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Evolution of periventricular leukomalacia during the neonatal period and infancy: correlation of imaging and
L S De Vries1, J S Wigglesworth, R Regev
1Department of Paediatrics and Neonatal Medicine, Royal Postgraduate Medical School, Hammersmith Hospital, London, U.K.
Insights
Cranial ultrasound accurately detects periventricular leukomalacia (PVL) in infants. While ultrasound lesions may resolve, pathological examination reveals lasting effects like glial scarring and impaired myelination.
Area of Science:
- Neonatal Neurology
- Pediatric Radiology
- Neuropathology
Background:
- Periventricular leukomalacia (PVL) is a significant cause of neurological morbidity in preterm infants.
- Accurate diagnosis of PVL is crucial for timely intervention and management.
- Cranial ultrasound is a widely used imaging modality for neonatal brain assessment.
Purpose of the Study:
- To evaluate the diagnostic accuracy of cranial ultrasound for periventricular leukomalacia (PVL).
- To correlate ultrasound findings with postmortem neuropathology to establish the natural history of PVL.
- To assess the long-term sequelae of PVL despite apparent resolution on ultrasound.
Main Methods:
- Retrospective analysis of cranial ultrasound studies in 68 infants over 4 years, with subsequent necropsy.
- Correlation of in-life ultrasound diagnoses with postmortem findings in 18 infants with PVL.
- Sequential ultrasound studies in 11 infants were compared with postmortem data to track PVL evolution.
Main Results:
- Cranial ultrasound demonstrated 91% accuracy, 72% sensitivity, and 98% specificity for PVL diagnosis.
- Early PVL showed small hemorrhages on postmortem in infants dying within 7 days.
- Cystic lesions were observed in life and postmortem, with resolution on ultrasound in long-term survivors, but pathological changes persisted.
Conclusions:
- Cranial ultrasound is a reliable tool for diagnosing PVL in infants.
- Ultrasound-detected PVL lesions can resolve over time, but underlying neuropathological changes like glial scarring and impaired myelination persist.
- Understanding the natural history of PVL is essential for interpreting imaging findings and predicting long-term outcomes.
Abstract:
Eighteen of 68 infants born over a 4-year period who had cranial ultrasound studies and later came to necropsy were found to have periventricular leukomalacia (PVL). Thirteen were diagnosed in life and there was one false positive diagnosis giving an accuracy of 91%, sensitivity of 72% and specificity of 98%. In 11 infants with sequential studies, who died at ages from 43 h to 3 years, the ultrasound findings were correlated with those at postmortem to establish the natural history of the condition. In infants who died within 7 days following the onset of the ultrasound changes, postmortem revealed early PVL without cysts: there were small haemorrhages into the affected areas in three of the four cases. In the five infants who died between 10 days and 9 weeks, cystic lesions were identified in life and at postmortem, but in two long-term survivors cysts resolved on ultrasound at 3-4 months of age. Correlation of ultrasound with postmortem findings demonstrated that, although the ultrasound lesions resolve, glial scarring and impaired myelination can still be demonstrated on careful pathological examination.