Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-8448b6f56d-cfpbc Total loading time: 0 Render date: 2024-04-24T11:48:03.167Z Has data issue: false hasContentIssue false

Chapter 18 - Neuroimaging in the Evaluation of Pattern and Timing of Fetal and Neonatal Brain Abnormalities

from Section 3 - Diagnosis of the Infant with Brain Injury

Published online by Cambridge University Press:  13 December 2017

By
Patrick D. Barnes
Edited by
David K. Stevenson ,
William E. Benitz ,
Philip Sunshine ,
Susan R. Hintz  and
Maurice L. Druzin
David K. Stevenson
Affiliation:
Stanford University, California
William E. Benitz
Affiliation:
Stanford University, California
Philip Sunshine
Affiliation:
Stanford University, California
Susan R. Hintz
Affiliation:
Stanford University, California
Maurice L. Druzin
Affiliation:
Stanford University, California
Get access

Summary

A summary is not available for this content so a preview has been provided. Please use the Get access link above for information on how to access this content.
Image of the first page of this content. For PDF version, please use the ‘Save PDF’ preceeding this image.'
Type
Chapter
Information
Fetal and Neonatal Brain Injury , pp. 283 - 311
Publisher: Cambridge University Press
Print publication year: 2017

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Barnes, P. Pediatric brain imaging. In Blickman, J, Parker, B, Barnes, P, eds., Pediatric Radiology: The Requisites, 3rd edn. Philadelphia: Elsevier, 2009: 205–70.Google Scholar
Barnes, P. Neuroimaging in the evaluation of pattern and timing of fetal and neonatal brain abnormalities. In Stevenson, D, Benitz, W, Sunshine, P, eds., Fetal and Neonatal Brain Injury, 4th edn. New York: Cambridge University Press, 2009: 209–31.Google Scholar
Izbudak, I1, Grant, PE. MR imaging of the term and preterm neonate with diffuse brain injury. Magn Reson Imaging Clin North Am 2011; 19(4): 709–31.Google Scholar
Barkovich, AJ, Raybaud, C:Pediatric Neuroimaging, 5th edn. Philadelphia: Lippincott Williams & Wilkins, Wolters Kluwer, 2011.Google Scholar
Volpe, JJ. Neurology of the Newborn, 5th edn. Philadelphia: Saunders Elsevier, 2008.Google Scholar
Ment, L, Bada, H, Barnes, P, et al. Practice parameter: neuroimaging of the neonate. Neurology 2002; 58: 1726–38.CrossRefGoogle ScholarPubMed
D’Alton, ME, Hankins, GDV, et al. Neonatal Encephalopathy and Cerebral Palsy: Defining the Pathogenesis and Pathophysiology, 1st edn. (Washington, DC: American College of Obstetricians and Gynecologists, 2003), table 5-2, 570; Neonatal Encephalopathy and Neurologic Outcome, 2nd edn. (2014), 149–72).Google Scholar
Barkovich, A. MR imaging of the neonatal brain. Neuroimag Clin North Am 2006; 16: 117–36.CrossRefGoogle ScholarPubMed
Rutherford, M, Srinivasan, L, Dyet, L, et al. MRI in perinatal brain injury. Pediatr Radiol 2006; 36: 582–92.Google Scholar
Zimmerman, R, Bilaniuk, L. Neuroimaging evaluation of cerebral palsy. Clin Perinatol 2006; 33: 517–44.Google Scholar
Triulzi, F, Parazzini, C, Righini, A. Patterns of damage in the mature neonatal brain. Pediatr Radiol 2006; 36: 608–20.CrossRefGoogle ScholarPubMed
Panigrahy, A, Blumel, S. Advances in MR neuroimaging techniques in the evaluation of neonatal encephalopathy. Top Magn Reson Imaging 2007; 18: 3–30.Google Scholar
Barnes, PD, Taylor, GA. Imaging of the neonatal central nervous system. Neurosurg Clin North Am 1998; 1: 17–48.CrossRefGoogle Scholar
