NEONATAL INTRACRANIAL ISCHEMIA AND HEMORRHAGE - DIAGNOSIS WITH US, CT, AND MR-IMAGING

PURPOSE: To assess the usefulness of ultrasound (US), computed tomogra phy (CT), and magnetic resonance (MR) imaging in the detection of intr acranial hemorrhage and ischemia in newborns. MATERIALS AND METHODS: S eventy-six neonates who underwent US within 72 hours of CT or MR exami nation were studied. Four observers rated images for the presence of g erminal matrix hemorrhage (GMH), intraventricular hemorrhage (IVH), in traparenchymal hemorrhage (IPH), extraaxial hemorrhage, and hypoxic-is chemic encephalopathy. RESULTS: In 39% of neonates, CT and MR imaging provided greater confidence than US for the diagnosis or exclusion of neonatal ischemia or hemorrhage. Kappa analysis revealed significantly better interobserver agreement with CT than with US for the detection of GMH, IVH, IPH, and cortical infarction or ischemia (P <.005). Inte robserver agreement was significantly better with MR imaging than with US for the detection of GMH, IVH, and cortical infarction or ischemia (P <.005). CONCLUSION: Sensitivity and interobserver agreement are be tter with MR imaging and CT than with US for the detection of neonatal cortical ischemia or infarction.