Comparison of cranial ultrasound and MRI for detecting BRAIN injury in extremely preterm infants and correlation with neurological outcomes at 1 and 3 years
This study aimed to investigate the accuracy of different grades of brain injuries on serial and term equivalent age (TEA)-cranial ultrasound imaging (cUS) as compared to TEA magnetic resonance imaging (MRI) in extremely preterm infants < 28 weeks, and determine the predictive value of imaging abnormalities on neurodevelopmental outcome at 1 and 3 years. Seventy-five infants were included in the study. Severe TEA-cUS injury had high positive predictive value-PPV (100%) for predicting severe MRI injury compared to mild to moderate TEA-cUS injury or severe injury on worst cranial ultrasound scan. Absence of moderate to severe injury on TEA cUS or worst serial cUS was a good predictor of a normal MRI (negative predictive values > 93%). Severe grade 3 injuries on TEA-US had high predictive values in predicting abnormal neurodevelopment at both 1 and 3 years of age (PPV 100%). All grades of MRI and worst serial cUS injuries poorly predicted abnormal neurodevelopment at 1 and 3 years. Absence of an injury either on a cranial ultrasound or an MRI did not predict a normal outcome. Multiple logistic regression did not show a significant correlation between imaging injury and neurodevelopmental outcomes.
What is Known:
• Preterm neonates are at increased risk of white matter and other brain injuries, which may be associated with adverse neurodevelopmental outcome.
• MRI is the most accurate method in detecting white matter injuries.
What is New:
• TEA-cUS can reliably detect severe brain injuries on MRI, but not mild/moderate lesions as well as abnormal neurodevelopment at 1 and 3 years.
• TEA-MRI brain injury is poor in predicting abnormal neurodevelopment at 1 and 3 years and normal cUS or MRI brain injury may not guarantee normal neurodevelopment.
KeywordsPreterm White matter injury Cranial ultrasound Magnetic resonance imaging Neurodevelopmental outcome Echogenicity
Bayley Scales of Infant Development
Cystic periventricular leukomalacia
Diffuse excessive high signal intensity
Diffusion weighted imaging
Fluid-attenuated inversion recovery
Magnetic resonance imaging
Neonatal intensive care unit
Negative predictive values
Positive predictive values
Punctate white matter lesions
Radiology information system and picture archiving communication system
Susceptibility weighted imaging
White matter injury
TC conceived and designed this study and revised the manuscript. KB collected data, drafted and revised the manuscript. AM performed statistical analysis and assisted with revision of manuscript. OK and RJ reviewed the US and MRI and assigned grades. They also helped with revision of manuscript.
Compliance with ethical standards
The study was approved by ACT Health Human Research Ethics Committee (ETHR.14.194).
The authors have no financial relationships relevant to this article to disclose.
Conflict of interest
The authors declare they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the ACT Health research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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