Accuracy of head ultrasound for the detection of intracranial hemorrhage in preterm neonates: Comparison with brain MRI and susceptibility-weighted imaging

Jarunee Intrapiromkul, Frances Northington, Thierry A G M Huisman, Izlem Izbudak, Avner Meoded, Aylin Tekes

Research output: Contribution to journalArticle

Abstract

Objectives: To evaluate the sensitivity and specificity of head ultrasound (HUS) in the detection of intracranial hemorrhage in premature neonates compared with brain MRI using susceptibility-weighted imaging (SWI). Material and methods: Ultrasound (US) and MRI scans of the brain using SWI in premature neonates were retrospectively evaluated for grade I-III germinal matrix hemorrhage (GMH), periventricular hemorrhagic infarction (PVHI), intra-axial hemorrhage other than PVHI, extra-axial hemorrhage in each cerebral hemisphere and cerebellar hemorrhage in each cerebellar hemisphere. The impact of these hemorrhagic findings on short-term clinical management was also reviewed. Results: Twelve neonates (mean age: 9.8 days; range: 3-23 days) with a mean gestational age of 32.8 weeks (range: 29.6-35.4 weeks) were included in the study. HUS had high sensitivity (100%) and specificity (93.3%) in detecting grade III GMH using SWI as a reference, but poor sensitivity (0%) in the detection of intraventricular hemorrhage with normal-sized ventricles (grade II GMH). US was not sensitive in detecting either small cerebellar or extra-axial hemorrhage. Conclusion: HUS was highly sensitive and specific in the evaluation of grade III GMH, whereas SWI was superior to HUS in detecting small intra-axial or extra-axial hemorrhage, and had no impact on short-term management. Given the low cost, lack of radiation and advantages of bedside evaluation, HUS should continue to be the first line of imaging for brain injury in the evaluation of premature neonates with suspected intracranial hemorrhage. However, the usefulness of SWI for predicting long-term neurological outcomes has yet to be determined.

Original languageEnglish (US)
Pages (from-to)81-88
Number of pages8
JournalJournal of Neuroradiology
Volume40
Issue number2
DOIs
StatePublished - May 2013

Fingerprint

Intracranial Hemorrhages
Head
Hemorrhage
Brain
Infarction
Sensitivity and Specificity
Cerebrum
Brain Injuries
Gestational Age
Magnetic Resonance Imaging
Radiation
Costs and Cost Analysis

Keywords

  • Hemorrhage
  • MRI
  • Preterm
  • SWI
  • Ultrasound

ASJC Scopus subject areas

  • Clinical Neurology
  • Radiology Nuclear Medicine and imaging
  • Radiological and Ultrasound Technology

Cite this

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title = "Accuracy of head ultrasound for the detection of intracranial hemorrhage in preterm neonates: Comparison with brain MRI and susceptibility-weighted imaging",
abstract = "Objectives: To evaluate the sensitivity and specificity of head ultrasound (HUS) in the detection of intracranial hemorrhage in premature neonates compared with brain MRI using susceptibility-weighted imaging (SWI). Material and methods: Ultrasound (US) and MRI scans of the brain using SWI in premature neonates were retrospectively evaluated for grade I-III germinal matrix hemorrhage (GMH), periventricular hemorrhagic infarction (PVHI), intra-axial hemorrhage other than PVHI, extra-axial hemorrhage in each cerebral hemisphere and cerebellar hemorrhage in each cerebellar hemisphere. The impact of these hemorrhagic findings on short-term clinical management was also reviewed. Results: Twelve neonates (mean age: 9.8 days; range: 3-23 days) with a mean gestational age of 32.8 weeks (range: 29.6-35.4 weeks) were included in the study. HUS had high sensitivity (100{\%}) and specificity (93.3{\%}) in detecting grade III GMH using SWI as a reference, but poor sensitivity (0{\%}) in the detection of intraventricular hemorrhage with normal-sized ventricles (grade II GMH). US was not sensitive in detecting either small cerebellar or extra-axial hemorrhage. Conclusion: HUS was highly sensitive and specific in the evaluation of grade III GMH, whereas SWI was superior to HUS in detecting small intra-axial or extra-axial hemorrhage, and had no impact on short-term management. Given the low cost, lack of radiation and advantages of bedside evaluation, HUS should continue to be the first line of imaging for brain injury in the evaluation of premature neonates with suspected intracranial hemorrhage. However, the usefulness of SWI for predicting long-term neurological outcomes has yet to be determined.",
keywords = "Hemorrhage, MRI, Preterm, SWI, Ultrasound",
author = "Jarunee Intrapiromkul and Frances Northington and Huisman, {Thierry A G M} and Izlem Izbudak and Avner Meoded and Aylin Tekes",
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T1 - Accuracy of head ultrasound for the detection of intracranial hemorrhage in preterm neonates

