Published online October 1, 2004
PEDIATRICS Vol. 114 No. 4 October 2004, pp. 992-998 (doi:10.1542/10.1542/peds.2003-0772-L)
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Neonatal Brain Magnetic Resonance Imaging Before Discharge Is Better Than Serial Cranial Ultrasound in Predicting Cerebral Palsy in Very Low Birth Weight Preterm Infants

Majid Mirmiran, MD, PhD*,{ddagger}, Patrick D. Barnes, MD§, Kathy Keller, MD§, Janet C. Constantinou, PhD*, Barry E. Fleisher, MD*, Susan R. Hintz, MD* and Ronald L. Ariagno, MD*

* Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Palo Alto, California
{ddagger} Netherlands Institute for Brain Research, Amsterdam, Netherlands
§ Department of Radiology, Stanford University School of Medicine, Palo Alto, California

Objective. To compare the value of serial cranial ultrasound (US) with a single magnetic resonance imaging (MRI) before discharge in very low birth weight preterm infants to predict cerebral palsy (CP).

Methods. Infants who weighed <1250 g at birth and were <30 weeks' gestational age underwent conventional brain MRI at near term (36–40 weeks' postmenstrual age) using 1.5 Tesla MRI scanner. Sagittal and axial T1 and T2 fluid attenuated inversion recovery and gradient recalled echo images were obtained. Cranial US was also obtained at least twice during the first 2 weeks of life. MRI and US images were interpreted by 2 independent radiologists, who were masked to clinical outcome, and scored as follows: category 1, no abnormality; category 2, subependymal hemorrhage or mineralization; category 3, moderate to severe ventriculomegaly; category 4, focal parenchymal abnormality with or without ventriculomegaly. For the purpose of this study, 1 and 2 were categorized as "normal," and 3 and 4 were categorized as "abnormal." The infants were assessed at a mean age of 20 and 31 months using the Amiel-Tison standardized neurodevelopmental examination.

Results. The sensitivity and specificity of MRI for predicting CP were 71% and 91% at 20 month and 86% and 89% at 31 months, respectively. The sensitivity and specificity of US for predicting CP were 29% and 86% at 20 months and 43% and 82% at 31 months.

Conclusions. As a predictor of outcome for CP, MRI at near-term in very low birth weight preterm neonates is superior to US. However, both US and MRI demonstrate high specificity.

Key Words: magnetic resonance imaging • ultrasound • preterm infant • brain injury • cerebral palsy

Abbreviations: VLBW, very low birth weight • CP, cerebral palsy • PVL, periventricular leukomalacia • US, ultrasound • MRI, magnetic resonance imaging • GA, gestational age • TR, repetition time • TE, echo time • NEX, number of excitations • FOV, field of view • GRE, gradient recalled echo • IVH, intraventricular hemorrhage • C, category • DTI, diffusion tensor magnetic resonance imaging

Accepted Jan 28, 2004.


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eLetters:

Read all eLetters

Is MRI really better than cranial ultrasound for predicting cerebral palsy in preterm infants?
Linda de Vries, et al.
Pediatrics Online, 27 Oct 2004 [Full text]
MRI is better than cranial ultrasound for predicting cerebral palsy in preterm infants
Majid Mirmiran, et al.
Pediatrics Online, 29 Oct 2004 [Full text]