European Journal of Pediatrics

, Volume 178, Issue 7, pp 1053–1061 | Cite as

Comparison of cranial ultrasound and MRI for detecting BRAIN injury in extremely preterm infants and correlation with neurological outcomes at 1 and 3 years

  • Katherine Burkitt
  • Owen Kang
  • Rajeev Jyoti
  • Abdel-Latif Mohamed
  • Tejasvi ChaudhariEmail author
Original Article


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.

Conclusion: This study demonstrates that TEA cUS can reliably identify severe brain abnormalities that would be seen on MRI imaging and positively predict abnormal neurodevelopment at both 1 and 3 years. Although MRI can pick up more subtle abnormalities that may be missed on cUS, their predictive value on neurodevelopmental impairment is poor. Normal cUS and MRI scan may not exclude abnormal neurodevelopment. Routine TEA-MRI scan provides limited benefit in predicting abnormal neurodevelopment in extremely preterm infants.

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.


Preterm White matter injury Cranial ultrasound Magnetic resonance imaging Neurodevelopmental outcome Echogenicity 



Bayley Scales of Infant Development


Cerebrospinal fluid


Cranial ultrasound


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


Ventricular index


White matter injury


Authors’ contributions

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).

Financial disclosure

The authors have no financial relationships relevant to this article to disclose.

Conflict of interest

The authors declare they have no conflict of interest.

Ethical approval

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.


