Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Neonatal Intracranial Ischemia and Hemorrhage : Role of Cranial Sonography and CT Scanning

  • Published : 2010.02.20
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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.

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References

  1. Alan H, Volpe JJ : Hypoxic ischemic cerebral Injury in the Newborn in Kenneth FS, Stephan A (eds) : Pediatr Neurol, ed 3. Mosby, 1999, Vol 1, pp191-204
  2. Ayyapan C, Rajeswasri PA, Edwin N : Clinical and computerized tomography evaluation of term neonates with perinatal asphyxia. Indian Pediatr 36 : 174-177, 1999
  3. Babcock DS, Ball W Jr : Postasphyxial encephalopathy in full-term infants; ultrasound diagnosis. Radiology 148 : 417-423, 1983 https://doi.org/10.1148/radiology.148.2.6867334
  4. Boal DK, Watterberg KL, Miles S, Gifford KL : Optimal cost-effective timing of cranial ultrasound screening in low-birth weight infants. Pediatr Radiol 25 : 425-428, 1995 https://doi.org/10.1007/BF02019054
  5. Blankenberg FG, Loh NN, Bracci P, D'Arceuil HE, Rhine WD, Norbash AM, et al. : Sonography, CT and MR imaging : a prospective comparison of neonates with suspected intracranial ischemia and hemorrhage. AJNR Am J Neuroradiol 21 : 213-218, 2000
  6. Blankenberg FG, Norbash AM, Lane B, Stevenson DK, Bracci PM, Enzmann DR : Neonatal intracranial ischemia and hemorrhage : diagnosis with US, CT and MR imaging. Radiology 199 : 253-259, 1996 https://doi.org/10.1148/radiology.199.1.8633155
  7. Burstein J, Papile LA, Burstein R : Intraventricular hemorrhage and hydrocephalus in premature newborn : a prospective study with CT. AJR Am J Roentgenol 132 : 631-635, 1979 https://doi.org/10.2214/ajr.132.4.631
  8. Donker DK, Hasman A, van Geijn HP : Interpretetion of low kappa values. Int J Biomed Comput 33 : 55-64, 1993 https://doi.org/10.1016/0020-7101(93)90059-F
  9. Fawer CL, Calame A : Ultrasound In imaging Techniques of the CNS of neonates. Verlag, 1994, pp79-106
  10. Fitz CR, Byrd SE, Vezina G : Imaging Modalities in Kuhn JP, Slovis TL, Haller JD (eds) : Caffey's Pediatric Diagnostic imaging, ed 10. Mosby, 2004, pp482-505
  11. Gupta AK : Hypoxic-Ischemic Encephalopathy in Berry M, Suri S, and Chouwdhry V, JP Brothers (eds) : Diagnostic Radiology : Pediatric Radiology. 1997, pp260-273
  12. Kazam E, Rudelli R, Monte W, Rubenstein WA, Ramirez de Arellano E, Kairam R, et al. : Sonographic diagnosis of cisternal subarachnoid hemorrhage in the premature infant. AJNR Am J Neuroradiol 15 : 1009-1020, 1994
  13. Laura RM, Keller SM : Intraventricular Hemorrhage of preterm neonate in Kenneth FS, Stephan A : Pediatric Neurology, ed 3. Mosby, 1999, Vol 1, pp205-219
  14. Mack LA, Wright K, Hirsh JH, Alvord EC, Guthrie RD, Shuman WP, et al. : Intracranial hemorrhage in premature infants : accuracy in sonographic evaluation. AJR Am J Roentgenol 137 : 245-250, 1981 https://doi.org/10.2214/ajr.137.2.245
  15. Ment LR, Bada HS, Barnes P, Grant PE, Hirtz D, Papile LA, et al. : Practice parameter : neuroimaging of the neonate : report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology 58 : 1726-1738, 2002 https://doi.org/10.1212/WNL.58.12.1726
  16. O'shea TM, Volberg F, Dillard RG : Reliability of interpretation of cranial ultrasound diagnosis of pathologically verified lesions in the brain of very preterm infants. Dev Med Child Neurol 35 : 457-471, 1993
  17. Perlman JM, Rollins N : Surveillance protocol for the detection of intracranial abnormalities in premature neonates. Arch Pediatr Adolesc Med 154 : 822-826, 2000 https://doi.org/10.1001/archpedi.154.8.822
  18. Patrizia V, Anna L, Valentina D, Francesca A, Giuseppe P, John CP, et al. : Intraventricular hemorrhage and periventricular leucomalacia in preterm infants. Obstet Gynecol 104 : 225-231, 2004 https://doi.org/10.1097/01.AOG.0000130838.02410.b7
  19. Rumack C, Wilson S, Charboneau W : Neonatal and Infant Brain Imaging in Rumack C, Wilson S, Chaboneau W : Diagnostic Ultrasound, ed 2. Mosby, 1997, Vol 2, Chapter 53, pp1443-1502
  20. Shah R, Gupta AK, Rehani MM, Pandey AK, Mukhopadhyay S : Effect of tube reduction on reader confidence in pediatric computed tomography. Clin Radiol 60 : 224-231, 2005 https://doi.org/10.1016/j.crad.2004.08.011
  21. Siu SLY, Kwong NS, So K : A 10-year review of intracranial haemorrhage in term neonates. HK J Pediatr 11 : 140-146, 2006
  22. Stark JE, Seibert JJ : Cerebral artery Doppler ultrasonography for the prediction of outcome after perinatal asphyxia. J Ultrasound Med 13 : 595-600, 1994 https://doi.org/10.7863/jum.1994.13.8.595
  23. Viera AJ, Garett JM : Understanding interobserver agreement : the kappa statistic. Fam Med 37 : 360-363, 2005
  24. Wycliffe ND, Thomson JR, Mcleary M, Holshouser B, Ashwal S : Pediatric Neuroimaging in Kenneth FS, Stephan A : Pediatric Neurology, ed3. Mosby, 1999, Vol 1, pp122-141

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