Investigators from the Netherlands and Sweden developed a scoring system for brain injury using MRI images (including diffusion weighted imaging) from neonates 36 weeks gestation or greater with hypoxic ischemic encephalopathy treated with total body hypothermia. The scoring system allocated points based on whether there were markers of brain injury in the grey matter, white matter, cerebellum, and in additional areas; and whether lesions were unilateral or bilateral. The subscore for grey matter injury was associated with an adverse outcome, defined as death, cerebral palsy or a Bayley III score of less than 85. The positive predictive value, negative predictive value, and area under the curve for the grey matter subscore were all >0.83, the specificity was >0.91, and the sensitivity was variable. The other subscores did not add to the predictive value.