T2 - Comparison with brain MRI and susceptibility-weighted imaging

AU - Intrapiromkul, Jarunee

AU - Northington, Frances

AU - Huisman, Thierry A G M

AU - Izbudak, Izlem

AU - Meoded, Avner

AU - Tekes, Aylin

PY - 2013/5

Y1 - 2013/5

N2 - Objectives: To evaluate the sensitivity and specificity of head ultrasound (HUS) in the detection of intracranial hemorrhage in premature neonates compared with brain MRI using susceptibility-weighted imaging (SWI). Material and methods: Ultrasound (US) and MRI scans of the brain using SWI in premature neonates were retrospectively evaluated for grade I-III germinal matrix hemorrhage (GMH), periventricular hemorrhagic infarction (PVHI), intra-axial hemorrhage other than PVHI, extra-axial hemorrhage in each cerebral hemisphere and cerebellar hemorrhage in each cerebellar hemisphere. The impact of these hemorrhagic findings on short-term clinical management was also reviewed. Results: Twelve neonates (mean age: 9.8 days; range: 3-23 days) with a mean gestational age of 32.8 weeks (range: 29.6-35.4 weeks) were included in the study. HUS had high sensitivity (100%) and specificity (93.3%) in detecting grade III GMH using SWI as a reference, but poor sensitivity (0%) in the detection of intraventricular hemorrhage with normal-sized ventricles (grade II GMH). US was not sensitive in detecting either small cerebellar or extra-axial hemorrhage. Conclusion: HUS was highly sensitive and specific in the evaluation of grade III GMH, whereas SWI was superior to HUS in detecting small intra-axial or extra-axial hemorrhage, and had no impact on short-term management. Given the low cost, lack of radiation and advantages of bedside evaluation, HUS should continue to be the first line of imaging for brain injury in the evaluation of premature neonates with suspected intracranial hemorrhage. However, the usefulness of SWI for predicting long-term neurological outcomes has yet to be determined.

AB - Objectives: To evaluate the sensitivity and specificity of head ultrasound (HUS) in the detection of intracranial hemorrhage in premature neonates compared with brain MRI using susceptibility-weighted imaging (SWI). Material and methods: Ultrasound (US) and MRI scans of the brain using SWI in premature neonates were retrospectively evaluated for grade I-III germinal matrix hemorrhage (GMH), periventricular hemorrhagic infarction (PVHI), intra-axial hemorrhage other than PVHI, extra-axial hemorrhage in each cerebral hemisphere and cerebellar hemorrhage in each cerebellar hemisphere. The impact of these hemorrhagic findings on short-term clinical management was also reviewed. Results: Twelve neonates (mean age: 9.8 days; range: 3-23 days) with a mean gestational age of 32.8 weeks (range: 29.6-35.4 weeks) were included in the study. HUS had high sensitivity (100%) and specificity (93.3%) in detecting grade III GMH using SWI as a reference, but poor sensitivity (0%) in the detection of intraventricular hemorrhage with normal-sized ventricles (grade II GMH). US was not sensitive in detecting either small cerebellar or extra-axial hemorrhage. Conclusion: HUS was highly sensitive and specific in the evaluation of grade III GMH, whereas SWI was superior to HUS in detecting small intra-axial or extra-axial hemorrhage, and had no impact on short-term management. Given the low cost, lack of radiation and advantages of bedside evaluation, HUS should continue to be the first line of imaging for brain injury in the evaluation of premature neonates with suspected intracranial hemorrhage. However, the usefulness of SWI for predicting long-term neurological outcomes has yet to be determined.

KW - Hemorrhage

KW - MRI

KW - Preterm

KW - SWI

KW - Ultrasound

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