Allison, JW, Seibert, JJ. Transcranial Doppler in the newborn with asphyxia. Neuroimag Clin North Am 1999; 9: 11–16.Google ScholarPubMed
Epelman, M1, Daneman, A, Chauvin, N, Hirsch, W. Head Ultrasound and MR imaging in the evaluation of neonatal encephalopathy: competitive or complementary imaging studies? Magn Reson Imaging Clin North Am. 2012; 20(1): 93–115.Google Scholar
Debillon, T, N’Guyen, S, Muet, A, et al. Limitations of ultrasonography for diagnosing white matter damage in preterm infants. Arch Dis Child Fetal Neonatal Ed 2003; 88: F275–9.CrossRefGoogle ScholarPubMed
Laptook, A, O’Shea, M, Shankaran, S, et al. Adverse neurodevelopmental outcomes among extremely low birth weight infants with normal head ultrasound. Pediatrics 2005; 115: 673–80.CrossRefGoogle ScholarPubMed
Pinto-Martin, JA, Riolo, S, Cnaan, A, et al. Cranial ultrasound prediction of disabling and nondisabling cerebral palsy at age two in a low birthweight population. Pediatrics 1995; 95: 249–54.Google Scholar
Maalouf, EF, Duggan, PJ, Counsell, SJ, et al. Comparison of findings on cranial ultrasound and magnetic resonance imaging in preterm neonates. Pediatrics 2001; 107: 719–27.Google Scholar
Sie, LT, van der Knapp, MD, van Wezel-Meijler, G, et al. Early MR features of hypoxic-ischemic brain injury in neonates with periventricular densities on sonograms. AJNR Am J Neuroradiol 2000; 21: 852–61.Google Scholar
Childs, AM, Cornette, L, Romenghi, LA, et al. Magnetic resonance and cranial ultrasound characteristics of periventricular white matter abnormalities in newborn infants. Clin Radiol 2001; 56: 647–55.Google Scholar
Roelants-van Rijn, AM, Groenendaal, F, Beek, FJ, et al. Parenchymal brain injury in the preterm infant: comparison of cranial ultrasound, MRI and neurodevelopmental outcome. Neuropediatrics 2001; 32: 80–9.CrossRefGoogle ScholarPubMed
Inder, TE, Anderson, NJ, Spencer, C, et al. White matter injury in the premature infant: a comparison between serial cranial sonographic and MR findings at term. AJNR Am J Neuroradiol 2003; 24: 805–9.Google Scholar
Miller, SP, Cozzio, C, Goldstein, RB, et al. Comparing the diagnosis of white matter injury in premature newborns with serial MR imaging and transfontanel ultrasonography findings. AJNR Am J Neuroradiol 2003; 24: 1661–9.Google Scholar
Hintz, SR, Barnes, PD, Bulas, D, et al. Neuroimaging and neurodevelopmental outcome in extremely preterm infants. Pediatrics. 2015; 135(1): e32–42.CrossRefGoogle ScholarPubMed
Mirmiran, M, Barnes, P, Keller, K, et al. Neonatal brain MRI before discharge is better than serial cranial ultrasound in predicting cerebral palsy in very low birth weight preterm infants. Pediatrics 2004; 114: 992–8.Google Scholar
Sanchez, R, Khong, PL, Ringertz, H. Radiologic protection in pediatric radiology: ICRP recommendations. Pediatr Radiol. 2013; 43(8): 920–1.Google Scholar
Vertinzksy, A, Barnes, P. Macrocephaly, increased intracranial pressure, and hydrocephalus in the infant and young child. Top Magn Reson Imaging 2007; 18: 31–52.Google Scholar
Barnes, P. Imaging of NAI and the mimics: issues and controversies in the era of evidence-based medicine. Radiol Clin North Am 2011; 49: 205–29.Google Scholar
Mukherjee, P. Advanced pediatric imaging. Neuroimag Clin North Am 2006; 16: 1–210.Google Scholar
Levine, D, Barnes, PD, Robertson, RR, et al. Fast MR imaging of fetal central nervous system abnormalities. Radiology 2003; 229: 51–61.Google Scholar
