Diagnostic Accuracy of Cranial Ultrasound for the Detection of Intracranial Hemorrhage in Preterm Neonates Using Magnetic Resonance Imaging As the Gold Standard.

Background and objective Intracranial hemorrhage (ICH) and white-matter damage are the main brain injuries in preterm infants. Magnetic resonance imaging (MRI) is the best way to examine cerebral bleeding. The evidence on cranial ultrasound diagnostic accuracy in neonates is limited in Pakistani publications, which show variability in evidence, necessitating the present study. The aim is to find out the diagnostic accuracy of cranial ultrasound for detecting ICH in preterm neonates, taking MRI as the gold standard. Methodology A cross-sectional study was carried out in the Department of Radiology, The Children's Hospital, Lahore, Pakistan, from June 19, 2018 to December 18, 2018. The study involved 103 preterm neonates of both genders aged between 1 and 27 days and presenting with suspicion of ICH. The cranial ultrasound with MRI (gold standard) was used to diagnose ICH, and the results of the cranial ultrasound were assessed accordingly. The diagnostic performance of ultrasound was estimated using parameters, e.g., sensitivity, specificity, accuracy, and positive and negative predictive values. The p < 0.05 was taken as statistically significant. Results The neonates had a mean age of 9.9 ± 6.6 days. There were 53 (51.5%) male and 50 (48.5%) female neonates. The cranial ultrasound diagnosed ICH in 39 (37.9%) neonates, which is confirmed by MRI as the gold standard. Cranial ultrasound had 100.0% sensitivity, 90.62% specificity, 94.17% accuracy, 86.67% positive predictive value, and 100.0% negative predictive value for detecting ICH in preterm neonates. Similar diagnostic performance was seen across age and gender groups (p > 0.05). Conclusion Cranial ultrasound was 100% sensitive, 90.6% specific, and 94.2% accurate in identifying cerebral bleeding in preterm neonates. The noninvasive, ionizing radiation-free nature and availability at the bedside of cranial ultrasound make it a promising future modality.