Curved reformat of the paediatric brain MRI into a ‘flat-earth map’ — standardised method for demonstrating cortical surface atrophy resulting from hypoxic–ischaemic encephalopathy

Hypoxic–ischaemic encephalopathy is optimally imaged with brain MRI in the neonatal period. However neuroimaging is often also performed later in childhood (e.g., when parents seek compensation in cases of alleged birth asphyxia). We describe a standardised technique for creating two curved reconstructions of the cortical surface to show the characteristic surface changes of hypoxic–ischaemic encephalopathy in children imaged after the neonatal period. The technique was applied for 10 cases of hypoxic–ischaemic encephalopathy and also for age-matched healthy children to assess the visibility of characteristic features of hypoxic–ischaemic encephalopathy. In the abnormal brains, fissural or sulcal widening was seen in all cases and ulegyria was identifiable in 7/10. These images could be used as a visual aid for communicating MRI findings to clinicians and other interested parties.