Garel, C, Delezide, A, Elmaleh-Berges, M, et al. Contribution of fetal MRI in the evaluation of cerebral ischemic lesions. AJNR Am J Neuroradiol 2004; 25: 1563–8.Google Scholar
Levine, D, Barnes, P. MR imaging of fetal CNS abnormalities. In Levine, D, ed., Atlas of Fetal MRI. Boca Raton, FL: Taylor & Francis, 2005: 25–72.Google Scholar
Griffiths, P, Widjaja, E, Paley, M, et al. Imaging of the fetal spine in utero: diagnostic accuracy and impact on management. Pediatr Radiol 2006; 36: 927–33.Google Scholar
Garel, C. New advances in fetal MR neuroimaging. Pediatr Radiol 2006; 36: 621–5.Google Scholar
Glenn, O, Barkovich, J. Magnetic resonance imaging of the fetal brain and spine, part 1. AJNR Am J Neuroradiol 2006; 27: 1604–11; Part 2. AJNR Am J Neuroradiol 2006; 27: 1807–14.Google Scholar
Barkovich, AJ, Baranski, K, Vigneron, D, et al. Proton MR spectroscopy in the evaluation of asphyxiated term neonates. AJNR Am J Neuroradiol 1999; 20: 1399–405.Google ScholarPubMed
Vigneron, DB. Magnetic resonance spectroscopic imaging of human brain development. Neuroimag Clin North Am 2006; 16; 75–86.CrossRefGoogle ScholarPubMed
Cecil, K. MR spectroscopy of metabolic disorders. Neuroimag Clin North Am 2006; 16: 87–116.Google Scholar
Barkovich, A, Miller, S, Bartha, A. MR imaging, MR spectroscopy, and diffusion tensor imaging of sequential studies in neonates with encephalopathy. AJNR Am J Neuroradiol 2006; 27: 533–47.Google Scholar
Wang, J, Licht, D. Pediatric perfusion MRI using arterial spin labeling. Neuroimag Clin North Am 2006; 16: 149–68.Google Scholar
Huppi, PS, Maier, SE, Peled, S, et al. Microstructural development of human newborn cerebral white matter assessed in vivo by diffusion tensor magnetic resonance imaging. Pediatr Res 1998; 44: 584–90.CrossRefGoogle ScholarPubMed
Neil, JJ, Shiran, SI, McKinstry, RC. Normal brain in human newborns: apparent diffusion coefficient and diffusion anisotropy measured by using diffusion tensor MR imaging. Radiology 1998; 209: 57–66.Google Scholar
Johnson, AJ, Lee, BCP, Lin, W. Echoplanar diffusion-weighted imaging in neonates and infants with suspected hypoxic–ischemic injury. AJNR Am J Neuroradiol 1999; 172: 219–26.Google Scholar
Robertson, RL, Ben-Sira, L, Barnes, PD, et al. MR line scan diffusion imaging of term neonates with perinatal brain ischemia. AJNR Am J Neuroradiol 1999; 20: 1658–70.Google Scholar
Phillips, MD, Zimmerman, RA. Diffusion imaging in pediatric hypoxic-ischemic injury. Neuroimag Clin North Am 1999; 9: 41–52.Google Scholar
Inder, T, Huppi, PS, Zientara, GP, et al. Early detection of periventricular leukomalacia by diffusion-weighted magnetic resonance imaging techniques. J Pediatr 1999; 134: 631–4.Google Scholar
Inder, TE, Huppi, PS, Warfield, S, et al. Periventricular white matter injury in the premature infant followed by reduced cerebral cortical gray matter volume at term. Ann Neurol 1999; 46: 755–60.Google Scholar
Huppi, PS, Murphy, B, Maier, SE, et al. Microstructural brain development after perinatal cerebral white matter injury assessed by diffusion tensor MR imaging. Pediatrics 2001; 107: 455–60.Google Scholar
Arzoumanian, Y, Mirmiran, M, Barnes, P, et al. Diffusion tensor brain imaging findings at term-equivalent age may predict neurologic abnormalities in low birth weight preterm infants. AJNR Am J Neuroradiol 2003; 24: 1646–53.Google ScholarPubMed
