SONOGRAPHIC DIAGNOSIS OF CISTERNAL SUBARACHNOID HEMORRHAGE IN THE PREMATURE-INFANT

PURPOSE: To evaluate sonographic criteria for the diagnosis of subarac hnoid, and particularly cisternal, hemorrhage in the preterm infant. M ETHODS: The subarachnoid cisterns were studied on cadaveric anatomic s ections and on postmortem ultrasonograms, as well as on in vivo ultras onograms of healthy neonates. Based on the normal ultrasound appearanc es of these cisterns, criteria were developed for the recognition of a bnormal cisternal fluid collections, which strongly suggest the presen ce of subarachnoid hemorrhage in the premature infant. These criteria were evaluated prospectively in a group of 63 preterm infants who unde rwent subsequent autopsy. RESULTS: In the 63 infants with neuropatholo gic verification, increased echogenicity and/or increased echo-free co ntent of the subarachnoid cisterns correctly predicted subarachnoid he morrhage 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 ciste rnal subarachnoid hemorrhage before intraventricular hemorrhage could be diagnosed. CONCLUSION: A highly specific, although somewhat insensi tive, sonographic diagnosis of subarachnoid hemorrhage can be made fro m the appearance of the subarachnoid cisterns. The diagnosis of subara chnoid hemorrhage may predate the ultrasound diagnosis of intraventric ular hemorrhage and may alert the neonatologist to the need for follow -up sonograms in the absence of ultrasound evidence of intraventricula r hemorrhage.