PURPOSE: We analyzed the relationship between MRI patterns and neurologic outcome and explored the effectiveness of MRI as a tool for predicting the outcome. METHODS: We analyzed 23 full term infants with severe HIE retrospectively who were admitted to our NICU from Sep. 1993 to May 1998. Their MRI findings were classified into 4 patterns : type I : deep gray matter injury; type II : cortical, subcortical white matter injury; type III : localized periventricular white matter injury; and type IV : mixed injury. Neurodevelopmental outcome was assessed at a mean age of 30.7 months and the patients were grouped in two - neurodevelopmentally normal(8 cases) and delayed(15 cases, including 4 deaths). RESULTS: All type I patients(n=3) showed severe neurodevelopmental delay. Of seven type II patients, three developed normally(42.9%) and four showed developmental delay(57.1%). All type III patients(n=4) developed normally(P=0.008). Of nine type IV patients, one(11.1%) developed normally and eight(88.9%) showed severe developmental delay. There were twelve patients with lesions including thalamus and basal ganglia injury in MRI(type I+IV) and most of them(n=11, 91.7%) were severely developmentally delayed(P=0.002). Acute total asphyxic insult was documented in 9 of the 23 infants, 8 of 9(88.9%) had patterns of lesions including thalamus and basal ganglia injury. The neurologic outcome was poor for all except one of these patients. CONCLUSION: All the patients with periventricular white matter injury in MRI developed normally whereas all except one patient with subcortical gray matter injury showed severe neurodevelopmental delay. The patterns of brain injury shown in the MRIs of term infants with severe HIE provided significant information about the prognosis for the neurodevelopmental outcome of these infants.