Counsell, S, Allsop, J, Harrison, M, et al. Diffusion-weighted imaging of the brain in preterm infants with focal and diffuse white matter abnormality. Pediatrics 2003; 112: 1–7.Google Scholar
Sagar, P, Grant, PE. Diffusion-weighted imaging: pediatric clinical applications. Neuroimag Clin North Am 2006; 16: 45–74.CrossRefGoogle ScholarPubMed
Mukherjee, P, McKinstry, R. Diffusion tensor imaging and tractography of human brain development. Neuroimag Clin North Am 2006; 16: 19–44.Google Scholar
van der Knaap, M, Valk, J. Classification of congenital abnormalities of the CNS. AJNR Am J Neuroradiol 1988; 9: 315–26.Google Scholar
Barkovich, AJ, Truwit, CL. Brain damage from perinatal asphyxia:correlation of MR findings with gestational age. AJNR Am J Neuroradiol 1990; 11: 1087–96.Google Scholar
Aida, N, Nishimura, G, Hachiya, Y, et al. MR imaging of perinatal brain damage: comparison of clinical outcome with initial follow-up MR findings. AJNR Am J Neuroradiol 1992; 19: 1909–22.Google Scholar
Barkovich, A, Hallam, D. Neuroimaging in perinatal hypoxic–ischemic injury. Ment Retard Dev Disabil Res Rev 1997; 3: 28–41.Google Scholar
Cowan, F, Rutherford, M, Groenendaal, F, et al. Origin and timing of brain lesions in term infants with neonatal encephalopathy. Lancet 2003; 361: 736–42.Google Scholar
Miller, S, Ramaswamy, V, Michelson, D, et al. Patterns of brain injury in term neonatal encephalopathy. J Pediatr 2005; 146: 453–60.Google Scholar
Lupton, BA, Hill, A, Roland, EH, et al. Brain swelling in the asphyxiated term newborn:pathogenesis and outcome. Pediatrics 1988; 82: 139–46.CrossRefGoogle ScholarPubMed
Vannucci, RC, Christensen, MA, Jager, JY. Nature, time-course, and extent of cerebral edema in perinatal hypoxic–ischemic brain damage. Pediatr Neurol 1993; 9: 29–34.Google Scholar
Pinto-Martin, JA, Riolo, S, Cnaan, A, et al. Cranial ultrasound prediction of disabling and nondisabling cerebral palsy at age two in a low birthweight population. Pediatrics 1995; 95: 249–54.Google Scholar
Goetz, MC, Gretebeck, RJ, Oh, KS, et al. Incidence, timing and follow-up of periventricular leukomalacia. Am J Perinatol 1995; 12: 325–7.Google Scholar
Valkama, AM, Pääkkö, ELE, Vainionpää, LK, et al. Magnetic resonance imaging at term and neuromotor outcome in preterm infants. Acta Paediatr 2000; 89: 348–55.Google Scholar
Perlman, JM, Rollins, N. Surveillance protocol for the detection of intracranial abnormalities in premature neonates. Arch Pediatr Adolesc Med 2000; 154: 822–6.CrossRefGoogle ScholarPubMed
Volpe, JJ. Neurobiology of periventricular leukomalacia in the premature infant. Pediatr Res 2001; 50: 553–62.Google Scholar
Panigrahy, A, Barnes, PD, Robertson, RL, et al. Volumetric brain differences in children with periventricular T2-signal hyperintensities:a grouping by gestational age at birth. AJR Am J Roentgenol 2001; 177: 695–702.Google Scholar
Miller, SP, Hoque, NN, Piecuch, RE, et al. The spectrum of cerebellar hemorrhage in premature newborns. Pediatr Res 2003; 53: 537A (abstract #3040).Google Scholar
Austin, NC, Woodward, L, Spencer, C, et al. Neurodevelopmental outcome at one year in a regional cohort of very low birth weight infants:correlation with MRI at term. Pediatr Res 2003; 53: 398A (abstract #2253).Google Scholar
Jenster, M, Bonifacio, S, Ruel, T, et al. Maternal or neonatal infection:association with neonatal encephalopathy outcomes. Pediatric Res 2014; 76: 93–9.Google Scholar
