title: Cinegraphic versus Combined Static and Cinegraphic Imaging for Initial Cranial Ultrasound Screening in Premature Infants.
abstract: BACKGROUND
  Cranial ultrasound is an essential screening and diagnostic tool in the care of neonates and is especially useful in the premature population for evaluation of potential germinal matrix/intraventricular hemorrhage (GM/IVH). There are typically two screening examinations, with the initial cranial sonography performed between 3 days and 14 days after birth, usually consisting of a series of static images plus several cinegraphic sweeps.
  
  
  OBJECTIVE
  Our primary goal was to assess whether cinegraphic sweeps alone are as accurate for diagnosing neurological abnormalities as combined static and cinegraphic imaging in the initial cranial US evaluation of premature infants. Our secondary goal was to establish the difference in time required to perform these two examinations.
  
  
  METHODS
  We retrospectively obtained 140 consecutive initial cranial US screening studies of premature infants. Three pediatric radiologists blinded to patient data read cinegraphic images alone and also combined (dual) imaging sets for a subset of subjects, recording findings for seven disease processes: germinal matrix/intraventricular hemorrhage (GM/IVH), right or left side; periventricular leukomalacia (PVL); choroid plexus cyst; subependymal cyst; cerebral and cerebellar infarction or hemorrhage; posterior fossa hemorrhage or infarction, and extra-axial hemorrhage. Separately, we compared retrospective dual imaging acquisition time against prospectively collected cinegraphic imaging time for premature infants undergoing initial cranial US evaluation.
  
  
  RESULTS
  Equivalence testing demonstrated no difference in equivalency between initial cranial US screening using cinegraphic evaluation alone and dual imaging for GM/IVH, cerebral and cerebellar infarct or hemorrhage, and subependymal cyst (all P < 0.05). For PVL and choroid plexus cyst, cinegraphic imaging and dual imaging did not demonstrate equivalence (P > 0.05). Cinegraphic images were obtained in less than one-third of the time required for dual imaging.
  
  
  CONCLUSIONS
  For the diagnoses that are critical to establish at initial screening (GM/IVH, cerebral and cerebellar infarct or hemorrhage) initial cranial US screening using cinegraphic sweeps was equivalent to dual imaging. Cinegraphic imaging required significantly less time to perform than dual imaging. We suggest that performance of cranial US screening using cinegraphic imaging alone is a potentially advantageous option in the initial evaluation of the premature neonate.
authors.affiliation: Department of Diagnostic Radiology, Florida Hospital, 601 E. Rollins St., Orlando, FL, 32803, USA. Cody.Odell.MD@flhosp.org.
authors.forename: M Cody
authors.initials: MC
authors.lastname: O'Dell
authors.affiliation: Department of Diagnostic Radiology, Texas Children's Hospital, Houston, TX, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Cassady
authors.affiliation: Department of Diagnostic Radiology, Florida Hospital, 601 E. Rollins St., Orlando, FL, 32803, USA.
authors.forename: Gregory
authors.initials: G
authors.lastname: Logsdon
authors.affiliation: Department of Diagnostic Radiology, Florida Hospital, 601 E. Rollins St., Orlando, FL, 32803, USA.
authors.forename: Laura
authors.initials: L
authors.lastname: Varich
mesh_terms: D001927:Brain Diseases / Q000000981:diagnostic imaging*; D004453:Echoencephalography / Q000379:methods*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D015588:Observer Variation; D011247:Pregnancy; D047928:Premature Birth / Q000000981:diagnostic imaging*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014741:Video Recording / Q000379:methods
keywords: Brain; Cinegraphic ultrasound imaging; Cranial ultrasound; Intraventricular hemorrhage; Neonatal head ultrasound; Neonates