Ultrasonographic Differential Diagnosis and Neurodevelopmental Outcome of Cerebral White Matter Lesions in Premature Infants

Bass, W. Thomas; Jones, Martha A; White, Larry E.; Montgomery, Thomas R.; Aiello, Frank; Karlowicz, M. Gary

doi:10.1038/sj.jp.7200190

Cited by 32 publications

(20 citation statements)

References 23 publications

(27 reference statements)

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“…This is similar to our experience (9). All aforementioned white matter echolucencies are a "hole in the brain," but have a totally different pathology, and a different long-term outcome (8,9).…”

supporting

confidence: 72%

“…Ultrasound machines using 7.5 MHz transducers, available at the time of enrollment of the patients studied by Dammann et al (6) in 1991-1993, enable identification of these diseases, provided that the children were examined often enough and for a sufficient number of weeks (7). Mixed lesions consisting of venous infarctions and cystic PVL were seen in only 11% of cases in a recent study (8). This is similar to our experience (9).…”

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confidence: 70%

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Groenendaal

2001

Pediatr Res

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confidence: 72%

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confidence: 70%

Correspondence

Groenendaal

2001

Pediatr Res

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“…Echodensities seen on ultrasound may represent edema, vascular congestion, or ischemic tissue, which may or may not become hemorrhagic. However, the ultrasound patterns of PHI and PVL described above have been commonly and consistently noted in previous studies 4,8,10,22 and correlate well with autopsy findings, with the exception of diffuse, non-cystic PVL. 19 This non-cystic form of PVL may be associated with normal neonatal ultrasound findings or seen as transient or persistent periventricular ''flares'' or echodensities.…”

Section: Discussionmentioning

confidence: 75%

Indices of Hemodynamic and Respiratory Functions in Premature Infants at Risk for the Development of Cerebral White Matter Injury

et al. 2002

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“…Although cUS has been shown to be a highly reliable technique to detect PVHI (8,9), its sensitivity to detect CST involvement and its prognostic value for USCP has not been uniformly established. One study found that frontal involvement was particularly associated with abnormal neuromotor development (10), whereas other studies have shown that a large PVHI involving more than one brain region or located posterior to the trigone is associated with development of USCP (5).…”

Section: Discussionmentioning

confidence: 99%

Neonatal DTI early after birth predicts motor outcome in preterm infants with periventricular hemorrhagic infarction

et al. 2015

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Background:To determine the association between early neonatal diffusion tensor imaging (DTI) and the development of unilateral spastic cerebral palsy (USCP) in preterm infants with periventricular hemorrhagic infarction (PVHI). Methods: Preterm infants with PVHI were assessed with early (≤4 wk after birth) and term-equivalent age MRI-DTI. Involvement of corticospinal tracts was assessed by visual assessment of the posterior limb of the internal capsule (PLIC) on DTI (classified asymmetrical, equivocal, or symmetrical) and by an atlas-based approach calculating fractional anisotropy asymmetry index in the PLIC. Motor outcome was assessed at ≥15 mo corrected age. results: Seven out of 23 infants with PVHI developed USCP. Their PLIC was visually scored as asymmetrical in 6 and equivocal in 1 on the early DTI. Thirteen out of 16 infants with a symmetrical motor development had a symmetrical PLIC on early DTI, the remaining 3 were equivocal. All infants with USCP had a fractional anisotropy asymmetry index of >0.05 (optimal cut-off value) on early DTI. In infants with a symmetrical motor development (n = 16), 14 had an asymmetry index ≤0.05 while 2 had an index >0.05. conclusion: DTI in preterm infants with PVHI within a few weeks after birth is associated with later motor development. P eriventricular hemorrhagic infarction (PVHI) is a serioustype of brain injury that occurs in around 1-3% of preterm infants with a gestational age below 37 wk (1-3). It is a complication of a germinal matrix hemorrhage that develops due to impaired venous drainage of the medullary veins in the periventricular white matter and may have an adverse effect on corticospinal tract (CST) development (4). PVHI leads in about 50-85% of infants to, mainly unilateral, spastic cerebral palsy (USCP) (2,3,5). The diagnosis is made with cranial ultrasound (cUS) and prediction of cerebral palsy is possible in most but not all infants taken the site and size of the lesion into account (5).MRI studies performed at term-equivalent age (TEA) will reliably predict motor outcome with asymmetry in myelination of the posterior limb of the internal capsule (PLIC) due to Wallerian degeneration being almost invariably associated with the development of USCP (6).Diffusion tensor imaging (DTI) allows the study of microstructural properties of the white matter (7). To the best of our knowledge, it has not yet been studied whether early disturbances in CST integrity shortly after the onset of PVHI relate to later development of USCP. In addition, the prognostic value of DTI for early prediction of USCP in infants with PVHI is still unknown.The aim of this study was to determine the association between MRI-DTI within 4 wk after birth and the development of USCP in preterm infants with PVHI. RESULTS PatientsThe clinical characteristics and motor outcome of the study group (n = 23) are summarized in Table 1. The infants who developed cerebral palsy (n = 7, 30%) all had USCP. Cranial Ultrasound FindingsIn 16 infants with a normal motor development, the cUS on which t...

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Ultrasonographic Differential Diagnosis and Neurodevelopmental Outcome of Cerebral White Matter Lesions in Premature Infants

Cited by 32 publications

References 23 publications

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Correspondence

Indices of Hemodynamic and Respiratory Functions in Premature Infants at Risk for the Development of Cerebral White Matter Injury

Neonatal DTI early after birth predicts motor outcome in preterm infants with periventricular hemorrhagic infarction

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