Article Figures & Data
Figures
- Fig 1.
Minimal white matter injury shown on ultrasonograms and MR images of premature neonate born 31.1 weeks after conception and studied at 32.9 weeks postconceptional age.
A, Coronal view transfontanel ultrasonograms show diffuse foci of mildly increased echogenicity (less than that of the choroid plexus) in addition to irregularity of the lateral borders of the periventricular white matter (arrowheads).
B, Corresponding MR images (spoiled gradient-echo volumetric images) show a few small foci of T1 hyperintensity in the absence of marked T2 hypointensity, which were thought to represent astrogliosis in the periventricular white matter without cavitation (arrow). The abnormalities shown by MR imaging and ultrasonography are not anatomically concordant, although both were graded as minimal white matter abnormalities.
- Fig 2.
Images show moderate to severe white matter injury in a premature neonate born 29.1 weeks after conception and studied at 32 weeks postconceptional age
A, Coronal view transfontanel ultrasonogram shows small areas of hypoechogenicity in the periventricular white matter, indicating small areas of cavitation, in addition to pronounced ventriculomegaly (arrowhead).
B and C, Corresponding MR images (spoiled gradient-echo volumetric images) show small areas of T1 hypointensity, indicating cavitation in the periventricular white matter (B, arrow), in addition to multiple small foci of T1 hyperintensity in the absence of marked T2 hypointensity, which were thought to represent astrogliosis in the periventricular white matter (C, arrow). The degree of ventriculomegaly is similar on the ultrasonogram and MR images. Note that the areas of T1 hyperintensity are more extensive than the small cystic lesions evident on the ultrasonogram or MR images.
Tables
Description of White Matter Abnormalities Ultrasonography Grade 1 Small foci of abnormal echogenicity less echogenic than choroid plexus Grade 2 Diffuse foci of increased echogenicity less than the choroid plexus or irregularity of the lateral borders of the periventricular white matter (junction of the normal halo and surrounding cortex) Grade 3 Focal areas of abnormal echogenicity greater than or equal to the echogenicity of the choroid plexus Grade 4 Diffuse increased echogenicity greater than or equal to the echogenicity of the choroid plexus Grade 5 Periventricular cysts (cavitation) defined as anechoic regions with increased through transmission MR imaging Normal No periventricular white matter abnormalities Minimal white matter abnormality Three or fewer areas of T1 signal abnormalities measuring <2 mm Moderate white matter abnormality Three areas of T1 signal abnormalities or areas measuring >2 mm but <5% of the hemisphere involved* Severe white matter abnormality T1 signal abnormalities involving >5% of the hemisphere * Percent of hemisphere involved estimated by visual inspection.
- TABLE 2:
Clinical characteristics of the MR imaging defined white matter abnormality groups
Normal n (%) Minimal WMA n (%) Moderate WMA n (%) P No. 14 10 8 Postconceptional age at birth .9 >24–26 weeks 3 (21) 1 (10) 1 (13) >26–28 weeks 3 (21) 2 (20) 2 (25) >28–30 weeks 6 (43) 4 (40) 2 (25) >30 weeks 2 (14) 3 (30) 3 (37) Male gender 3 (21) 7 (70) 6 (75) .02 Birth weight [median (range)] 1187 (485–1615) 1102 (650–1600) 1075 (630–1830) .9 Assisted delivery* 6 (43) 3 (30) 5 (63) .4 5-min Apgar score [median (range)] 7 (1–9) 7 (1–10) 4.5 (0–7) .3 Prenatal betamethasone 10 (71) 5 (50) 6 (75) .5 Chorioamnionitis 1 (7) 0 0 1.0 Chronic lung disease 7 (50) 3 (30) 3 (38) .9 Note.—WMA indicates white matter abnormality.
* Cesarean section or vacuum extraction.
- TABLE 3:
Highest grade of periventricular echogenicity and the grade of periventricular echogenicity shown on the last neonatal sonogram in the MR imaging-defined white matter abnormality groups
Normal (n=14) n (%) Minimal WMA (n=10) n (%) Moderate WMA (n=8) n (%) Highest Grade Last Study Highest Grade Last Study Highest Grade Last Study Grade periventricular Echogenicity None 4 (29) 13 (93) 5 (50) 6 (60) 1 (13) 7 (87) Grade 1 3 (21) 1 (7) 2 (20) 3 (30) 2 (25) 0 Grade 2 7 (50) 0 2 (20) 1 (10) 2 (25) 0 Grade 3 0 0 1 (10) 0 2 (25) 1 (13) Grade 5 0 0 0 0 1 (13) 0 Duration periventricular Echogenicity (if present) Transient 3 (30) 0 2 (29) Persistent 6 (60) 3 (60) 5 (71) Uncertain 1 (10) 2 (40) 0 Note.—WMA indicates white matter abnormality.
- TABLE 4:
Highest grade of intraventricular hemorrhage, ventriculomegaly, and thalamic echogenicity in the MR imaging-defined white matter abnormality groups
Normal (n=14) Minimal WMA (n=10) Moderate WMA (n = 8) P US MR imaging US MR imaging US MR imaging Intraventricular Hemorrhage .2 Grade 1 6 (43%) 5 (36%) 4 (40%) 2 (20%) 1 (13%) 1 (13%) Grade 2 1 (7%) 0 0 0 2 (25%) 1 (13%) Grade 3 0 0 1 (10%) 1 (10%) 2 (25%) 3 (38%) Ventriculomegaly .02 Borderline (8–10 mm) 1 (7%) 0 1 (10%) 1 (10%) 0 0 Definite (>10 mm) 0 0 1 (10%) 0 4 (50%) 4 (50%) Thalamic echogenicity 1 (7%) 0 1 (10%) 0 0 0 1.0 Note.—WMA indicates white matter abnormality; US, ultrasonography.
- TABLE 5:
Periventricular echogenicity and ventriculomegaly shown on sonograms as predictors of MR imaging-defined white matter abnormalities*
Relative Risk of WMA (95% CI) Sensitivity % Specificity % Positive Predictive Value % Negative Predictive Value % Minimal to moderate WMA Periventricular echogenicity 0.9 44 50 53 41 Grade 2–5 on any sonogram (0.5–1.7) P value .8 Periventricular echogenicity 2.0 22 100 100 50 Grade 3–5 on any sonogram (1.4–2.9) P value .06 Moderate WMA only Periventricular echogenicity .9 38 58 23 74 Grade 2–5 on any sonogram (0.3–3.0) P value .8 Periventricular echogenicity 4.2 38 96 75 82 Grade 3–5 on any sonogram (1.6–11.1) P value .04 Definite ventriculomegaly on any sonogram 2.1 28 100 100 52 (1.4–3.1) P valuey .05 * Ultrasonography is compared with MR imaging in the absence of an in vivo gold standard of brain injury in the newborn.
Note.—WMA indicates white matter abnormality; CI, confidence interval.
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