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Correlation between neuroimaging and neurological outcome in periventricular leukomalacia: diagnostic criteria
K Hashimoto1, H Hasegawa, Y Kida
1Division of Neonatal Medicine, Matsudo City Hospital, Matsudo, Chiba, Japan. hasikazu@hotmail.com
Insights
Diagnosing periventricular leukomalacia (PVL) in preterm infants requires multiple neuroimaging techniques. Combining ultrasonography, CT, and MRI provides accurate PVL diagnosis and aids in understanding risk factors.
Area of Science:
- Neonatal neurology
- Pediatric neuroimaging
Background:
- Periventricular leukomalacia (PVL) is a primary cause of cerebral palsy in premature infants.
- Early and accurate diagnosis of PVL is critical for timely intervention.
Purpose of the Study:
- To establish reliable neuroimaging criteria for diagnosing periventricular leukomalacia (PVL) in preterm infants.
- To improve the understanding of PVL occurrence rates and associated clinical risk factors.
Main Methods:
- Investigated 747 preterm infants (<36 weeks gestation) using serial cranial ultrasonography and computed tomography (CT) scans.
- Followed clinical course for over 3 years, with magnetic resonance imaging (MRI) at 12-18 months corrected age.
- Correlated early neuroimaging findings with later clinical outcomes.
Main Results:
- Single early imaging examinations were insufficient for PVL diagnosis.
- Combined ultrasonography, CT, and MRI enabled definitive clinical diagnosis of PVL.
- Ultrasonographic findings of cystic PVL and prolonged periventricular echogenicity (PVE 2 or PVE 3) over 3 weeks, confirmed by MRI after 11 months corrected age, predicted clinical PVL.
Conclusions:
- Neuroimaging criteria were developed to aid in the diagnosis of PVL.
- Established criteria may facilitate accurate determination of PVL incidence and clinical risk factors.
Background:
Periventricular leukomalacia (PVL) is the most important factor in cerebral palsy in preterm infants.
Methods:
In the present study, we investigated 747 preterm infants of less than 36 weeks gestation who were repeatedly examined by cranial ultrasonography and computed tomography (CT) scanning at around 40 weeks of corrected post-menstrual age. The clinical course of these infants was followed for more than 3 years and they were examined by magnetic resonance imaging (MRI) between 12 and 18 months of age.
Results:
Single examinations in early infancy were not sufficient to diagnose PVL, but the combination of ultrasonography, CT and MRI examinations allowed the clinical diagnosis of PVL. In preterm infants, clinical PVL could be predicted from cystic PVL and periventricular echogenicity (PVE) 3 or PVE 2 prolonged over 3 weeks on ultrasonography and confirmed by MRI after 11 months of corrected age.
Conclusions:
We tried to determine diagnostic criteria for PVL by neuroimaging. Such criteria from neuroimaging for PVL may be useful for determining the exact occurrence rate of and clinical risk factors for PVL.