Is sequential cranial ultrasound reliable for detection of white matter injury in very preterm infants?
BACKGROUND
Cranial ultrasound (cUS) may not be reliable for detection of diffuse white matter (WM) injury. Our aim was to assess in very preterm infants the reliability of a classification system for WM injury on sequential cUS throughout the neonatal period, using magnetic resonance imaging (MRI) as reference standard.


METHODS
In 110 very preterm infants (gestational age <32 weeks), serial cUS during admission (median 8, range 4-22) and again around term equivalent age (TEA) and a single MRI around TEA were performed. cUS during admission were assessed for presence of WM changes, and contemporaneous cUS and MRI around TEA additionally for abnormality of lateral ventricles. Sequential cUS (from birth up to TEA) and MRI were classified as normal/mildly abnormal, moderately abnormal, or severely abnormal, based on a combination of findings of the WM and lateral ventricles. Predictive values of the cUS classification were calculated.


RESULTS
Sequential cUS were classified as normal/mildly abnormal, moderately abnormal, and severely abnormal in, respectively, 22%, 65%, and 13% of infants and MRI in, respectively, 30%, 52%, and 18%. The positive predictive value of the cUS classification for the MRI classification was high for severely abnormal WM (0.79) but lower for normal/mildly abnormal (0.67) and moderately abnormal (0.64) WM.


CONCLUSIONS
Sequential cUS during the neonatal period detects severely abnormal WM in very preterm infants but is less reliable for mildly and moderately abnormal WM. MRI around TEA seems needed to reliably detect WM injury in very preterm infants.
Leijser
Lara M
LM
Department of Pediatrics, Division of Neonatology, J6-S, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
de Bruïne
Francisca T
FT
van der Grond
Jeroen
J
Steggerda
Sylke J
SJ
Walther
Frans J
FJ
van Wezel-Meijler
Gerda
G
D001921:Brain / Q000473:pathology; D001930:Brain Injuries / Q000175:diagnosis* / Q000000981:diagnostic imaging* / Q000473:pathology; D004453:Echoencephalography / Q000379:methods*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000000981:diagnostic imaging* / Q000473:pathology; D020547:Lateral Ventricles / Q000000981:diagnostic imaging / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D009413:Nerve Fibers, Myelinated / Q000000981:diagnostic imaging / Q000473:pathology; D011446:Prospective Studies; D015203:Reproducibility of Results; D012720:Severity of Illness Index