Neonatal Intracranial Ischemia and Hemorrhage : Role of Cranial Sonography and CT Scanning

Abstract

Objective: To evaluate the role of cranial sonography and computed tomography in the diagnosis of neonatal intracranial hemorrhage and hypoxic-ischemic injury in an Indian set-up.

Methods: The study included 100 neonates who underwent cranial sonography and computed tomography (CT) in the first month of life for suspected intracranial ischemia and hemorrhage. Two observers rated the images for possible intracranial lesions and a kappa statistic for interobserver agreement was calculated.

Results: There was no significant difference in the kappa values of CT and ultrasonography (USG) for the diagnosis of germinal matrix hemorrhage/intraventricular hemorrhage (GMH/IVH) and periventricular leucomalacia (PVL) and both showed good interobserver agreement. USG, however detected more cases of GMH/IVH (24 cases) and PVL (19) cases than CT (22 cases and 16 cases of IVH and PVL, respectively). CT had significantly better interobserver agreement for the diagnosis of hypoxic ischemic injury (HII) in term infants and also detected more cases (33) as compared to USG (18). CT also detected 6 cases of extraaxial hemorrhages as compared to 1 detected by USG.

Conclusion: USG is better modality for imaging preterm neonates with suspected IVH or PVL. However, USG is unreliable in the imaging of term newborns with suspected HII where CT or magnetic resonance image scan is a better modality.

Keywords: CT-scan; Hypoxic ischemic injury; Ultrasonography.

Fig. 1

Ultrasonography and computed tomography of a neonate showing B/L grade III germinal matrix and intraventricular hemorrhage with hydrocephalus.

Fig. 2

Early periventricular leucomalacia: ultrasonography shows increased echogenicity in B/L frontal and left parietal region.

Fig. 3

Early periventricular leucomalacia: computed tomography of the above patient shows low attenuation of white matter in B/L frontal and parietal regions. A small focus of bleed is seen in right frontal region.

Fig. 4

Computed tomography of a patient showing cystic periventricular leucomalacia.

Fig. 5

Ultrasonography of same patient showing cystic periventricular leucomalacia.