Original Article

Pediatric Radiology

, Volume 40, Issue 8, pp 1390-1396

First online:

Appearances of diffuse excessive high signal intensity (DEHSI) on MR imaging following preterm birth

  • Anthony R. HartAffiliated withDepartment of Neonatology, Jessop Wing, Sheffield Teaching Hospital NHS Foundation TrustAcademic Unit of Radiology, Royal Hallamshire Hospital, University of SheffieldDepartment of Academic Radiology, Royal Hallamshire Hospital, University of Sheffield Email author 
  • , Michael F. SmithAffiliated withDepartment of Neonatology, Jessop Wing, Sheffield Teaching Hospital NHS Foundation Trust
  • , Alan S. RigbyAffiliated withPostgraduate Medical Centre, Castle Hill Hospital, University of Hull
  • , Lauren I. WallisAffiliated withAcademic Unit of Radiology, Royal Hallamshire Hospital, University of Sheffield
  • , Elspeth H. WhitbyAffiliated withAcademic Unit of Radiology, Royal Hallamshire Hospital, University of Sheffield

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Abstract

Background

Diffuse damage to the periventricular white matter has recently been suggested to be a cause of the cognitive deficits seen following preterm birth. It is unclear whether this form of injury can be visualised on MR imaging, but one group has described diffuse excessive high signal intensity (DEHSI) as a possible form of diffuse white matter injury. This finding is dependant on window imaging and the subjective assessment of the reviewer, but little data have been published on the degree of subjectivity on its appearance among raters.

Objective

To assess the subjectivity of DEHSI on conventional and ultrafast T2-weighted MR imaging following preterm birth.

Materials and methods

An observational study of 40 preterm infants who had MR imaging of the brain around term-equivalent age, including conventional fast spin-echo (FSE) and ultrafast single-shot fast spin-echo (SSFSE) T2-weighted sequences in the axial plane. Images were anonymised and scored twice by four observers for the presence of DEHSI. Inter- and intra-observer agreement were calculated.

Results

Sixty-five percent of conventional and 100% of the ultrafast images were of diagnostic quality. DEHSI was noted in between 0% and 69.2% of conventional images and 27.5–90% of the ultrafast images. Inter- and intra-observer agreement ranged from none to moderate.

Conclusion

The visual appearances of DEHSI on conventional FSE and ultrafast SSFSE T2-W images are highly subjective, limiting its clinical application.

Keywords

White matter Periventricular leukomalacia MRI Preterm Infant