  1. 1.
    Ajayi-Obe M, Saeed N, Cowan FM, Rutherford MA, Edwards AD (2000) Reduced development of cerebral cortex in extremely proterm infants. Lancet. 356:1162–1163. CrossRefGoogle Scholar
  2. 2.
    Brouwer MJ, Kersbergen KJ, van Kooij B et al (2017) Preterm brain injury on term-equivalent age MRI in relation to perinatal factors and neurodevelopmental outcome at two years. PLoS One.
  3. 3.
    Cheong JLY, Thompson DK, Spittle AJ, Potter CR, Walsh JM, Burnett AC, Lee KJ, Chen J, Beare R, Matthews LG, Hunt RW, Anderson PJ, Doyle LW (2016) Brain volumes at term-equivalent age are associated with 2-year neurodevelopment in moderate and late preterm children. J Pediatr 174:91–97.e1. CrossRefGoogle Scholar
  4. 4.
    Ciambra G, Arachi S, Protano C, Cellitti R, Caoci S, di Biasi C, Gualdi G, de Curtis M (2013) Accuracy of transcranial ultrasound in the detection of mild white matter lesions in newborns. Neuroradiol J 26:284–289. CrossRefGoogle Scholar
  5. 5.
    de Kieviet JF, Zoetebier L, van Elburg RM et al (2012) Brain development of very preterm and very low-birthweight children in childhood and adolescence: a meta-analysis. Dev Med Child NeurolGoogle Scholar
  6. 6.
    De Vries LS, Van Haastert ILC, Rademaker KJ et al (2004) Ultrasound abnormalities preceding cerebral palsy in high-risk preterm infants. J Pediatr 144:815–820. CrossRefGoogle Scholar
  7. 7.
    Edwards AD, Redshaw ME, Kennea N, Rivero-Arias O, Gonzales-Cinca N, Nongena P, Ederies M, Falconer S, Chew A, Omar O, Hardy P, Harvey ME, Eddama O, Hayward N, Wurie J, Azzopardi D, Rutherford MA, Counsell S, ePrime Investigators (2018) Effect of MRI on preterm infants and their families: a randomised trial with nested diagnostic and economic evaluation. Arch Dis Child Fetal Neonatal Ed 103:F15–F21. CrossRefGoogle Scholar
  8. 8.
    Hamrick SEG, Miller SP, Leonard C, Glidden DV, Goldstein R, Ramaswamy V, Piecuch R, Ferriero DM (2004) Trends in severe brain injury and neurodevelopmental outcome in premature newborn infants: the role of cystic periventricular leukomalacia. J Pediatr 145:593–599. CrossRefGoogle Scholar
  9. 9.
    Hart AR, Whitby EW, Griffiths PD, Smith MF (2008) Magnetic resonance imaging and developmental outcome following preterm birth: review of current evidence. Dev Med Child Neurol 50:655–663CrossRefGoogle Scholar
  10. 10.
    Hintz SR, Barnes PD, Bulas D, Slovis TL, Finer NN, Wrage LA, Das A, Tyson JE, Stevenson DK, Carlo WA, Walsh MC, Laptook AR, Yoder BA, van Meurs KP, Faix RG, Rich W, Newman NS, Cheng H, Heyne RJ, Vohr BR, Acarregui MJ, Vaucher YE, Pappas A, Peralta-Carcelen M, Wilson-Costello DE, Evans PW, Goldstein RF, Myers GJ, Poindexter BB, McGowan EC, Adams-Chapman I, Fuller J, Higgins RD, for the SUPPORT Study Group of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network (2015) Neuroimaging and neurodevelopmental outcome in extremely preterm infants. Pediatrics 135:e32–e42. CrossRefGoogle Scholar
  11. 11.
    Ho T, Dukhovny D, Zupancic JAF et al (2015) Choosing wisely in newborn medicine: five opportunities to increase value. Pediatrics 136:e482–e489. CrossRefGoogle Scholar
  12. 12.
    Horsch S, Skiöld B, Hallberg B et al (2010) Cranial ultrasound and MRI at term age in extremely preterm infants. Arch Dis Child Fetal Neonatal Ed 95:F310–F314. CrossRefGoogle Scholar
  13. 13.
    Hüppi PS, Warfield S, Kikinis R, Barnes PD, Zientara GP, Jolesz FA, Tsuji MK, Volpe JJ (1998) Quantitative magnetic resonance imaging of brain development in premature and mature newborns. Ann Neurol 43:224–235. CrossRefGoogle Scholar
  14. 14.
    Inder TE (2005) Abnormal cerebral structure is present at term in premature infants. Pediatrics 115:286–294. CrossRefGoogle Scholar
  15. 15.
    Johnson S, Fawke J, Hennessy E, Rowell V, Thomas S, Wolke D, Marlow N (2009) Neurodevelopmental disability through 11 years of age in children born before 26 weeks of gestation. Pediatrics 124:e249–e257. CrossRefGoogle Scholar
  16. 16.
    Johnson S, Moore T, Marlow N (2014) Using the Bayley-III to assess neurodevelopmental delay: which cut-off should be used? Pediatr Res 75:670–674. CrossRefGoogle Scholar
  17. 17.
    Kerr-Wilson CO, MacKay DF, Smith GCS, Pell JP (2012) Meta-analysis of the association between preterm delivery and intelligence. J Public Heal (United Kingdom) 34:209–216. Google Scholar
  18. 18.
    Leijser LM, De Bruïne FT, Van Der Grond J et al (2010) Is sequential cranial ultrasound reliable for detection of white matter injury in very preterm infants? Neuroradiology. 52:397–406. CrossRefGoogle Scholar
  19. 19.
    Maalouf EF, Duggan PJ, Counsell SJ, Rutherford MA, Cowan F, Azzopardi D, Edwards AD (2001) Comparison of findings on cranial ultrasound and magnetic resonance imaging in preterm infants. Pediatrics 107:719–727. CrossRefGoogle Scholar
  20. 20.
    Nongena P, Ederies A, Azzopardi DV, Edwards AD (2010) Confidence in the prediction of neurodevelopmental outcome by cranial ultrasound and MRI in preterm infants. Arch Dis Child Fetal Neonatal Ed 95:F388–F390CrossRefGoogle Scholar
  21. 21.
    Pandit AS, Ball G, Edwards AD, Counsell SJ (2013) Diffusion magnetic resonance imaging in preterm brain injury. Neuroradiology 55:65–95CrossRefGoogle Scholar
  22. 22.
    Pearce R, Baardsnes J (2012) Term MRI for small preterm babies: do parents really want to know and why has nobody asked them? Acta Paediatr Int J Paediatr 101:1013–1015CrossRefGoogle Scholar
  23. 23.
    Rademaker KJ, Uiterwaal CSPM, Beek FJA, van Haastert I, Lieftink AF, Groenendaal F, Grobbee DE, de Vries LS (2005) Neonatal cranial ultrasound versus MRI and neurodevelopmental outcome at school age in children born preterm. Arch Dis Child Fetal Neonatal Ed 90:F489–F493. CrossRefGoogle Scholar
  24. 24.
    Roelants-Van Rijn AM, Groenendaal F, Beek FJA et al (2001) Parenchymal brain injury in the preterm infant: comparison of cranial ultrasound, MRI and neurodevelopmental outcome. Neuropediatrics. 32:80–89. CrossRefGoogle Scholar
  25. 25.
    Saigal S, Doyle LW (2008) An overview of mortality and sequelae of preterm birth from infancy to adulthood. Lancet 371:261–269CrossRefGoogle Scholar
  26. 26.
    Skiöld B, Vollmer B, Böhm B, Hallberg B, Horsch S, Mosskin M, Lagercrantz H, Ådén U, Blennow M (2012) Neonatal magnetic resonance imaging and outcome at age 30 months in extremely preterm infants. J Pediatr 160:559–566.e1. CrossRefGoogle Scholar
  27. 27.
    van Noort-van der Spek IL, Franken M-CJP, Weisglas-Kuperus N (2012) Language functions in preterm-born children: a systematic review and meta-analysis. Pediatrics 129:745–754. CrossRefGoogle Scholar
  28. 28.
    Van Wezel-Meijler G, De Bruïne FT, Steggerda SJ et al (2011) Ultrasound detection of white matter injury in very preterm neonates: practical implications. Dev Med Child Neurol 53:29–34. CrossRefGoogle Scholar
  29. 29.
    Volpe J (2008) Neurology of the newborn. Elsevier Health Sciences, LondonGoogle Scholar
  30. 30.
    Weinstein M, Ben Bashat D, Gross-Tsur V, Leitner Y, Berger I, Marom R, Geva R, Uliel S, Ben-Sira L (2014) Isolated mild white matter signal changes in preterm infants: a regional approach for comparison of cranial ultrasound and MRI findings. J Perinatol 34:476–482. CrossRefGoogle Scholar
  31. 31.
    Woodward LJ, Anderson PJ, Austin NC, Howard K, Inder TE (2006) Neonatal MRI to predict neurodevelopmental outcomes in preterm infants. N Engl J Med 355:685–694. CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Medical School, College of Medicine, Biology & EnvironmentAustralian National UniversityActonAustralia
  2. 2.Department of RadiologyThe Canberra HospitalGarranAustralia
  3. 3.Department of Neonatology, Centenary Hospital for Women and ChildrenCanberra HospitalGarranAustralia

Personalised recommendations