Inder, TE, Wells, SJ, Mogridge, NB, et al. Defining the nature of the cerebral abnormalities in the premature infant: a qualitative magnetic resonance imaging study. J Pediatr 2003; 143: 171–9.Google Scholar
Panigrahy, A, Barnes, PD, Robertson, RL, et al. Quantitative analysis of the corpus callosum in children with cerebral palsy and developmental delay: correlation with cerebral white matter volume. Pediatr Radiol 2005; 35: 1199–207.Google Scholar
Bodensteiner, J, Johnsen, S. MRI findings in children surviving extremely premature delivery and extremely low birthweight with cerebral palsy. J Child Neurol 2006; 21: 743–7.Google Scholar
Dyet, L, Kennea, N, Counsell, S, et al. Natural history of brain lesions in extremely preterm infants studied with serial MRI from birth and neurodevelopmental assessment Pediatrics 2006; 118: 536–48.Google Scholar
Khwaja, O, Volpe, J. Pathogenesis of cerebral white matter injury of prematurity. Arch Dis Child Fetal Neonatal Ed 2008; 93: F153–61.Google Scholar
Barkovich, AJ. MR and CT evaluation of profound neonatal and infantile asphyxia. AJNR Am J Neuroradiol 1992; 13: 959–72.Google Scholar
Barkovich, AJ, Sargent, SK. Profound asphyxia in the premature infant: imaging findings. AJNR Am J Neuroradiol 1995; 16: 1837–46.Google Scholar
Barkovich, AJ, Westmark, K, Partridge, C, et al. Perinatal asphyxia: MR findings in the first 10 days. AJNR Am J Neuroradiol 1995; 16: 427–39.Google Scholar
Roland, EH, Poskitt, K, et al. Perinatal hypoxic-ischemic thalamic injury: clinical features and neuroimaging. Ann Neurol 1998; 44: 161–6.Google Scholar
Sargent, M, Poskitt, K, Roland, E, et al. Cerebellar vermian atrophy after neonatal hypoxic–ischemic encephalopathy. AJNR Am J Neuroradiol 2004; 25: 1008–15.Google Scholar
Boichot, C, Walker, P, Durand, C, et al. Term neonate prognosis after perinatal asphyxia: contributions of MR imaging, MR spectroscopy, relaxation times, and ADCs. Radiology 2006; 239: 839–48.Google Scholar
Shankaran, S, Barnes, P, Hintz, S, et al. Brain injury following trial of hypothermia for neonatal hypoxic-ischemic encephalopathy. Arch Dis Child Fetal Neonatal Ed 2012; 97(6): F398–404.Google Scholar
Bulas, D, Neonatal, Glass P. ECMO: neuroimaging and neurodevelopmental outcome. Semin Perinatol 2005; 29: 58–65.Google Scholar
Zuerrer, M, Martin, E, Boltshauser, E. MRI of intracranial hemorrhage in neonates and infants at 2.35 tesla. Neuroradiology 1991; 33: 223–9.Google Scholar
DeVeber, G, Andrew, M, Adams, C, et al. Cerebral sinovenous thrombosis in children. N Engl J Med 2001; 345: 417–23.Google Scholar
Carvalho, K, Bodensteiner, J, Connolly, P, et al. Cerebral venous thrombosis in children. J Child Neurol 2001; 16: 574–85.Google Scholar
Lynch, J, Hirtz, D, deVeber, G, et al. Report of the National Institute of Neurologic Disorders and Stroke Workshop on Perinatal and Childhood Stroke. Pediatrics 2002; 109: 116–23.Google Scholar
DeVeber, G. Arterial ischemic strokes in infants and children: an overview of current approaches. Semin Thrombos Hemost 2003; 29: 567–73.Google Scholar
Sebire, G, Tabarki, B, Saunders, DE, et al. Cerebral venous thrombosis in children: risk factors, presentation, diagnosis, and outcome. Brain 2005; 128: 477–89.Google Scholar
Kirton, A, deVeber, G. Cerebral palsy secondary to perinatal ischemic stroke. Clin Perinatol 2006; 33: 367–86.Google Scholar
Fitzgerald, K, Williams, LS, Garg, BP, et al. Cerebral sinovenous thrombosis in the neonate. Arch Neurol 2006; 63: 405–9.Google Scholar
