What are the chronic MRI findings associated with Profound Perinatal Hypoxic Ischemic Injury, specifically in the deep gray matter and white matter?

In chronic Profound Perinatal Hypoxic Ischemic Injury, MRI shows high T2 signal intensity in the deep gray matter, particularly affecting the basal ganglia and thalami. The white matter exhibits high T2 signal in the perirolandic cortex, with associated cortical thinning and atrophy. Key diagnostic features include the sparing of the subcortical U-fibers and the presence of cystic encephalomalacia. Clinical pearls include recognizing the pattern of injury in relation to the timing and severity of the hypoxic event. Common pitfalls include confusing these findings with leukodystrophies or other metabolic disorders.