No. of lesions detected (SD)	3.35 (3.62)		1.20 (2.89)		1.20 (3.24)