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

Area of Science:

• Neonatal neurology
• Pediatric neuroimaging
• Perinatal medicine

Background:

• Cystic periventricular leukomalacia (cPVL) is a significant cause of neurological impairment in preterm infants.
• Early detection of cPVL is crucial for timely intervention and management.
• Current imaging protocols may vary in their ability to detect cPVL at different developmental stages.

Purpose of the Study:

• To compare the detection rates of cPVL using cranial imaging at different time points in high-risk infants.
• To evaluate the efficacy of early ( < 28 days) versus late ( ~ 36 weeks postmenstrual age) imaging for cPVL diagnosis.
• To determine if combining early and late imaging improves overall cPVL detection.

Main Methods:

• Retrospective review of prospectively collected data from 31,708 infants in the NICHD Neonatal Research Network.
• Inclusion criteria: infants < 1,000g birth weight or < 29 weeks gestational age.
• Comparison of cPVL diagnosis using early cranial ultrasound (CUS) (< 28 days) and late imaging (CUS, MRI, or CT closest to 36 weeks postmenstrual age [PMA]).

Main Results:

• Of 12,739 eligible infants, 664 (5.2%) had cPVL detected by either early or late imaging.
• Late imaging identified 569 cases, early imaging identified 250 cases, and 155 cases were detected by both.
• cPVL detected on early imaging was not visible on late imaging in 14.3% of cases, more common in infants < 26 weeks gestation (18.5% vs 11.5%).

Conclusions:

• Serial cranial imaging, including assessments at < 28 days and ~ 36 weeks PMA, significantly improves the detection of cPVL.
• This dual-imaging approach is particularly beneficial for identifying cPVL in extremely premature infants.
• Optimizing imaging timing enhances diagnostic accuracy for cPVL in vulnerable neonatal populations.