Normal Cerebellar Growth by Using Three-dimensional US in the Preterm Infant from Birth to Term-corrected Age

Abstract

Purpose To establish cross-sectional and longitudinal reference values for cerebellar size in preterm infants with normal neuroimaging findings and normal 2-year neurodevelopmental outcome by using cranial ultrasonography (US). Materials and Methods This prospective study consecutively enrolled preterm infants admitted to a neonatal intensive care unit from June 2011 to June 2014 with a birth weight of less than or equal to 1500 g and/or gestational age (GA) of less than or equal to 32 weeks. They underwent weekly cranial US from birth to term-equivalent age and magnetic resonance (MR) imaging at term-equivalent age. The infants underwent neurodevelopmental assessments at age 2 years with Bayley Scales of Infant and Toddler Development, 3rd edition (BSID-III). Patients with adverse outcomes (death or abnormal neuroimaging findings and/or BSID-III score of <85) were excluded. The following measurements were performed: vermis height, craniocaudal diameter, superior width, inferior width, vermis area, and transcerebellar diameter. Statistical analyses were conducted by using multilevel analyses. Results A total of 137 infants with a mean GA at birth of 29.4 weeks (range, 25-32 weeks) were included. Transcerebellar diameter increased by 1.04 mm per week on average; vermis height and craniocaudal diameter increased by 0.55 mm and 0.59 mm, respectively. Superior vermian width increased by an average of 0.45 mm, whereas inferior vermian width increased by an average of 0.51 mm per week. Vermis area was found to increase by 0.22 cm per week on average. The sex effect was significant (female lower than male) for vermis height (P < .05), craniocaudal diameter (P < .05), inferior vermian width (P <. 05), and vermis area (P <. 05). Conclusion Cross-sectional and longitudinal reference values were established for cerebellar growth in preterm infants, which may be included in routine cranial US.

Ultrasonographic Estimation of Total Brain Volume: 3D Reliability and 2D Estimation. Enabling Routine Estimation During NICU Admission in the Preterm Infant

“…As 3D US is not widely available we have focused on its utility to make 2D US measurements reliable compared to a 3D US manual segmentation and to both linear and volumetric MRI measures. However, this study reinforces the potential role 3D US has in the NICU which has been previously recognized by other authors ( 26 , 27 ) and by our group ( 14 , 16 , 28 , 29 ). 3D allows navigation through the three planes once a whole brain acquisition has been obtained, is faster than 2D US and allows review offline of any possible section of interest instead of having a static 2D image saved ( 30 – 32 ).…”

“…Weekly cranial 2D US and 3D US were performed with the infant lying supine with his or her head turned to the right. Volume acquisition was carried out through the 4D option in the 3D/4D Voluson i portable ultrasound system (GE Healthcare) as previously described by our group ( 14 , 16 ). Through this option, with the transducer positioned in the third coronal plane, the beam moves from anterior to posterior planes using a center frequency of 6.5 MHz with a scan angle set at 90°.…”

“…for MRI scans and I.B.F and E.R.G for US scans) blinded to clinical information. Based on previous studies by our group ( 16 ), we estimated a necessary sample size ranging from 12 to 22 to detect relevant differences for different measures within and among both techniques. All linear measurements were repeated three times to evaluate intraobserver variability.…”

Pontine and Cerebellar Development in Low-Birthweight Infants at Term-Equivalent Age

“…15 The present study showed that cerebellar vermian growth in LBW infants was similar to that in term infants, and that cerebellar hemispheric growth was also delayed in the former, perhaps reflecting faster growth of the cerebellar hemisphere relative to the cerebellar vermis in the perinatal period. In a 3-dimensional US in the 137 preterm infants, Benavente-Fernández et al 2 demonstrated that cerebellar hemispheric growth was faster than vermian growth. Several other studies have also confirmed this.…”

Signal Intensity and Volume of Pituitary and Thyroid Glands in Preterm and Term Infants

“…Magnetic resonance imaging (MRI) is often performed for preterm neonates with low birth weight (LBW) and postnatal growth retardation to assess the brain for abnormalities 10–12 . The anterior lobe of the pituitary gland in the term infant is known to be hyperintense on T 1 ‐weighted imaging, which is attributed to a high amount of endoplasmic reticulum and high levels of protein synthetic activity 13–15 .…”