Barnes, C, deVeber, G. Prothrombotic abnormalities in childhood ischaemic stroke. Thromb Res 2006; 118: 67–74.Google Scholar
Ehtisham, A, Stern, B. Cerebral venous thrombosis: a review. Neurologist 2006; 12: 32–8.Google Scholar
Huang, A, Robertson, R. Spontaneous superficial parenchymal and leptomeningeal hemorrhage in term neonates. AJNR Am J Neuroradiol 2004; 25: 469–75.Google Scholar
Govaert, P, Vanhaesebrouck, P, de Praeter, C. Traumatic neonatal intracranial bleeding and stroke. Arch Dis Child 1992; 67: 840–5.Google Scholar
Castillo, M, Fordham, LA. MR of neurologically symptomatic newborns after vacuum extraction delivery. AJNR Am J Neuroradiol 1995; 16: 816–18.Google Scholar
Heuser, C, Knight, S, Esplin, S, et al. Tachysystole in term labor:incidence, risk factors, outcomes, and effect on fetal heart tracings. Am J Obstet Gynecol 2013; 209: 32e1–6.Google Scholar
Keller, K, Barnes, P. Rickets vs. abuse: a national and internationsl epidemic. Pediatr Radiol 2008; 38: 1210–16.Google Scholar
Alexander, J, Leveno, K, Hauth, J, et al. Fetal injury associated with cesarean delivery. Obstet Gynecol 2006; 108: 885–90.Google Scholar
Doumouchtsis, S, Arulkumaran, S. Head trauma after instrumental births. Clin Perinatol 2008; 35: 69–83.Google Scholar
Schneider, JF1, Hanquinet, S, Severino, M, Rossi, A. MR imaging of neonatal brain infections. Magn Reson Imaging Clin North Am. 2011; 19(4): 761–75.Google Scholar
Jenster, M, Bonifacio, S, Ruel, T, et al. Maternal or neonatal infection: association with neonatal encephalopathy outcomes. Pediatr Res 2014; 76: 93–9.Google Scholar
DeVries, L, Verboon-Maciolek, M, Cowan, F, et al. The role of cranial US and MRI in the diagnosis of infections of the central nervous system. Early Hum Dev 2006; 82: 819–25.Google Scholar
Hoon, AH. Neuroimaging in cerebral palsy:patterns of brain dysgenesis and injury. J Child Neurol 2005; 12: 936–9.Google Scholar
Rodriguez, D, Young Poussaint, T. Neuroimaging of the child with developmental delay. Top Magn Reson Imaging 2007; 18: 75–92.Google Scholar
Valk, J, van der Knapp, MS. Toxic encephalopathy. AJNR Am J Neuroradiol 1992; 13: 747–60.Google Scholar
van der Knaap, MS, Valk, J. Magnetic Resonance of Myelination and Myelin Disorders, 3rd edn. New York: Springer, 2005.Google Scholar
Patay, Z. MR imaging workup of inborn errors of metabolism of early postnatal onset. Magn Reson Imaging Clin North Am. 2011; 19(4): 733–59;Google Scholar
Vanderver, A. Tools for diagnosis of leukodystrophies and other disorders presenting with white matter disease. Curr Neurol Neurosci Rep 2005; 5: 110–18.Google Scholar
Murakami, Y, Yamashita, Y, Matsuishi, T, et al. Cranial MRI of neurologically impaired children suffering from neonatal hypoglycemia. Pediatr Radiol 1999; 29: 23–7.Google Scholar
Alkalay, A, Flores-Sarnat, L, Sarnat, H, et al. Brain imaging findings in neonatal hypoglycemia. Clin Pediatr 2005; 44: 783–90.CrossRefGoogle ScholarPubMed
Barkovich, A, Ali, F, Rowley, H, et al. Imaging patterns of neonatal hypoglycemia. AJNR Am J Neuroradiol 1998; 19: 523–8.Google Scholar
Govaert, P, Lequin, M, Swarte, R, et al. Changes in globus pallidus with (pre) term kernicterus. Pediatrics 2003; 112: 1256–63.Google Scholar
Dublin, A, Hald, J, Wootton-Gorges, S. Isolated sulfite oxidase deficiency: MR imaging features. AJNR Am J Neuroradiol 2002; 23: 484–5.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×