Neonatal cranial ultrasound versus MRI and neurodevelopmental outcome at school age in preterm born children

Karin J Rademaker ¹, Cuno S.P.M. Uiterwaal ², Frederik J.A. Beek ², Ingrid C van Haastert ², Arno F Lieftink ², Floris Groenendaal ², Diederick E Grobbee ² and Linda S de Vries ^2*

¹ Wilhelmina Children's Hospital, University Medical Centre Utrecht, Netherlands
² University Medical Centre Utrecht, Netherlands

^* To whom correspondence should be addressed. E-mail: l.devries{at}wkz.azu.nl.

Accepted 20 May 2005

Abstract

Aim:To examine the correlation between neonatal cranial ultrasound and school age MRI and neurodevelopmental outcome.

Methods:In a prospective two years cohort study, 221 children (GA 32 weeks and/or BW 1500 grams) participated at a median age of 8.1 years (inclusion percentage 78%). Conventional MRI, IQ (subtests of the WISC) and motor performance (Movement Assessment Battery for Children) at school age were primary outcome measurements.

Findings:Overall there was poor correspondence between ultrasound group classifications and MRI group classifications, except for the severe group (over 70% agreement). There was only a 1 % chance of the children with a normal cranial ultrasound to have a major lesion on MRI. Mean IQ was significantly lower in children with major ultrasound or MRI lesions, but also lower in children with minor lesions on MRI compared to children with a normal MRI (91 ±16, 100 ± 13, 104 ± 13 for major lesions, minor lesions and normal MRI, respectively). Median Total Impairment Score was significantly higher in children with major lesions on ultrasound or MRI as well as in children with minor lesions on MRI (TIS 4.0, TIS 6.25 for normal and minor lesions on MRI respectively, p=<0.0001).

Conclusions:A normal neonatal cranial ultrasound excluded a severe lesion on MRI in 99% of the cases. MRI correlated stronger with mean IQ and median TIS than ultrasound. Subtle white matter lesions are better detected with MRI which could explain the better correlation of MRI with IQ and motor performance.

Keywords: MRI, neonatal cranial ultrasound, neurodevelopment, preterm born infants

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