Diffuse basal ganglia or thalamus hyperechogenicity in preterm infants

Abstract

Objective: To determine the incidence and factors associated with diffuse basal ganglia or thalamus hyperechogenicity (BGTH) in preterm infants.Study Design: (1) Review of serial neurosonograms among neonates with gestational age (GA) <34 weeks born at Weiler Hospital during a 21-month period; (2) Color Doppler flow imaging; (3) Case-control study using GA group-matched controls; and (4) Blind reading of CT scans or MRIs in patients with BGTH.Results: Among 289 infants, 24 (8.3%) had diffuse BGTH. Color Doppler flow imaging was normal in nine patients. The incidence of diffuse BGTH was inversely related to GA (P<0.01). Logistic regression (n ¼ 96) showed that diffuse BGTH was significantly associated with requirement of high-frequency oscillation (HFO) (P ¼ 0.031), severe intraventricular hemorrhage (IVH) (P ¼ 0.004), hypotension requiring vasopressors (P ¼ 0.040), hypoglycemia (P ¼ 0.031) and male gender (P ¼ 0.014). Most patients with diffuse BGTH had normal basal ganglia and thalamus on CT/MRI, one had a hemorrhage, and one had an ischemic infarction.Conclusions: In our series, diffuse BGTH occurred in 8.3%, and was associated with factors similar to those previously reported. In contrast, several series have reported almost exclusively linear or punctuate hyperechoic foci, corresponding to hyperechogenicity of the lenticulostriate vessels. Our data provide further evidence to suggest that diffuse BGTH and hyperechogenicity of the lenticulostriate vessels are two different entities. Additional studies are required to determine the longterm significance of diffuse BGTH.

Preterm cranial ultrasound scanning is both feasible and effective in a middle‐income country

“…The authors concluded that this BGT echogenicity was a prematurity-related normal maturational phenomenon. Another pattern of BGT echogenicity, which was not necessarily bilateral but frequently associated with other brain lesions in more immature and unstable infants, was also described in 10% of VLBW infants, (23,24). The pattern of BGT echogenicity in our cohort seems different to both of these studies, but the high incidence, the association with better conditions at birth and the inverse correlation with other imaging abnormalities suggest that they may have been a transient nonpathological finding.…”

Quantification of Deep Gray Matter in Preterm Infants at Term-Equivalent Age Using Manual Volumetry of 3-Tesla Magnetic Resonance Images

“…1 The basal ganglia and thalamus also were shown to have both diffuse and focal punctuate hyperechogenicity on ultrasound in preterm infants during the early neonatal period, 6 although by term-equivalent age only 4% of infants have major persisting thalamic abnormality detected by conventional MRI. 7 Some studies have suggested that WM disease may be linked to abnormalities in the basal ganglia and thalamus. Lin et al 8 examined the relationship of WM disease and thalamic abnormality by manual delineation of the thalamic area on 2-dimensional MRIs in ex-preterm infants; the finding of a reduction in the ratio of area of the thalami to the cerebellum at 9 to 12 months in children with periventricular leucomalacia was compared with patient controls.…”

Easily Overlooked Sonographic Findings in the Evaluation of Neonatal Encephalopathy: Lessons Learned From Magnetic Resonance Imaging

“…In normal neonates, the basal ganglia and thalami are intermediate to low in echogenicity. Despite allegations that US underestimates the extent of injury to the deep gray matter, 34 thalamic injury may be documented with US as subtle or pronounced areas of increased echogenicity that may be unilateral or bilateral and are most often diffuse [60][61][62] (Fig. 14E); these areas are particularly conspicuous when linear US images or magnified views are used.…”