Predicting outcome after perinatal asphyxia is still an unresolved problem and many standard clinical and radiological methods have failed to do so. MRI is a new technique that allows early and detailed anatomical and functional assessment of the extent of brain injury. It is our hypothesis that early MRI better predicts neurodevelopmental outcome at 3 months of age than clinical parameters. Design: Prospective cohort study of term birth infants with perinatal asphyxia. Methods: Standard T1 and T2 weighted precontrast and postcontrast MR were obtained and severity scores were formed ranging from 1 to 5 for 2 regions: the deep cerebral nuclei (Score A) and the cerebral hemispheres (Score B); in addition, an enhancement score was formed based on the difference of pre and postcontrast signal intensity, ranging from 0 (normal) to 4 (abnormal enhancement in deep cerebral nuclei and cerebral cortex). Neurologic outcome was assessed by a child neurologist blinded to MRI findings using a scoring system from 0= normal to 6=death. Results: 37 infants with a mean gestational age of 39 weeks (35-42wks) and a mean birth weight of 3344 gm (1625-5000gm) completed the 3 months follow up exam. 5 min. Apgar ranged from 0 to 9 with a median of 5; mean pH was 7.01 (6.8-7.3), mean base excess -13.7 (-27 to -4). MR was assessed at a mean age of 6 days. Using multiple regression model, standard clinical measures did not predict neurologic outcome (pH: p=.47, BE: p=.2). Apgar at 5 minutes significantly(p=.03) predicted outcome when using the more detailed outcome assessment but not when outcome was dichotomously defined (p=.2). Combining MR Scores A and B to a summary score best predicted neurologic outcome (p<.001). MR score A and enhancement score also correlated significantly with neurologic outcome(R=.54, p=.001; R=.47,p=.009 respectively) whereas MR score B did not (R=.2, p=.3). Conclusion: Using a detailed scoring system for MR and neurodevelopmental outcome, MR is the best predictor of neurodevelopmental outcome after perinatal asphyxia. Supported 1P20NS32553 and MO1RRO1271