PMC3128202_01
Serial magnetic resonance imaging (MRI) features of an evolving in utero cerebellar infarct. Fetal MRI at 26 weeks: A, Sagittal T2-weighted half-Fourier acquisition single-shot turbo spin echo image demonstrates decreased T2 signal returned from the posterior cerebellum. B, Axial gradient echo image demonstrates evidence of blooming consistent with hemorrhagic infarction. C, Axial diffusion-weighted imaging and apparent diffusion coefficient maps demonstrate restricted diffusion abnormality returned from both cerebellar hemispheres consistent with completed infarction. Fetal MRI at 30 weeks: D, Axial gradient echo image demonstrates evolution of the previous hemorrhage along with new evidence of volume loss with increased extra-axial cerebrospinal fluid space surrounding both cerebellar hemispheres. Postnatal MRI: E, Sagittal T1-weighted image demonstrates increased T1-weighted signal consistent with methemoglobin and/or calcification in the atrophic appearing posterior fossa contents. F, Axial T2-weighted gradient echo image demonstrates evidence of altered blood and blood products within the posterior fossa. Postnatal magnetic resonance angiogram: Axial (G) and coronal (H) collapsed maximum intensity projections demonstrate the absence of flow within the left vertebral artery.
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MRI at 26 weeks gestation revealed obstructive hydrocephalus, abnormal T2-weighted signal in the cerebellum (Figure 1A), and diffuse signal abnormality on gradient echo sequences in the bilateral cerebellar hemispheres extending into the midbrain consistent with hemorrhage (Figure 1B). Diffusion-weighted imaging and apparent diffusion coefficient maps were consistent with completed infarction of the bilateral cerebellar hemispheres (Figure 1C). A repeat MRI at 30 weeks of gestation demonstrated persistent abnormal signal in the cerebellum with decreased mass effect and decreased supratentorial hydrocephalus along with cerebellar volume loss and evolution of the hemorrhagic component (Figure 1D). T1-weighted signal returned from the cerebellar remnants (Figure 1E). There was abnormal T2-weighted, gradient echo signal within the posterior fossa suggestive of abnormal blood products (Figure 1F). Magnetic resonance angiogram demonstrated partial signal loss returned from the left distal vertebral artery at the V3 and V4 levels (Figure 1G and 1H).