Limitations of ultrasonography for diagnosing white matter damage in preterm infants

• Published in: Archives of disease in childhood. Fetal and neonatal edition Vol. 88; no. 4; pp. F275 - 279
• Main Authors: Debillon, T, N’Guyen, S, Muet, A, Quere, M P, Moussaly, F, Roze, J C
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health 01.07.2003; BMJ; BMJ Publishing Group LTD; National Library of Medicine - MEDLINE Abstracts
• Subjects: Age; Age Factors; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Attention Deficit Hyperactivity Disorder; Biological and medical sciences; Brain Infarction - diagnosis; Brain Infarction - diagnostic imaging; Brain Injuries - diagnosis; Brain Injuries - diagnostic imaging; Cysts; early diagnosis; Echoencephalography; Emergency and intensive care: neonates and children. Prematurity. Sudden death; Gangrene; Humans; Infant, Low Birth Weight; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases - diagnosis; Infant, Premature, Diseases - diagnostic imaging; Intensive care medicine; Intensive Care, Neonatal; Leukomalacia, Periventricular - diagnosis; Leukomalacia, Periventricular - diagnostic imaging; Magnetic Resonance Imaging; Medical sciences; MRI; NMR; Nuclear magnetic resonance; Original; periventricular leucomalacia; Predictive Value of Tests; Premature birth; preterm; Prospective Studies; PVL; Respiratory distress syndrome; Sensitivity and Specificity; Studies; ultrasonography; white matter damage; WMD; Sonography; Human; Premature; Newborn; Echography; Infant; Nervous system; Diagnosis; Nuclear magnetic resonance imaging; White matter; Comparative study
• ISSN: 1359-2998; 1468-2052
• DOI: 10.1136/fn.88.4.F275

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; κ coefficient = 0.86) but not for moderate lesions (non-cystic leucomalacia and parenchymal punctate haemorrhages; κ = 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.