OBJECTIVE: To study the diagnostic value of the signal intensity on T1-weighted images of MRI and proton magnetic resonance spectroscopy (1H MRS) for neonatal hypoxic-ischemic encephalopathy (HIE). METHODS: Thirty full-term neonates with HIE admitted into the Department of Neonatology of the First Affiliated Hospital of Medical College, Xi′an Jiaotong University between January, 2007 and December 2009 were enrolled. Ten normal neonates born at the same period served as control group. Cerebral MRI and 1H MRS examinations were performed within 15 days after birth. RESULTS: In the HIE group, the signal intensity of the posterolateral lentiform nucleus was higher than or equal to that of the posterior limb of internal capsule, but in the control group, the results were opposite, namely, the signal intensity of the postero-lateral lentiform nucleus was lower than that of the posterior limb of internal capsule. The ratios of lactic acid/creatinine and glutamate/creatinine in the basal ganglia and the frontal lobe shown by 1H MRS increased significantly in the HIE group compared with controls (P<0.05 or 0.01). The differences of the signal intensity between the posterolateral lentiform nucleus and the posterior limb of internal capsule were positively correlated with the ratios of lactic acid/creatinine and glutamate/creatinine shown by 1H MRS (P<0.05). CONCLUSIONS: The comparison of the signal intensity between the posterolateral lentiform nucleus and the posterior limb of internal capsule on T1-weighted images of the cerebral MRI is valuable for the diagnosis of neonatal HIE and the accuracy of diagnosis can be improved when combined with 1H MRS.