Screening Cranial Imaging at Multiple Time Points Improves Cystic Periventricular Leukomalacia Detection

Abstract

Objective The aim of this study is to determine whether the cystic periventricular leukomalacia (cPVL) detection rate differs between imaging studies performed at different time points.

Design We retrospectively reviewed the prospectively collected data of 31,708 infants from the NICHD Neonatal Research Network. Inclusion criteria were infants < 1,000 g birth weight or < 29 weeks' gestational age who had cranial imaging performed using both early criterion (cranial ultrasound [CUS] < 28 days chronological age) and late criterion (CUS, magnetic resonance imaging, or computed tomography closest to 36 weeks postmenstrual age [PMA]). We compared the frequency of cPVL diagnosed by early and late criteria.

Results About 664 (5.2%) of the 12,739 infants who met inclusion criteria had cPVL using either early or late criteria; 569 using the late criterion, 250 using the early criterion, and 155 patients at both times. About 95 (14.3%) of 664 cPVL cases seen on early imaging were no longer visible on repeat screening closest to 36 weeks PMA. Such disappearance of cPVL was more common in infants < 26 weeks' gestation versus infants of 26 to 28 weeks' gestation (18.5 vs. 11.5%; p = 0.013).

Conclusions Cranial imaging at both < 28 days chronological age and closest to 36 weeks PMA improves cPVL detection, especially for more premature infants.

Keywords

cystic periventricular leukomalacia - screening cranial imaging - extremely low birth weight preterm infants

• References

• 1 Ment LR, Bada HS, Barnes P , 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 2002; 58 (12) 1726-1738
• 2 Canadian Paediatric Society. Routine screening cranial ultrasound examinations for the prediction of long term neurodevelopmental outcomes in preterm infants. Paediatr Child Health (Oxford) 2001; 6 (1) 39-52
• 3 Trounce JQ, Fagan D, Levene MI. Intraventricular haemorrhage and periventricular leucomalacia: ultrasound and autopsy correlation. Arch Dis Child 1986; 61 (12) 1203-1207
• 4 Bejar R, Coen RW, Merritt TA , et al. Focal necrosis of the white matter (periventricular leukomalacia): sonographic, pathologic, and electroencephalographic features. AJNR Am J Neuroradiol 1986; 7 (6) 1073-1079
• 5 Bass WT. Periventricular leukomalacia. Neoreviews 2011; 12: e76-e84
• 6 Bass WT, Jones MA, White LE, Montgomery TR, Aiello III F, Karlowicz MG. Ultrasonographic differential diagnosis and neurodevelopmental outcome of cerebral white matter lesions in premature infants. J Perinatol 1999; 19 (5) 330-336
• 7 Piecuch RE, Leonard CH, Cooper BA, Sehring SA. Outcome of extremely low birth weight infants (500 to 999 grams) over a 12-year period. Pediatrics 1997; 100 (4) 633-639
• 8 Pinto-Martin JA, Riolo S, Cnaan A, Holzman C, Susser MW, Paneth N. Cranial ultrasound prediction of disabling and nondisabling cerebral palsy at age two in a low birth weight population. Pediatrics 1995; 95 (2) 249-254
• 9 De Vries LS, Van Haastert IL, Rademaker KJ, Koopman C, Groenendaal F. Ultrasound abnormalities preceding cerebral palsy in high-risk preterm infants. J Pediatr 2004; 144 (6) 815-820
• 10 Perlman JM, Rollins N. Surveillance protocol for the detection of intracranial abnormalities in premature neonates. Arch Pediatr Adolesc Med 2000; 154 (8) 822-826
• 11 McCrea HJ, Ment LR. The diagnosis, management, and postnatal prevention of intraventricular hemorrhage in the preterm neonate. Clin Perinatol 2008; 35 (4) 777-792 , vii
• 12 Burdjalov V, Srinivasan P, Baumgart S, Spitzer AR. Handheld, portable ultrasound in the neonatal intensive care nursery: a new, inexpensive tool for the rapid diagnosis of common neonatal problems. J Perinatol 2002; 22 (6) 478-483
• 13 Dubowitz LMS, Bydder GM, Mushin J. Developmental sequence of periventricular leukomalacia. Correlation of ultrasound, clinical, and nuclear magnetic resonance functions. Arch Dis Child 1985; 60 (4) 349-355
• 14 Shankaran S, Langer JC, Kazzi SN, Laptook AR, Walsh M ; National Institute of Child Health and Human Development Neonatal Research Network. Cumulative index of exposure to hypocarbia and hyperoxia as risk factors for periventricular leukomalacia in low birth weight infants. Pediatrics 2006; 118 (4) 1654-1659
• 15 de Vries LS, Benders MJ, Groenendaal F. Imaging the premature brain: ultrasound or MRI?. Neuroradiology 2013; 55 (Suppl. 02) 13-22
• 16 Pierrat V, Duquennoy C, van Haastert IC, Ernst M, Guilley N, de Vries LS. Ultrasound diagnosis and neurodevelopmental outcome of localised and extensive cystic periventricular leucomalacia. Arch Dis Child Fetal Neonatal Ed 2001; 84 (3) F151-F156
• 17 Hayakawa F, Okumura A, Kato T, Kuno K, Watanabe K. Determination of timing of brain injury in preterm infants with periventricular leukomalacia with serial neonatal electroencephalography. Pediatrics 1999; 104 (5 Pt 1) 1077-1081
• 18 Ito T, Hashimoto K, Kadowaki K , et al. Ultrasonographic findings in the periventricular region in premature newborns with antenatal periventricular leukomalacia. J Perinat Med 1997; 25 (2) 180-183
• 19 DeVries LS, Eken P, Dubowitz LMS. The spectrum of leucomalacia using cranial ultrasound. Behav Brain Res 1992; 49 (1) 1-6
• 20 Volpe JJ. Cerebral white matter injury of the premature infant-more common than you think. Pediatrics 2003; 112 (1 Pt 1) 176-180
• 21 Khwaja O, Volpe JJ. Pathogenesis of cerebral white matter injury of prematurity. Arch Dis Child Fetal Neonatal Ed 2008; 93 (2) F153-F161
• 22 Maalouf EF, Duggan PJ, Counsell SJ , et al. Comparison of findings on cranial ultrasound and magnetic resonance imaging in preterm infants. Pediatrics 2001; 107 (4) 719-727
• 23 Dyet LE, Kennea N, Counsell SJ , et al. Natural history of brain lesions in extremely preterm infants studied with serial magnetic resonance imaging from birth and neurodevelopmental assessment. Pediatrics 2006; 118 (2) 536-548
• 24 Hintz SR, Slovis T, Bulas D , et al; NICHD Neonatal Research Network. Interobserver reliability and accuracy of cranial ultrasound scanning interpretation in premature infants. J Pediatr 2007; 150 (6) 592-596 , 596.e1–596.e5