White matter necrosis in very low birth weight infants: Neuropathologic and ultrasonographic findings in infants surviving six days or longer

Comparing brain white matter on sequential cranial ultrasound and MRI in very preterm infants

“…These results are partially consistent with those from previous studies, indicating that severely abnormal WM on cUS generally predicts adverse outcome [3,6,7,30]. However, in infants with normal WM, cUS has been suggested to be a poor predictor of neurodevelopmental outcome, attributed to the lower sensitivity of cUS for detecting diffuse and more subtle WM injury [4,5,11,12,18,21,23]. Differences between those and our studies include the cUS classification of WM changes; we did not consider the total duration of periventricular echodensities but focused on their degree and homogeneity, comparing the echogenicity of the WM to that of the choroid plexus, and relating outcome to the most severe WM changes during admission.…”

“…Diffuse WM injury has been described in MRI and pathology studies in newborn infants [4,5,10,12,[18][19][20][21][22][23][24]. Several studies have found a poor predictive value of cUS for detecting diffuse or more subtle WM injury [4,5,7,11,12,18,21,23].…”

“…Several studies have found a poor predictive value of cUS for detecting diffuse or more subtle WM injury [4,5,7,11,12,18,21,23]. It has been suggested that MRI should be performed in all very preterm infants, particularly in those with only mild (non-cystic) or no WM changes on cUS [5,11,12,23].…”

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

“…2,39,40 The neurodevelopmental abnormalities in infants with persistent white matter echogenicity indicate there was significant white matter injury even though cysts were not evident. 41 Possibly, a better grading system for nonhemorrhagic bilateral white matter injury would include persistent white matter change without cysts as mild PVL. 20,42,43 Although this study indicates that ultrasonography can differentiate the major types of neonatal brain injury, its value as a prognostic tool is limited to the extremes of each lesion.…”

The magnetic resonance revolution in brain imaging: impact on neonatal intensive care

“…Abnormal echogenicity on US is not lesion specific and, on the basis of pathological correlation studies, US has poor sensitivity and specificity in detecting subtle or diffuse brain injury. 24 Several studies have suggested that conventional MR imaging is more sensitive for detecting WMD than US both early after birth 25 and at a corrected age of term, 26 but as yet there has been no correlation with neurodevelopmental outcome. MR imaging may be helpful in the early diagnosis of PVL: diffusion weighted imaging detected PVL in a 30 week gestation infant at a time when both US and conventional MR imaging were normal.…”