Accuracy of Transcranial Ultrasound in the Detection of Mild White Matter Lesions in Newborns

Abstract

Cranial Ultrasound (cUS) may not be sensitive enough to detect subtle white matter (WM) injuries. Our study compared serial cUS with MRI at term equivalent age (TEA) to determine if it is possible to identify an ultrasound representation of subtle diffuse WM injuries such as punctate lesions (PWMLs) and diffuse excessive high signal intensity (DEHSI). Fifty-six very preterm infants were scanned sequentially from birth to TEA, an MRI was performed at TEA. Each echodensity found on cUS was classified as absent, transient (≤7 days), or prolonged (>7 days). A transient periventricular echodensity was detected in seven infants (12.5%), and a prolonged echodensity in 15 (26.8%). MRI examinations were performed in all 56 infants. No altered signal intensity was found in 18 infants (32.1%). DEHSI was detected in 14 infants (25%), and PWMLs were detected in eight babies (14.3%). Both abnormalities were found in 16 infants (28.6%). The positive predictive values of the prolonged echodensity for DEHSI and PWMLs were 86.7% and 46.7% respectively. However, a significant statistical correspondence (p=0.002, Odds Ratio 11.9) was found comparing DEHSI with cUS abnormal echodensities. Serial cUS during the neonatal period in preterm infants is essential and cannot be replaced with MRI at TEA. MRI seems to be more reliable in detecting mild or moderate WM abnormalities. However, serial cUS performed by an experienced neonatologist can provide valuable information on early WM changes such as prolonged echodensities that could potentially lead to a diffuse injury.

Serial cranial ultrasonography or early MRI for detecting preterm brain injury?

“…All other diffuse WMI on MRI were already detected on CUS by inhomogeneous echodensities on CUS. This confirms the assumption that inhomogeneous hyperechogenicities are the CUS correlates of punctate WMI and stresses the important value of advanced dedicated serial CUS to detect diffuse non-cystic WMI 7 9 16–18. However, MRI is needed to assess extent and localisation of WMI for prediction of its full impact on outcome 26.…”

Application of 2‐ and 3‐Dimensional Sonography Using the Virtual Organ Computer‐Aided Analysis Technique to Measure the Hippocampal Formation and Its Correlation With Corrected Gestational Age in Neonates

“…Two‐ and three‐dimensional sonography can be used to observe the development of each cerebral sulcus of the embryo . During the period between birth and infantile fontanel closure, transcranial sonography can display intracranial internal structures, including the hippocampal formation, which is a unique advantage of sonography . As a convenient and minimally invasive technique, transcranial sonography has been widely applied to the diagnosis of neonatal ischemic and anoxic encephalopathy, intracerebral hemorrhage, and intracranial structural abnormalities .…”

Brain ultrasound in Canavan disease

“…Though the diagnosis is not found in many patients with leukodystrophies, distinctive clinical and neuroimaging features unique to them can aid in diagnosis. MR is the most important neuroimaging modality for patients with leukodystrophies and it seems to be more reliable in detecting mild or moderate white matter abnormalities than cranial ultrasound [11][12][13]. Furthermore, diffusion-weighted MR allows the detection of major diffusion abnormalities and the identification of various edema types, of which the socalled myelin edema is particularly relevant to leukodystrophies, in particular CD [12].…”

“…Furthermore, diffusion-weighted MR allows the detection of major diffusion abnormalities and the identification of various edema types, of which the socalled myelin edema is particularly relevant to leukodystrophies, in particular CD [12]. However, brain sonography can provide valuable information on white matter changes and it is a bed-side procedure characterized by safety and cheapness [13]. An integrated approach may be the most appropriate and cost-effective to study neonatal and infant neurological diseases.…”

“…On the other hand, experience with sonographic analysis in leukodystrophies is limited. CD differential diagnosis should include X-linked adrenoleukodystrophy, Krabbe disease, metachromatic leukodystrophy, Pelizaeus-Merzbacher disease, Alexander disease (AD), and megalencephalic leukoencephalopathy with subcortical cysts [11][12][13][14]. In Alexander disease, US disclosed the obliteration of sulci and of the normal intracerebral landmarks with a decrease in acoustic attenuation of cerebral tissue and with an alteration in white matter echogenicity characterized by a ground-glass appearance [9].…”