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AJNR - American Journal of Neuroradiology

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American Journal of Neuroradiology 21:213-218 (1 2000)
© 2000 American Society of Neuroradiology

ARTICLE

Sonography, CT, and MR Imaging: A Prospective Comparison of Neonates with Suspected Intracranial Ischemia and Hemorrhage

Francis G. Blankenberg^,a, Nyu-Nyu Loh^a, Paige Bracci^a, Helen E. D'Arceuil^a, William D. Rhine^a, Alexander M. Norbash^a, Barton Lane^a, Angela Berg^a, Brenda Person^a, Michelle Coutant^a and Dieter R. Enzmann^a

^a From the Department of Radiology (F.G.B., N.-N.L., H.E.D., A.M.N., B.L., D.R.E.), Stanford University School of Medicine, Stanford, the Department of Epidemiology and Biostatistics (P.B.), Cancer Epidemiology Studies, San Francisco, and the Departments of Pediatrics, Neonatal Medicine (W.D.R.) and Pediatric Radiology (A.B., B.P., M.C.), Lucile Salter Packard Children's Hospital, Palo Alto, CA.

BACKGROUND AND PURPOSE: Sonography, CT, and MR imaging are commonly used to screen for neonatal intracranial ischemia and hemorrhage, yet few studies have attempted to determine which imaging technique is best suited for this purpose. The goals of this study were to compare sonography with CT and MR imaging prospectively for the detection of intracranial ischemia or hemorrhage and to determine the prognostic value(s) of neuroimaging in neonates suspected of having hypoxic-ischemic injury (HII).

METHODS: Forty-seven neonates underwent CT (n = 26) or MR imaging (n = 24) or both (n = 3) within the first month of life for suspected HII. Sonography was performed according to research protocol within an average of 14.4 ± 9.6 hours of CT or MR imaging. A kappa analysis of interobserver agreement was conducted using three independent observers. Infants underwent neurodevelopmental assessment at ages 2 months (n = 47) and 2 years (n = 26).

RESULTS: CT and MR imaging had significantly higher interobserver agreement (P < .001) for cortical HII and germinal matrix hemorrhage (GMH) (Grades I and II) compared with sonography. MR imaging and CT revealed 25 instances of HII compared with 13 identified by sonography. MR imaging and CT also revealed 10 instances of intraparenchymal hemorrhage (>1 cm, including Grade IV GMH) compared with sonography, which depicted five. The negative predictive values of neuroimaging, irrespective of technique used, were 53.3% and 58.8% at the 2-month and 2-year follow-up examinations, respectively.

CONCLUSION: CT and MR imaging have significantly better interobserver agreement for cortical HII and GMH/intraventricular hemorrhage and can reveal more instances of intraparenchymal hemorrhage compared with sonography. The absence of neuroimaging findings on sonograms, CT scans, or MR images does not rule out later neurologic dysfunction.

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