Easily Overlooked Sonographic Findings in the Evaluation of Neonatal Encephalopathy: Lessons Learned From Magnetic Resonance Imaging

Dinan, David; Daneman, Alan; Guimaraes, Carolina V.; Chauvin, Nancy A.; Victoria, Teresa; Epelman, Mónica

doi:10.1053/j.sult.2014.07.003

Cited by 20 publications

(9 citation statements)

References 103 publications

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“…Variable-frequency transducers allow the sonographer to focus on near-, mid-, and far-field pathologies. Many lesions such as subdural hematomas or deep gray matter abnormalities once poorly visualized by US are now more readily apparent [7]. With optimal technique and view, US can delineate multiple focal intracranial pathologies such as intracranial hemorrhages, calcifications, ischemia, and brain abscesses.…”

mentioning

confidence: 99%

Head Ultrasound in Neonatal Hypoxic-Ischemic Injury and Its Mimickers for Clinicians: A Review of the Patterns of Injury and the Evolution of Findings Over Time

et al. 2018

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Hypoxic-ischemic injury (HII) of the neonatal brain and resulting clinical hypoxic-ischemic encephalopathy remains a significant cause of morbidity and mortality in the neonatal population. Ultrasound (US) has emerged as a powerful screening tool for evaluation of a neonate with suspected HII. The pattern of injury on brain imaging has crucial implications in therapies and predicted neurodevelopmental outcomes. US has become increasingly effective at determining the pattern, timing, and extent of injury in HII as well as differentiating these findings from a host of diagnoses that can result in a similarly appearing clinical picture. Repeated US studies over a patient’s course can define the evolution of findings from the acute through chronic phase in addition to identifying any complications of therapy. US also has the added benefits of easy portability, no need for patient sedation, and a relatively low cost when compared to other imaging modalities like magnetic resonance imaging (MRI). It is crucial that clinicians understand the full capabilities of advanced US in identifying an underlying diagnosis, directing appropriate therapy, monitoring disease progress, and finally in predicting outcomes, thus improving the care of neonates with encephalopathy. The following article demonstrates the breadth of uses for US in the full-term neonate with encephalopathy, its limitations, the patterns of injury seen, and their evolution over time. We will also briefly review several clinical mimickers of HII for comparison.

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confidence: 99%

Head Ultrasound in Neonatal Hypoxic-Ischemic Injury and Its Mimickers for Clinicians: A Review of the Patterns of Injury and the Evolution of Findings Over Time

et al. 2018

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“…The following potential CUS items were found in the literature: slitlike ventricles, impaired differentiation white/grey matter, "fourcolumn" sign, hyperechogenicity of the thalamus, putamen, subcortical white matter, periventricular white matter, hippocampus, brainstem and vermis, visibility of the posterior limb internal capsule (PLIC) and RI of a cerebral artery ≤0.55. 17,[22][23][24][25][26][27][28]30 We excluded hyperechogenicity of the hippocampus, vermis and brainstem because these structures were rarely depicted on the available CUS images. The RI was scored based on all available ultrasounds; if the RI was ≤0.55 at one of these CUS, this item was scored as abnormal.…”

Section: Development Of the Cus Scoring Systemmentioning

confidence: 99%

The development and validation of a cerebral ultrasound scoring system for infants with hypoxic-ischaemic encephalopathy

et al. 2020

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BACKGROUND: Hypoxic-ischaemic encephalopathy (HIE) is an important cause of morbidity and mortality in neonates. When the gold standard MRI is not feasible, cerebral ultrasound (CUS) might offer an alternative. In this study, the association between a novel CUS scoring system and neurodevelopmental outcome in neonates with HIE was assessed. METHODS: (Near-)term infants with HIE and therapeutic hypothermia, a CUS on day 1 and day 3-7 after birth and available outcome data were retrospectively included in cohort I. CUS findings on day 1 and day 3-7 were related to adverse outcome in univariate and the CUS of day 3-7 also in multivariable logistic regression analyses. The resistance index, the sum of deep grey matter and of white matter involvement were included in multivariable logistic regression analyses. A comparable cohort from another hospital was used for validation (cohort II). RESULTS: Eighty-three infants were included in cohort I and 35 in cohort II. The final CUS scoring system contained the sum of white matter (OR = 2.6, 95% CI 1.5-4.7) and deep grey matter involvement (OR = 2.7, 95% CI 1.7-4.4). The CUS scoring system performed well in cohort I (AUC = 0.90) and II (AUC = 0.89). CONCLUSION: This validated CUS scoring system is associated with neurodevelopmental outcome in neonates with HIE.

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“…17). 2,8,17 It should be noted that severe HII may be complicated by secondary hemorrhage and can be extremely difficult to differentiate from PVHI.…”

Section: Application Of Advanced Techniques In Neonatal Cranial Ultramentioning

confidence: 99%

“…2,7 Multiple studies have shown that an RI value below 0.55 measured in the ACA in the first 24 to 72 hours of life following HII correlates with a poor neurodevelopment prognosis. 7,17 Later in the course of brain injury, as cerebral edema increases, increased ICP results in elevated RI. 2,7 In severe HII injury to deep brain structures is seen on ultrasound as diffusely increased echogenicity in the basal ganglia and thalami, well visualized using linear array transducers.…”

Section: Application Of Advanced Techniques In Neonatal Cranial Ultramentioning

confidence: 99%

Neonatal Cranial Ultrasound: Advanced Techniques and Image Interpretation

Riedesel

2017

J Pediatr Neurol

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Neonatal cranial ultrasound has become an essential part of the routine care of neonates. Ultrasound is noninvasive, relatively inexpensive, and can be performed at the bedside. Addition of advanced ultrasound techniques such as use of high-frequency linear transducers, additional acoustic windows, and color and pulsed wave Doppler can significantly improve image quality and diagnostic accuracy of cranial ultrasound. This review will focus on these techniques and their application in the detection of central nervous system pathology in the high-risk preterm and term neonates.

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Easily Overlooked Sonographic Findings in the Evaluation of Neonatal Encephalopathy: Lessons Learned From Magnetic Resonance Imaging

Cited by 20 publications

References 103 publications

Head Ultrasound in Neonatal Hypoxic-Ischemic Injury and Its Mimickers for Clinicians: A Review of the Patterns of Injury and the Evolution of Findings Over Time

Head Ultrasound in Neonatal Hypoxic-Ischemic Injury and Its Mimickers for Clinicians: A Review of the Patterns of Injury and the Evolution of Findings Over Time

The development and validation of a cerebral ultrasound scoring system for infants with hypoxic-ischaemic encephalopathy

Neonatal Cranial Ultrasound: Advanced Techniques and Image Interpretation

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