Sonography, CT, and MR imaging: A prospective comparison of neonates with suspected intracranial ischemia and hemorrhage

BACKGROUND AND PURPOSE: Sonography, CT, and MR imaging are commonly used to screen for neonatal intracranial ischemia and hemorrhage, yet few studies have attempted to determine which imaging technique is best suited for this purpose. The goals of this study were to compare sonography with CT and MR imaging prospectively for the detection of intracranial ischemia or hemorr hage and to determine the prognostic value(s) of neuroimaging in neonates s uspected of having hypoxic-ischemic injury (HII). METHODS: Forty-seven neonates underwent CT (n = 26) or MR imaging (n = 24) or both (n = 3) within the first month of life for suspected HII. Sonograph y was performed according to research protocol within an average of 14.4 +/ - 9.6 hours of CT or MR imaging. A kappa analysis of interobserver agreemen t was conducted using three independent observers. Infants underwent neurod evelopmental assessment at ages 2 months (n = 47) and 2 years (n = 26). RESULTS: CT and MR imaging had significantly higher interobserver agreement (P < .001) for cortical HII and germinal matrix hemorrhage (GMH) (Grades I and II) compared with sonography, MR imaging and CT revealed 25 instances of HII compared with 13 identified by sonography, MR imaging and CT also re vealed 10 instances of intraparenchymal hemorrhage (>1 cm, including Grade IV GMH) compared with sonography, which depicted five. The negative predict ive values of neuroimaging, irrespective of technique used, were 53.3% and 58.8% at the 2-month and 2-year follow-up examinations, respectively. CONCLUSION: CT and MR imaging have significantly better interobserver agree ment for cortical HII and GMH/intraventricular hemorrhage and can reveal mo re instances of intraparenchymal hemorrhage compared with sonography. The a bsence of neuroimaging findings on sonograms, CT scans, or MR images does n ot rule out later neurologic dysfunction.