Alterations on magnetic resonance imaging of the neonatal brain: correlations with prenatal risk factors and transfontanellar ultrasound findings

Abstract Objective: To describe the alterations seen on magnetic resonance imaging (MRI) of the brain in newborns, correlating those alterations with the transfontanellar ultrasound (TFUS) findings, and to describe the main risk factors identified. Materials and Methods: We evaluated the examinations of 51 patients who were submitted to brain MRI with a neonatal protocol during hospitalization. We evaluated the MRI findings and correlated them with previous TFUS findings, using the last TFUS performed in order to minimize the risk of bias. Data were obtained from medical records, and the images were reviewed by a radiologist specializing in neuroimaging. Results: Of the 51 patients evaluated, 21 (41.2%) were extremely preterm infants and 22 (43.1%) were extremely-low-birth-weight infants. Alterations were seen on 16 (31.4%) of the TFUS examinations and on 30 (58.8%) of the brain MRI scans, the most common finding being germinal matrix hemorrhage. The positive and negative predictive values of TFUS in relation to MRI were 87% and 54%, respectively. Conclusion: Because TFUS proved to be capable of distinguishing mild and moderate (grade I and II) germinal matrix hemorrhage from the severe forms (grades III and IV), it can be considered a good tool for screening and follow-up, especially in infants with severe disease and risk factors.

摘要
研究目的：描述新生儿脑部磁共振成像（Magnetic Resonance Imaging, MRI）所见的异常改变，并将这些异常与经囟门超声（transfontanellar ultrasound, TFUS）检查结果相关联，同时明确已识别的主要危险因素。
材料与方法：本研究评估了51例住院期间采用新生儿扫描方案接受脑部MRI检查的患者的检查资料。我们将MRI检查结果与此前的经囟门超声检查结果进行关联分析，为最大限度降低偏倚风险，采用末次经囟门超声检查结果作为对照。研究数据来源于患者病历，影像资料由神经影像学专业放射科医师进行阅片复核。
结果：在51例评估患者中，21例（41.2%）为极早早产儿，22例（43.1%）为极低出生体重儿。16例（31.4%）的经囟门超声检查存在异常，30例（58.8%）的脑部MRI扫描存在异常，其中最常见的检出结果为生发基质出血。经囟门超声相对于MRI的阳性预测值与阴性预测值分别为87%与54%。
结论：鉴于经囟门超声可有效区分轻、中度（Ⅰ、Ⅱ级）生发基质出血与重度（Ⅲ、Ⅳ级）病变，其可作为良好的筛查与随访工具，尤其适用于存在严重疾病及危险因素的新生儿。