Neonatal Intracranial Ischemia and Hemorrhage : Role of Cranial Sonography and CT Scanning (original) (raw)
Related papers
AJNR. American journal of neuroradiology, 2000
Sonography, CT, and MR imaging are commonly used to screen for neonatal intracranial ischemia and hemorrhage, yet few studies have attempted to determine which imaging technique is best suited for this purpose. The goals of this study were to compare sonography with CT and MR imaging prospectively for the detection of intracranial ischemia or hemorrhage and to determine the prognostic value(s) of neuroimaging in neonates suspected of having hypoxic-ischemic injury (HII). Forty-seven neonates underwent CT (n = 26) or MR imaging (n = 24) or both (n = 3) within the first month of life for suspected HII. Sonography was performed according to research protocol within an average of 14.4 +/- 9.6 hours of CT or MR imaging. A kappa analysis of interobserver agreement was conducted using three independent observers. Infants underwent neurodevelopmental assessment at ages 2 months (n = 47) and 2 years (n = 26). CT and MR imaging had significantly higher interobserver agreement (P < .001) fo...
The Journal of Pediatrics, 1983
The aim of this study was to validate brain imaging techniques in the preterm infant. A homogeneous group of very immature (<32 week) neonates dying in the neonatal period were sequentially scanned with linear-array real-time ultrasound scans, and after death with compound B static sector ultrasound and high-resolution computed tomography (CT) scans. All three imaging techniques were correlated with the autopsy results. All germinal matrix bleeds >5ram in size and intraventricular hemorrhages associated with ventricular dilation or distortion were accurately diagnosed, In the immature infant it was difficult to distinguish the normal highly vascular germinal matrix and choroid plexus from hemorrhage into the brain or ventricles, respectively. Further studies that address the questions of accurate timing and incidence of bleeds must consider the spatial resolution of the individual scanner, the maturity of the brain, the site and size of the lesion, and the evolution of the lesion. For the diagnosis of major hemorrhagic lesions in the preterm infant, either ultrasound or CT scans may be used with confidence. (J PEDIATR 102:275, 1983)
2019
Background: Perinatal asphyxia plays a major role in neonatal morbidity and death throughout the world. An estimated 130 million infants are born each year, of which 4 million die within first 28 days of life. Pakistan has the third highest neonatal death rate in the world with incidence of prenatal asphyxia reaching up to 9%. Magnetic resonance imaging (MRI) of the brain is the standard imaging modality in such cases, but a good correlation between cranial sonography and MRI of brain has been reported. The aim of this study was to determine diagnostic accuracy of cranial sonography in detection of neonatal hypoxic ischemic encephalopathy (HIE) in clinically suspected premature neonates. Patients and methods: This cross-sectional survey was conducted in Sir Ganga Ram Hospital, Department of Radiology and Medical Imaging between March-August, 2017. Total 303 premature neonates were included in the study hospitalized in Neonatology unit of the hospital with clinical suspicion of hypoxic ischemic encephalopathy. Transcranial sonography (CUS) was performed in first month of life and findings were recorded. Then 1.5 Tesla MRI machine was used for imaging brain using T1-weighted, T2-weighted and fluid-attenuated inversion recovery (FLAIR) sequences. The sonographic results were then compared with MRI findings. Results: The mean age of mothers was 29.3years. The mean gestational age at birth was 33.9weeks. In this study, there were 157 (51.8%) males and 146 (48.2%) female neonates. The sensitivity, specificity, PPV, NPV and diagnostic accuracy of cranial sonography were 97.8%, 96.0%, 97.2%, 96.8% and 97.0%, respectively taking MRI as gold standard. Conclusion: Cranial sonography has high accuracy in detection of hypoxic ischemic encephalopathy in neonates and can be used as initial imaging modality.
2010
The authors reviewed available evidence on neonatal neuroimaging strategies for evaluating both very low birth weight preterm infants and encephalopathic term neonates. Imaging for the preterm neonate: Routine screening cranial ultrasonography (US) should be performed on all infants of Ͻ30 weeks' gestation once between 7 and 14 days of age and should be optimally repeated between 36 and 40 weeks' postmenstrual age. This strategy detects lesions such as intraventricular hemorrhage, which influences clinical care, and those such as periventricular leukomalacia and low-pressure ventriculomegaly, which provide information about long-term neurodevelopmental outcome. There is insufficient evidence for routine MRI of all very low birth weight preterm infants with abnormal results of cranial US. Imaging for the term infant: Noncontrast CT should be performed to detect hemorrhagic lesions in the encephalopathic term infant with a history of birth trauma, low hematocrit, or coagulopathy. If CT findings are inconclusive, MRI should be performed between days 2 and 8 to assess the location and extent of injury. The pattern of injury identified with conventional MRI may provide diagnostic and prognostic information for term infants with evidence of encephalopathy. In particular, basal ganglia and thalamic lesions detected by conventional MRI are associated with poor neurodevelopmental outcome. Diffusion-weighted imaging may allow earlier detection of these cerebral injuries. Recommendations: US plays an established role in the management of preterm neonates of Ͻ30 weeks' gestation. US also provides valuable prognostic information when the infant reaches 40 weeks' postmenstrual age. For encephalopathic term infants, early CT should be used to exclude hemorrhage; MRI should be performed later in the first postnatal week to establish the pattern of injury and predict neurologic outcome.
