Skip to main content

Advertisement

Log in

Gray-scale ultrasound findings of hypoxic-ischemic injury in term infants

  • Pictorial Essay
  • Published:
Pediatric Radiology Aims and scope Submit manuscript

Abstract

Brain ultrasound has become a critical tool for bedside screening and monitoring of hypoxic-ischemic injury in infants. Transfontanellar ultrasound in infants allows delineation of anatomical structures of the brain and posterior fossa. The technique’s low cost, lack of ionizing radiation and repeatability make it a popular alternative to magnetic resonance imaging. The published literature on interpreting hypoxic-ischemic injury on brain ultrasound is wide and varied, yet diagnostic challenges remain when detecting subtle or diffuse changes. This pictorial essay summarizes and illustrates the spectrum of sonographic findings of hypoxic-ischemic injuries in term infants.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
Fig. 13
Fig. 14
Fig. 15

Similar content being viewed by others

References

  1. Barkovich AJ (1997) The encephalopathic neonate: choosing the proper imaging technique. AJNR Am J Neuroradiol 18:1816–1820

    CAS  PubMed  PubMed Central  Google Scholar 

  2. Meijler G (2010) Neonatal cranial ultrasonography. Springer-Verlag, Berlin Heidelberg

    Google Scholar 

  3. van Wezel-Meijler G, Steggerda SJ, Leijser LM (2010) Cranial ultrasonography in neonates: role and limitations. Semin Perinatol 34:28–38

    Article  Google Scholar 

  4. Daneman A, Epelman M (2015) Neurosonography: in pursuit of an optimized examination. Pediatr Radiol 45(Suppl 3):S406–S412

    Article  Google Scholar 

  5. Daneman A, Epelman M, Blaser S, Jarrin JR (2006) Imaging of the brain in full-term neonates: does sonography still play a role? Pediatr Radiol 36:636–646

    Article  Google Scholar 

  6. Dinan D, Daneman A, Guimaraes CV et al (2014) Easily overlooked sonographic findings in the evaluation of neonatal encephalopathy: lessons learned from magnetic resonance imaging. Semin Ultrasound CT MR 35:627–651

    Article  Google Scholar 

  7. Epelman M, Daneman A, Kellenberger CJ et al (2010) Neonatal encephalopathy: a prospective comparison of head US and MRI. Pediatr Radiol 40:1640–1650

    Article  Google Scholar 

  8. Cotten CM, Shankaran S (2010) Hypothermia for hypoxic-ischemic encephalopathy. Expert Rev Obstet Gynecol 5:227–239

    Article  Google Scholar 

  9. Shalak L, Perlman JM (2004) Hypoxic-ischemic brain injury in the term infant-current concepts. Early Hum Dev 80:125–141

    Article  Google Scholar 

  10. Salas J, Tekes A, Hwang M et al (2018) Head ultrasound in neonatal hypoxic-ischemic injury and its mimickers for clinicians: a review of the patterns of injury and the evolution of findings over time. Neonatology 114:185–197

    Article  Google Scholar 

  11. Gopagondanahalli KR, Li J, Fahey MC et al (2016) Preterm hypoxic-ischemic encephalopathy. Front Pediatr 4:114

    Article  Google Scholar 

  12. Volpe JJ (2009) Brain injury in premature infants: a complex amalgam of destructive and developmental disturbances. Lancet Neurol 8:110–124

    Article  Google Scholar 

  13. Chacko A, Andronikou S, Mian A et al (2020) Cortical ischaemic patterns in term partial-prolonged hypoxic-ischaemic injury — the inter-arterial watershed demonstrated through atrophy, ulegyria and signal change on delayed MRI scans in children with cerebral palsy. Insights Imaging 11:53

    Article  Google Scholar 

  14. de Vries LS, Cowan FM (2009) Evolving understanding of hypoxic-ischemic encephalopathy in the term infant. Semin Pediatr Neurol 16:216–225

    Article  Google Scholar 

  15. Cowan F, Rutherford M, Groenendaal F et al (2003) Origin and timing of brain lesions in term infants with neonatal encephalopathy. Lancet 361:736–742

    Article  Google Scholar 

  16. Lally PJ, Montaldo P, Oliveira V et al (2019) Magnetic resonance spectroscopy assessment of brain injury after moderate hypothermia in neonatal encephalopathy: a prospective multicentre cohort study. Lancet Neurol 18:35–45

    Article  Google Scholar 

  17. Hwang M (2018) Introduction to contrast-enhanced ultrasound of the brain in neonates and infants: current understanding and future potential. Pediatr Radiol 49:254–262

    Article  Google Scholar 

  18. Shi Y, Zhao J-N, Liu L et al (2012) Changes of positron emission tomography in newborn infants at different gestational ages, and neonatal hypoxic-ischemic encephalopathy. Pediatr Neurol 46:116–123

    Article  Google Scholar 

  19. de Vries LS, Groenendaal F (2010) Patterns of neonatal hypoxic-ischaemic brain injury. Neuroradiology 52:555–566

