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Intraventricular haemorrhage and periventricular leucomalacia: ultrasound and autopsy correlation
Abstract:
The brains of 30 infants who died after at least one real time ultrasound scan were examined after fixation. The ultrasound diagnosis of either periventricular haemorrhage or periventricular leucomalacia was compared with the macroscopic and histological appearances. Each hemisphere was considered separately for both periventricular haemorrhage and periventricular leucomalacia. The accuracy of ultrasound diagnosis for periventricular haemorrhage was 88%, with sensitivity of 91% and specificity of 85%. The accuracy for periventricular leucomalacia was 90%, with sensitivity of 85% and specificity of 93%. Ultrasound was shown to diagnose the entire range of periventricular leucomalacia lesions. Three hemispheres showed the appearance of prolonged flare, and this correlated with extensive spongiosis and microcalcification of the periventricular white matter, although no macroscopic lesion was seen.
Insights
Real-time ultrasound accurately diagnoses periventricular haemorrhage and periventricular leucomalacia in infants. This neuroimaging technique shows high sensitivity and specificity for detecting these critical brain conditions in newborns.
Area of Science:
- Neonatal Neurology
- Pediatric Radiology
- Neuroimaging
Background:
- Periventricular haemorrhage (PVH) and periventricular leucomalacia (PVL) are significant causes of neurological impairment in preterm infants.
- Accurate and timely diagnosis of PVH and PVL is crucial for appropriate management and prognostication.
Purpose of the Study:
- To evaluate the diagnostic accuracy of real-time ultrasound in identifying periventricular haemorrhage and periventricular leucomalacia.
- To compare ultrasound findings with post-mortem macroscopic and histological examinations.
Main Methods:
- Post-mortem examination of 30 infant brains following at least one real-time ultrasound scan.
- Comparative analysis of ultrasound diagnoses against macroscopic and histological findings for PVH and PVL in each cerebral hemisphere.
Main Results:
- Ultrasound demonstrated 88% accuracy for periventricular haemorrhage (91% sensitivity, 85% specificity).
- Ultrasound showed 90% accuracy for periventricular leucomalacia (85% sensitivity, 93% specificity).
- Ultrasound identified the full spectrum of periventricular leucomalacia lesions, including subtle changes correlating with white matter spongiosis and microcalcification.
Conclusions:
- Real-time ultrasound is a highly accurate method for diagnosing periventricular haemorrhage and periventricular leucomalacia in infants.
- Ultrasound can detect a wide range of periventricular leucomalacia, even in the absence of visible macroscopic lesions.