Blankenberg F G, Loh N N, Bracci P, D'Arceuil H E, Rhine W D, Norbash A M, Lane B, Berg A, Person B, Coutant M, Enzmann D R
Department of Radiology, Stanford University School of Medicine, CA 94305, USA.
AJNR Am J Neuroradiol. 2000 Jan;21(1):213-8.
Sonography, CT, and MR imaging are commonly used to screen for neonatal intracranial ischemia and hemorrhage, yet few studies have attempted to determine which imaging technique is best suited for this purpose. The goals of this study were to compare sonography with CT and MR imaging prospectively for the detection of intracranial ischemia or hemorrhage and to determine the prognostic value(s) of neuroimaging in neonates suspected of having hypoxic-ischemic injury (HII).
Forty-seven neonates underwent CT (n = 26) or MR imaging (n = 24) or both (n = 3) within the first month of life for suspected HII. Sonography was performed according to research protocol within an average of 14.4 +/- 9.6 hours of CT or MR imaging. A kappa analysis of interobserver agreement was conducted using three independent observers. Infants underwent neurodevelopmental assessment at ages 2 months (n = 47) and 2 years (n = 26).
CT and MR imaging had significantly higher interobserver agreement (P < .001) for cortical HII and germinal matrix hemorrhage (GMH) (Grades I and II) compared with sonography. MR imaging and CT revealed 25 instances of HII compared with 13 identified by sonography. MR imaging and CT also revealed 10 instances of intraparenchymal hemorrhage (>1 cm, including Grade IV GMH) compared with sonography, which depicted five. The negative predictive values of neuroimaging, irrespective of technique used, were 53.3% and 58.8% at the 2-month and 2-year follow-up examinations, respectively.
CT and MR imaging have significantly better interobserver agreement for cortical HII and GMH/intraventricular hemorrhage and can reveal more instances of intraparenchymal hemorrhage compared with sonography. The absence of neuroimaging findings on sonograms, CT scans, or MR images does not rule out later neurologic dysfunction.
超声检查、CT和磁共振成像（MR成像）常用于筛查新生儿颅内缺血和出血，但很少有研究试图确定哪种成像技术最适合此目的。本研究的目的是前瞻性地比较超声检查与CT和MR成像在检测颅内缺血或出血方面的效果，并确定神经影像学检查对怀疑有缺氧缺血性损伤（HII）的新生儿的预后价值。
47例新生儿因怀疑有HII在出生后第一个月内接受了CT检查（n = 26）或MR成像检查（n = 24）或两者都接受了检查（n = 3）。超声检查按照研究方案在CT或MR成像平均14.4 +/- 9.6小时内进行。由三名独立观察者进行观察者间一致性的kappa分析。婴儿在2个月（n = 47）和2岁（n = 26）时接受神经发育评估。
与超声检查相比，CT和MR成像在皮质HII和生发基质出血（GMH，I级和II级）方面观察者间一致性显著更高（P <.001）。MR成像和CT发现25例HII，而超声检查发现13例。MR成像和CT还发现10例脑实质内出血（>1 cm，包括IV级GMH），而超声检查仅显示5例。无论使用何种技术，神经影像学检查在2个月和2年随访检查时的阴性预测值分别为53.3%和58.8%。
与超声检查相比，CT和MR成像在皮质HII和GMH/脑室内出血方面观察者间一致性明显更好，并且能发现更多脑实质内出血的病例。超声检查、CT扫描或MR图像上未发现神经影像学异常并不能排除后期出现神经功能障碍。
