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

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Abstract

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.

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Data availability

Raw data for this study was collected on excel sheet using a data pro forma. This data is available from the corresponding author upon reasonable request.

Abbreviations

BSID:

Bayley Scales of Infant Development

CSF:

Cerebrospinal fluid

cUS:

Cranial ultrasound

cPVL:

Cystic periventricular leukomalacia

DEHSI:

Diffuse excessive high signal intensity

DWI:

Diffusion weighted imaging

FLAIR:

Fluid-attenuated inversion recovery

MRI:

Magnetic resonance imaging

NICU:

Neonatal intensive care unit

NPV:

Negative predictive values

PPV:

Positive predictive values

PWML:

Punctate white matter lesions

RIS-PACS:

Radiology information system and picture archiving communication system

SWI:

Susceptibility weighted imaging

VI:

Ventricular index

WMI:

White matter injury

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Author information

Authors and Affiliations

  1. Medical School, College of Medicine, Biology & Environment, Australian National University, Acton, ACT, Australia

    Katherine Burkitt, Rajeev Jyoti, Abdel-Latif Mohamed & Tejasvi Chaudhari

  2. Department of Radiology, The Canberra Hospital, Garran, ACT, Australia

    Owen Kang & Rajeev Jyoti

  3. Department of Neonatology, Centenary Hospital for Women and Children, Canberra Hospital, Yamba Drive, Garran, ACT, 2605, Australia

    Abdel-Latif Mohamed & Tejasvi Chaudhari

Authors
  1. Katherine Burkitt
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  2. Owen Kang
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  3. Rajeev Jyoti
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  4. Abdel-Latif Mohamed
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  5. Tejasvi Chaudhari
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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.

Corresponding author

Correspondence to Tejasvi Chaudhari.

Ethics declarations

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.

Additional information

Communicated by Patrick Van Reempts

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Burkitt, K., Kang, O., Jyoti, R. et al. Comparison of cranial ultrasound and MRI for detecting BRAIN injury in extremely preterm infants and correlation with neurological outcomes at 1 and 3 years. Eur J Pediatr 178, 1053–1061 (2019). https://doi.org/10.1007/s00431-019-03388-7

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  • DOI: https://doi.org/10.1007/s00431-019-03388-7

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