    Article  Google Scholar 

  20. Huang BY, Castillo M (2008) Hypoxic-ischemic brain injury: imaging findings from birth to adulthood. Radiographics 28:417–439

    Article  Google Scholar 

  21. Ashwal S, Majcher JS, Longo LD (1981) Patterns of fetal lamb regional cerebral blood flow during and after prolonged hypoxia: studies during the posthypoxic recovery period. Am J Obstet Gynecol 139:365–372

    Article  CAS  Google Scholar 

  22. Connolly B, Kelehan P, O'Brien N et al (1994) The echogenic thalamus in hypoxic ischaemic encephalopathy. Pediatr Radiol 24:268–271

    Article  CAS  Google Scholar 

  23. Soghier LM, Vega M, Aref K et al (2006) Diffuse basal ganglia or thalamus hyperechogenicity in preterm infants. J Perinatol 26:230–236

    Article  CAS  Google Scholar 

  24. Naidich TP, Gusnard DA, Yousefzadeh DK (1985) Sonography of the internal capsule and basal ganglia in infants: 1. Coronal sections. AJNR Am J Neuroradiol 6:909–917

    CAS  PubMed  PubMed Central  Google Scholar 

  25. van Wezel-Meijler G, Leijser LM, Wiggers-de Bruine FT et al (2011) Diffuse hyperechogenicity of basal ganglia and thalami in preterm neonates: a physiologic finding? Radiology 258:944–950

    Article  Google Scholar 

  26. Rutherford MA, Pennock JM, Dubowitz LM (1994) Cranial ultrasound and magnetic resonance imaging in hypoxic-ischaemic encephalopathy: a comparison with outcome. Dev Med Child Neurol 36:813–825

    Article  CAS  Google Scholar 

  27. Miller SP, Ramaswamy V, Michelson D et al (2005) Patterns of brain injury in term neonatal encephalopathy. J Pediatr 146:453–446

    Article  Google Scholar 

  28. Swarte R, Lequin M, Cherian P et al (2009) Imaging patterns of brain injury in term-birth asphyxia. Acta Paediatr 98:586–592

    Article  Google Scholar 

  29. Epelman M, Daneman A, Chauvin N, Hirsch W (2012) Head ultrasound and MR imaging in the evaluation of neonatal encephalopathy: competitive or complementary imaging studies? Magn Reson Imaging Clin N Am 20:93–115

    Article  Google Scholar 

  30. Yikilmaz A, Taylor GA (2008) Cranial sonography in term and near-term infants. Pediatr Radiol 38:605–616

    Article  Google Scholar 

  31. Leijser LM, de Vries LS, Cowan FM (2006) Using cerebral ultrasound effectively in the newborn infant. Early Hum Dev 82:827–835

    Article  Google Scholar 

  32. Toma P, Granata C (2015) Brain sonography. Springer, Berlin Heidelberg

    Book  Google Scholar 

  33. Winkler P (1998) Advances in paediatric CNS ultrasound. Eur J Radiol 26:109–120

    Article  CAS  Google Scholar 

  34. Grant EG, Schellinger D, Richardson JD et al (1983) Echogenic periventricular halo: normal sonographic finding or neonatal cerebral hemorrhage. AJR Am J Roentgenol 140:793–796

    Article  CAS  Google Scholar 

  35. Goncalves FG, Hwang M (2020) Superficial anatomy of the neonatal cerebrum — an ultrasonographic roadmap. Pediatr Radiol. https://doi.org/10.1007/s00247-020-04794-y

  36. Perlman JM (2007) Pathogenesis of hypoxic-ischemic brain injury. J Perinatol 27:S39–S46

    Article  CAS  Google Scholar 

  37. Haas RH (2005) Vascular disease, 2nd edn. Wiley, Boston

  38. Laptook AR, Corbett RJT (2002) The effects of temperature on hypoxic-ischemic brain injury. Clin Perinatol 29:623–649

    Article  Google Scholar 

  39. Gorelik N, Faingold R, Daneman A, Epelman M (2016) Intraventricular hemorrhage in term neonates with hypoxic-ischemic encephalopathy: a comparison study between neonates treated with and without hypothermia. Quant Imaging Med Surg 6:504–509

    Article  Google Scholar 

  40. Gieron-Korthals M, Colon J (2005) Hypoxic-ischemic encephalopathy in infants: new challenges. Fetal Pediatr Pathol 24:105–120

    Article  Google Scholar 

  41. Bano S, Chaudhary V, Garga UC (2017) Neonatal hypoxic-ischemic encephalopathy: a radiological review. J Pediatr Neurosci 12:1–6

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Misun Hwang.

Ethics declarations

Conflicts of interest

None

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hwang, M. Gray-scale ultrasound findings of hypoxic-ischemic injury in term infants. Pediatr Radiol 51, 1738–1747 (2021). https://doi.org/10.1007/s00247-021-04983-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00247-021-04983-3

Keywords

Navigation