Limitations of ultrasonography for diagnosing white matter damage in preterm infants

Abstract

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

Figure 1

Comparison between the results of early ultrasonography (US) and early magnetic resonance imaging (MRI) performed on the same day in 79 preterm infants. PVL, Periventricular leucomalacia; HM, haemorrhage.

Figure 2

(A, B) Cystic periventricular leucomalacia. (A) T1 weighted image in the transverse plane low signal in the white matter (arrow) and (B) corresponding T2 weighted image in the same area showing high signal (arrow). Bilateral cysts in the white matter. (C, D) Non-cystic periventricular leucomalacia. (C) T1 weighted image in the transverse plane and (D) corresponding T2 weighted image in the same area showing high signal intensity in the white matter (arrows). (E, F) Parenchymal punctate haemorrhage. (E) T1 weighted image in the transverse plane showing circular high signal (arrow) and (F) corresponding T2 weighted image in the same area showing low signal (arrow).

Figure 3

Comparison of the cerebral lesion diagnoses from early and late imaging in 51 preterm infants. US, Ultrasonography; MRI, magnetic resonance imaging; PVL, periventricular leucomalacia; HM, haemorrhage.