Historical Perspectives

Introduction

Imaging of the central nervous system is the most important advance in clinical neurology in the 20th century, providing for the first time a “window on the brain.” Initially, the view was somewhat opaque, but successive generations of scanning techniques and modifications to technology resulted by the end of the century in images of remarkable anatomic-like clarity. Although such advances have provided access to the brains of patients in all age groups, the study of the neonatal brain has particularly benefited clinicians at a time when survival of very immature infants was increasing dramatically and concern was developing about the causes of neurodevelopmental disability in the surviving child.

The brain of the immature infant initially was imaged using computed tomography (CT) scanning by Papile and colleagues ( 1) from Albuquerque in 1978, and in the following year, Karen Pape, ( 2) a Canadian working in London, described the diagnosis of brain damage in preterm babies scanned with real-time ultrasonography. These and subsequent articles showed that intraventricular hemorrhage occurred commonly in preterm infants, most of the babies who had these lesions survived, and a surprisingly high proportion showed few abnormal clinical signs at the time of the hemorrhage. In 1983, we at the Hammersmith Hospital in London used real-time ultrasonography to diagnose hemorrhagic periventricular leukomalacia with the evolution to cystic degeneration in surviving sick preterm infants. ( 3)

Although these two techniques led to a massive new interest in causation and prevention of brain pathology in preterm infants, both suffered from a number of disadvantages. CT exposed the babies to potentially high levels of X-irradiation and, therefore, could be performed only infrequently. In addition, the baby had to be transported from the intensive care environment to the scanner, which might be situated a considerable distance away. Ultrasonography had the great …