title: Usefulness of routine head ultrasound scans before surgery for congenital heart disease.
abstract: OBJECTIVE
  The purpose of this study was to assess the utility of preoperative head ultrasound scan (HUS) in a cohort of newborns also undergoing preoperative MRI as part of a prospective research study of brain injury in infants having surgery for congenital heart disease (CHD).
  
  
  METHODS
  A total of 167 infants diagnosed with CHD were included in this 3-center study. None of the patients had clinical signs or symptoms of preoperative brain injury, and all patients received both HUS and brain MRI before undergoing surgical intervention. HUS and MRI results were reported by experienced neuroradiologists who were blinded to any specific clinical details of the study participants. The findings of the individual imaging modes were compared to evaluate for the presence of brain injury.
  
  
  RESULTS
  Preoperative brain injury was present on HUS in 5 infants (3%) and on MRI in 44 infants (26%) (P < .001). Four of the HUS showed intraventricular hemorrhage not seen on MRI, suggesting false-positive results, and the fifth showed periventricular leukomalacia. The predominant MRI abnormality was white matter injury (n = 32). Other findings included infarct (n = 16) and hemorrhage (n = 5).
  
  
  CONCLUSIONS
  Preoperative brain injury on MRI was present in 26% of infants with CHD, but only 3% had any evidence of brain injury on HUS. Among positive HUS, 80% were false-positive results. Our findings suggest that routine HUS is not indicated in asymptomatic term or near-term neonates undergoing surgery for CHD, and MRI may be a preferable tool when the assessment of these infants is warranted.
authors.affiliation: Department of Pediatrics, Texas Children's Hospital, Houston, TX 77030, USA.
authors.forename: Danielle R
authors.initials: DR
authors.lastname: Rios
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Welty
authors.forename: Julia K
authors.initials: JK
authors.lastname: Gunn
authors.forename: John
authors.initials: J
authors.lastname: Beca
authors.forename: Charles G
authors.initials: CG
authors.lastname: Minard
authors.forename: Michelle
authors.initials: M
authors.lastname: Goldsworthy
authors.forename: Lee
authors.initials: L
authors.lastname: Coleman
authors.forename: Jill V
authors.initials: JV
authors.lastname: Hunter
authors.forename: Dean B
authors.initials: DB
authors.lastname: Andropoulos
authors.forename: Lara S
authors.initials: LS
authors.lastname: Shekerdemian
mesh_terms: D001930:Brain Injuries / Q000000981:diagnostic imaging* / Q000601:surgery; D004453:Echoencephalography; D005260:Female; D006257:Head / Q000000981:diagnostic imaging*; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D008297:Male; D011300:Preoperative Care; D011446:Prospective Studies; D012307:Risk Factors
keywords: MRI; brain imaging; congenital heart disease; head ultrasound; neonate