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Updated: May 11, 2026
State of the Art Cranial Ultrasound Imaging in Neonates
Published on: February 2, 2015
Cerebral volume at term age: comparison between preterm and term-born infants using cranial ultrasound
Andre M Graca1, Katia Regina Viegas Cardoso, João Manuel Franco Pereira da Costa
1Serviço de Neonatologia - Departamento de Pediatria, Hospital de Santa Maria/Centro Académico de Medicina de Lisboa, Lisboa, Portugal. graca.am@gmail.com
Insights
Very preterm infants without major brain lesions still show compromised brain growth. This new 3D ultrasound model helps identify smaller brain volumes in these infants, potentially predicting neurodevelopmental outcomes.
Area of Science:
- Neonatal neuroimaging
- Pediatric neurodevelopment
- Medical ultrasound technology
Background:
- Very preterm infants face high neurodevelopmental impairment risks.
- Cerebral ultrasound (cUS) can detect major lesions, but many preterm infants with poor outcomes lack these lesions.
- Understanding brain growth in preterm infants without major lesions is crucial.
Purpose of the Study:
- To present a 3D cUS model for measuring cranial and brain volumes.
- To compare brain volumes in preterm infants (without major lesions) at term equivalent age (TEA) with term-born controls.
- To assess the influence of gestational age (GA) and small for gestational age (SGA) status on brain size.
Main Methods:
- A cohort of very preterm infants and term-born controls were scanned at TEA.
- Infants with major cerebral lesions were excluded from the study.
- A mathematical model estimated cranial and brain volumes from cUS measurements of intracranial diameters and brain structures.
Main Results:
- Preterm infants had longer, narrower, and taller heads than controls.
- Estimated intracranial volume was similar, but preterms had larger extracerebral space and ventricles.
- Preterm infants exhibited smaller estimated cerebral volumes compared to controls, associated with lower GA and SGA status.
Conclusions:
- A novel 3D cUS model accurately measures cranial and brain volumes.
- Even without major lesions, very preterm infants show reduced extrauterine cerebral growth.
- This model aids in identifying preterm infants with smaller brains, enabling future neurodevelopmental outcome correlation.
Background And Aims:
Very preterm infants are at particular risk of neurodevelopmental impairments. This risk can be anticipated when major lesions are seen on cerebral ultrasound (cUS). However, most preterm infants do not have such lesions yet many have a relatively poor outcome. Our study aims were to describe a tri-dimensional cUS model for measuring cranial and brain volume and to determine the range of brain volumes found in preterm infants without major cUS lesions at term equivalent age (TEA) compared to term-born control infants. We also aimed to evaluate whether gestational age (GA) at birth or being small for gestational age (SGA) influenced estimated brain size.
Methods:
We scanned a cohort of very preterm infants at TEA and term-born controls. Infants with major cerebral lesions were excluded. Measurements of intracranial diameters (bi-parietal, longitudinal, cranial height), brain structures, ventricles and extracerebral space (ECS) were made. A mathematical model was built to estimate from the cUS measurements the axial area and volumes of the cranium and brain. Appropriate statistical methods were used for comparisons; a p-value under 0.05 was considered significant. SGA infants from both groups were analysed separately.
Results:
We assessed 128 infants (72 preterms and 56 controls). The preterms' head was longer (11.5 vs. 10.5 cm, p < 0.001), narrower (7.8 vs. 8.4 cm, p < 0.001) and taller (8.9 vs. 8.6 cm, p < 0.01) than the controls'. Estimated intracranial volume was not statistically different between the groups (411 vs. 399 cm(3), NS), but preterms had larger estimated ECS volume (70 vs. 22 cm(3), p < 0.001), lateral ventricular coronal areas (33 vs. 12 mm(2), p < 0.001) and thalamo-occipital distances (20 vs. 16 mm, p < 0.001), but smaller estimated cerebral volume (340 vs. 377 cm(3), p < 0.001). Smaller brain volumes were associated with being of lower gestational age and birth weight and being small-for-gestational age.
Conclusions:
We have developed a model using cranial ultrasound for measuring cranial and brain volumes. Using this model our data suggest that even in the absence of major cerebral lesions, the average extrauterine cerebral growth of very preterm infants is compromised. Our model can help in identifying those preterm infants with smaller brains. Later follow-up data will determine the neurodevelopmental outcome of these preterm infants in relation to their estimated brain volumes.
