The differentiation between terminal zones and pathological signal intensity changes
on MRI of children and young adults is of diagnostic importance. We assessed the diagnostic
value of several morphological features on MRI to differentiate between terminal zones
and hypoxic–ischemic white matter injury. We selected all brain MRI examinations performed
in subjects up to 20 years of age showing increased signal intensity on T2-weighted
images in the peritrigonal areas. Seventy-five individuals were assigned to a patient
group (n=28) if there was evidence of hypoxia–ischemia during the perinatal period or a control
group (n=47). Aspect, location, extent, shape, and borders of signal intensity changes in
the peritrigonal areas were studied. Signal intensity of the peritrigonal areas was
related to the signal intensity of the surrounding white matter. Presence of Virchow
Robin spaces, hypoxic–ischemic abnormalities, and local atrophy was also recorded.
Chi-squared tests assessed whether presence or absence of morphological characteristics
differed between patients and controls. Logistic regression analysis studied which
characteristics were best to discriminate between the two groups. Very high signal
intensity of the peritrigonal areas on FLAIR (odds ratio 25) and presence of local
atrophy (odds ratio 14.3) were best predictors to discriminate between the two groups.
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© 2008 Published by Elsevier Inc.
