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Posterior fossa abnormalities in high-risk term infants: comparison of ultrasound and MRI

S J Steggerda1, F T de Bruïne, V E H J Smits-Wintjens

  • 1Department of Neonatology, Leiden University Medical Centre, Leiden, The Netherlands, s.j.steggerda@lumc.nl.

European Radiology
|April 23, 2015
PubMed

Insights

Posterior fossa abnormalities are common in high-risk newborns. Adding mastoid fontanelle views to cranial ultrasound (CUS) significantly improves detection of these abnormalities, aiding early diagnosis.

Area of Science:

  • Neonatal Neurology
  • Pediatric Radiology
  • Neuroimaging

Background:

  • Posterior fossa (PF) abnormalities present diagnostic challenges in high-risk term neonates.
  • Cranial ultrasound (CUS) is a primary imaging modality, but its efficacy for PF assessment can be limited.

Purpose of the Study:

  • To evaluate the characteristics of PF abnormalities in high-risk term neonates.
  • To determine the diagnostic performance of CUS, with and without mastoid fontanelle (MF) views, for detecting PF abnormalities compared to MRI.

Main Methods:

  • Retrospective analysis of 113 term neonates who underwent both CUS and MRI.
  • Calculation of sensitivity, specificity, and predictive values for routine CUS and CUS with MF views.

Main Results:

  • PF abnormalities were identified in 46/113 infants by CUS, with MRI confirming 43 and revealing additional findings in 32.
  • Routine CUS had low sensitivity (16%) for major PF abnormalities, while adding MF views increased sensitivity to 82%.
  • MF views detected 57% of all PF abnormalities (major/minor) with 95% specificity; however, acute hypoxic-ischemic injury and small hemorrhages were often missed by CUS.

Conclusions:

  • PF abnormalities are frequent in high-risk term infants.
  • Incorporating MF views into CUS enhances the detection of clinically significant PF abnormalities.
  • MRI remains superior for identifying hypoxic-ischemic injury and small posterior fossa hemorrhages.
Abstract

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