ORIGINAL ARTICLE

Limitations of ultrasonography for diagnosing white matter damage in preterm infants

T Debillon¹, S N’Guyen¹, A Muet¹, M P Quere², F Moussaly², J C Roze¹

¹ Neonatal Intensive Care Unit, University Hospital, Nantes, France
² Radiology and Magnetic Resonance Imaging Unit, University Hospital, Nantes

Correspondence to:
Correspondence to:
Dr Debillon, Service de Néonatologie, Hôpital Mére-Enfant, 9 Quai Moncousu, CHRU Nantes 44 093, Nantes Cedex 01, France;
thierry.debillon{at}chu-nantes.fr

Objectives: To compare the accuracy of ultrasonography (US) and magnetic resonance imaging (MRI) in diagnosing white matter abnormalities in preterm infants and to determine the specific indications for MRI.

Design: Prospective cohort study.

Setting: A neonatal intensive care unit in France.

Patients: All preterm infants (≤ 33 weeks gestation) without severe respiratory distress syndrome precluding MRI.

Main outcome measures: US and MRI performed contemporaneously during the third postnatal week were analysed by an independent observer. The findings were compared with those of a term MRI scan, the results of which were taken as the final diagnosis. Statistical analysis was performed to determine which early imaging study best predicted the term MRI findings.

Results: The early US and MRI findings (79 infants) correlated closely for severe lesions (cystic periventricular leucomalacia and parenchymal infarction; coefficient = 0.86) but not for moderate lesions (non-cystic leucomalacia and parenchymal punctate haemorrhages; = 0.62). Overall, early MRI findings predicted late MRI findings in 98% of patients (95% confidence interval (CI) 89.5 to 99.9) compared with only 68% for early US (95% CI 52.1 to 79.2).

Conclusions: US is highly effective in detecting severe lesions of the white matter in preterm infants, but MRI seems to be necessary for the diagnosis of less severe damage. MRI performed at about the third week of life is highly predictive of the final diagnosis at term.

Keywords: white matter damage; preterm; early diagnosis; magnetic resonance imaging; ultrasonography

Abbreviations: PVL, periventricular leucomalacia; WMD, white matter damage; US, ultrasonography; MRI, magnetic resonance imaging

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

Relevant Article

Fantoms

Martin Ward Platt
Arch. Dis. Child. Fetal Neonatal Ed. 2003 88: F260. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

• Nanba, Y., Matsui, K., Aida, N., Sato, Y., Toyoshima, K., Kawataki, M., Hoshino, R., Ohyama, M., Itani, Y., Goto, A., Oka, A. (2007). Magnetic Resonance Imaging Regional T1 Abnormalities at Term Accurately Predict Motor Outcome in Preterm Infants. Pediatrics 120: e10-e19 [Abstract] [Full Text]  
• McLoone, E, O'Keefe, M, Donoghue, V, McLoone, S, Horgan, N, Lanigan, B (2006). RetCam image analysis of optic disc morphology in premature infants and its relation to ischaemic brain injury.. Br J Ophthalmol 90: 465-471 [Abstract] [Full Text]  
• Pisani, F., Leali, L., Moretti, S., Turco, E., Volante, E., Bevilacqua, G. (2006). Transient Periventricular Echodensities in Preterms and Neurodevelopmental Outcome. J Child Neurol 21: 230-236 [Abstract]  
• Rademaker, K J, Uiterwaal, C S P M, Beek, F J A, van Haastert, I C, Lieftink, A F, Groenendaal, F, Grobbee, D E, de Vries, L S (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 [Abstract] [Full Text]  
• Mirmiran, M., Barnes, P. D., Keller, K., Constantinou, J. C., Fleisher, B. E., Hintz, S. R., Ariagno, R. L. (2004). Neonatal Brain Magnetic Resonance Imaging Before Discharge Is Better Than Serial Cranial Ultrasound in Predicting Cerebral Palsy in Very Low Birth Weight Preterm Infants. Pediatrics 114: 992-998 [Abstract] [Full Text]