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Updated: May 29, 2026
State of the Art Cranial Ultrasound Imaging in Neonates
Published on: February 2, 2015
Ultrasound detection of white matter injury in very preterm neonates: practical implications
Gerda van Wezel-Meijler1, Francisca T De Bruïne, Sylke J Steggerda
1Department of Paediatrics, Subdivision of Neonatology, Leiden University Medical Center, Leiden, The Netherlands. G.van_Wezel-Meijler@lumc.nl
Insights
Cranial ultrasonography (CUS) can predict white matter injury in preterm infants, especially with findings like peri-intraventricular hemorrhage (P/IVH). Absence of CUS abnormalities suggests a favorable neurological outcome.
Area of Science:
- Neonatal neurology
- Pediatric neuroimaging
Background:
- Diffuse white matter injury in preterm neonates is often undetected by cranial ultrasonography (CUS).
- Accurate early detection is crucial for predicting neurological outcomes.
Purpose of the Study:
- To evaluate the predictive value of CUS abnormalities for MRI-defined white matter injury and neurological outcomes in very preterm neonates.
- To optimize CUS strategies for detecting white matter injury.
Main Methods:
- Serial CUS and single MRI were performed on 67 very preterm neonates.
- Predictive values of CUS findings for MRI white matter classification and neurological outcomes at 2 years corrected age were calculated.
- The impact of CUS timing and frequency was assessed.
Main Results:
- Periventricular echodensities (PVEs) indicated potential white matter abnormalities on MRI, but their absence did not rule out injury.
- Peri-intraventricular hemorrhage (P/IVH) strongly predicted abnormal white matter on MRI.
- P/IVH and abnormal ventricular size/shape predicted unfavorable outcomes, while CUS normality predicted favorable outcomes.
- CUS timing and frequency did not affect predictive values.
Conclusions:
- PVEs on CUS suggest a significant likelihood of white matter injury on MRI.
- P/IVH is a strong predictor of both white matter injury on MRI and unfavorable neurological outcomes.
- While CUS absence of PVEs and P/IVH doesn't guarantee normal white matter, it predicts a favorable outcome.
Aim:
Diffuse white matter injury is not well detected by cranial ultrasonography (CUS). The aim of this study was twofold: (1) to assess in very preterm neonates the predictive values of individual CUS abnormalities for white matter injury on MRI and neurological outcome; (2) to develop a strategy optimizing CUS detection of white matter injury.
Method:
Very preterm neonates (n=67; 44 males, 23 females) underwent serial CUS and single MRI. Predictive values of CUS findings for a white matter classification on MRI, individual MRI findings, and neurological outcome at 2 years corrected age were calculated. The effects of timing and frequency of CUS were evaluated.
Results:
Periventricular echodensities (PVEs) predicted abnormal white matter on MRI, but absence of PVEs did not predict absence of white matter changes. Peri- and intraventricular haemorrhage (P/IVH) was highly predictive of abnormal white matter on MRI. Frequency and timing of CUS did not influence predictive values. P/IVH and abnormal ventricular size/shape were reasonably predictive of unfavourable outcome, whereas absence of CUS abnormalities predicted a favorable outcome.
Interpretation:
(1) If PVEs are present, there is a significant chance of abnormal white matter on MRI. (2) Increasing frequency of CUS does not increase its diagnostic performance for white matter injury. (3) P/IVH is highly predictive of abnormal white matter on MRI and reasonably predictive of unfavourable outcome. (4) Absence of PVEs and P/IVH on CUS does not guarantee normal white matter, but predicts a favourable outcome.
