Kazam E, Rudelli R, Monte W, Rubenstein W A, Ramirez de Arellano E, Kairam R, Paneth N
Department of Radiology, New York Hospital-Cornell Medical Center 10021.
AJNR Am J Neuroradiol. 1994 Jun;15(6):1009-20.
To evaluate sonographic criteria for the diagnosis of subarachnoid, and particularly cisternal, hemorrhage in the preterm infant.
The subarachnoid cisterns were studied on cadaveric anatomic sections and on postmortem ultrasonograms, as well as on in vivo ultrasonograms of healthy neonates. Based on the normal ultrasound appearances of these cisterns, criteria were developed for the recognition of abnormal cisternal fluid collections, which strongly suggest the presence of subarachnoid hemorrhage in the premature infant. These criteria were evaluated prospectively in a group of 63 preterm infants who underwent subsequent autopsy.
In the 63 infants with neuropathologic verification, increased echogenicity and/or increased echo-free content of the subarachnoid cisterns correctly predicted subarachnoid hemorrhage with an accuracy of 75%, sensitivity of 69%, and specificity of 93%. The positive and negative predictive values were 97% and 46%, respectively. In 47% of the cases, ultrasound correctly detected cisternal subarachnoid hemorrhage before intraventricular hemorrhage could be diagnosed.
A highly specific, although somewhat insensitive, sonographic diagnosis of subarachnoid hemorrhage can be made from the appearance of the subarachnoid cisterns. The diagnosis of subarachnoid hemorrhage may predate the ultrasound diagnosis of intraventricular hemorrhage and may alert the neonatologist to the need for follow-up sonograms in the absence of ultrasound evidence of intraventricular hemorrhage.
评估超声诊断早产儿蛛网膜下腔出血，尤其是脑池出血的标准。
研究了尸体解剖切片、尸检超声图像以及健康新生儿的活体超声图像中的蛛网膜下腔脑池。基于这些脑池的正常超声表现，制定了识别异常脑池积液的标准，这强烈提示早产儿存在蛛网膜下腔出血。在一组63例接受后续尸检的早产儿中对这些标准进行了前瞻性评估。
在63例经神经病理学证实的婴儿中，蛛网膜下腔脑池回声增强和/或无回声内容物增加对蛛网膜下腔出血的正确预测准确率为75%，敏感性为69%，特异性为93%。阳性预测值和阴性预测值分别为97%和46%。在47%的病例中，超声在诊断脑室内出血之前正确检测到了脑池蛛网膜下腔出血。
根据蛛网膜下腔脑池的表现可以做出高度特异性（尽管有些不敏感）的蛛网膜下腔出血超声诊断。蛛网膜下腔出血的诊断可能早于脑室内出血的超声诊断，并且在没有脑室内出血超声证据的情况下，可能提醒新生儿科医生需要进行后续超声检查。