Transcranial Ultrasound in Comparison to MRI in Evaluation of Hypoxic Ischemic Injury in Neonates
The Egyptian Journal of Hospital Medicine
Background: Hypoxic-ischemic injury is the most common cause of encephalopathy in newborns. Objectives: The goal of our study was to demonstrate the role of transcranial ultrasound (TCUS) compared to MRI in assessment of neonatal encephalopathy. Patients and methods: Consecutive thirty sex neonates with hypoxic-ischemic encephalopathy (HIE) were included. All cases had undergone MR imaging as well as transcranial ultrasound study of the brain. The study was conducted between May 2015 and September 2017. They were collected from the Neonatology Intensive Care Unit at Elsayed Galal and El-Demerdash University Hospitals. Results: Our study found that stages I and II showed mild to moderate HIE presented with peripheral pattern and white matter injuries while stage III revealed severe HIE presented with central pattern of injury (BGT). In addition, our study reported that all patients with stage III of HIE showed severe central pattern on MRI. Conclusion: MRI imaging is considered a sensitive technique in detecting different MR patterns of encephalopathy in newborns. MRI placed other imaging modalities in diagnostic assessment and early predictor of future development of neurological abnormalities in neonates with encephalopathy.
Cranial sonography in term and near-term infants
Pediatric Radiology, 2008
Sonographic patterns of brain injury in the term and near-term infant are quite different from those in the premature infant. Although periventricular leukomalacia and germinal matrix hemorrhage are rarely seen in term infants, selective neuronal injury, parasagittal infarction, focal stroke, diffuse hypoxic-ischemic injury, and deep parenchymal hemorrhages are more common lesions. In addition, congenital brain tumors, hamartomatous lesions, such as hemimegalencephaly, and tuberous sclerosis can mimic ischemic and hemorrhagic injury. Sonography remains an important tool in the initial evaluation of intracranial abnormalities in critically ill term and near-term infants. An understanding of the differences in etiology, sonographic patterns, and limitations of sonography in the term infant is essential for accurate and effective diagnoses in this age group.
INDIAN JOURNAL OF APPLIED RESEARCH, 2020
BACKGROUND: Incomplete formation and maturation of the central nervous system makes it extremely vulnerable to injury, in the case of premature neonates. This can result in a broad range of neurodevelopmental abnormalities. Cranial ultrasound is a sensitive tool for the early detection of these.Preterm neonates, defined as childbirth occurring at less than 37 completed weeks of gestation, is a major determinant of neonatal mortality and morbidity because of their greater risk for intraventricular hemorrhage (IVH) and hypoxic ischemic encephalopathy (HIE). The morbidity associated with preterm birth often extends to later life, resulting in enormous physical, psychological and economic costs. Currently, many imaging modalities are available like Cranial Ultrasonography, Computed Tomography and Magnetic Resonance Imaging to detect the intracranial abnormalities in these neonates. However advantages of Cranial Ultrasonography are easy availability, not expensive, easy to perform, quick...
Paediatric and …, 1992
Overa %-month period, 1105 newborns weighing between 501 and 2000g at birth were enrolled in a prospective study of the aetiology and consequences of neonatal brain haemorrhage. The three participating hospitals cared for approximately 85% of births in the study weight range in Middlesex, Monmouth and Ocean counties, New Jersey. Cranial ultrasonographic imaging through the anterior fontanelle was carried out at a mean age of 4.9 & 2.2 hours, 25.5 & 4.8 hours and 7.2 k 0.8 days to detect haemorrhage and other brain lesions. In 93.2% of study infants, scans were read by two independent expert readers (blind to the clinical status of the child) with submission of the scan to a third reader in cases of disagreement. Confirmation of both presence or absence and, when present, scan of first diagnosis of germinal matrix and/or intraventricular haemorrhage (GMVH) by two independent readers was achieved in 76.3% of study infants. The first two readers agreed as to presence or absence of GM/IVH in 82.4% of infants (Kappa = 0.56). Interobserver agreement was affected by the reported scan quality and by the number of scans available, but not by the hospital of origin, race or birthweight of the infant.
Imaging of the brain in full-term neonates: does sonography still play a role?
Pediatric Radiology, 2006
To date the literature comparing the usefulness of US and MR examinations of the neonatal brain suggests that US is not as effective a modality as MR. However, available studies were done on older equipment and published descriptions of the abnormalities found in the term brain are often incomplete. The purpose of this article is to emphasize technical factors that may be useful to optimize US imaging of the term neonatal brain, to provide a description of the sonographic findings in the brain in full-term neonates with hypoxic-ischaemic injury and to provide some data regarding the accuracy of sonography. While MR imaging may reveal abnormalities of the brain more floridly than sonography, we believe that sonography remains an extremely useful modality for evaluation of the full-term neonatal brain and it is probably a more accurate modality in this age group than the current literature suggests. Further prospective studies comparing sonographic and MR imaging findings are required to document the accuracy of sonography better and to help us define the role of this modality better. Such studies may help us select which patients really require MR imaging.