Preterm white matter injury: ultrasound diagnosis and classification

• Published in: Pediatric research Vol. 87; no. Suppl 1; pp. 37 - 49
• Main Authors: Agut, Thais, Alarcon, Ana, Cabañas, Fernando, Bartocci, Marco, Martinez-Biarge, Miriam, Horsch, Sandra
• Format: Journal Article
• Language: English
• Published: New York Nature Publishing Group US 01-03-2020; Nature Publishing Group
• Subjects: Medicin och hälsovetenskap; Medicine; Medicine & Public Health; Newborn babies; Pediatric Surgery; Pediatrics; Review; Review Article; Ultrasonic imaging
• ISSN: 0031-3998; 1530-0447; 1530-0447
• DOI: 10.1038/s41390-020-0781-1

White matter injury (WMI) is the most frequent form of preterm brain injury. Cranial ultrasound (CUS) remains the preferred modality for initial and sequential neuroimaging in preterm infants, and is reliable for the diagnosis of cystic periventricular leukomalacia. Although magnetic resonance imaging is superior to CUS in detecting the diffuse and more subtle forms of WMI that prevail in very premature infants surviving nowadays, recent improvement in the quality of neonatal CUS imaging has broadened the spectrum of preterm white matter abnormalities that can be detected with this technique. We propose a structured CUS assessment of WMI of prematurity that seeks to account for both cystic and non-cystic changes, as well as signs of white matter loss and impaired brain growth and maturation, at or near term equivalent age. This novel assessment system aims to improve disease description in both routine clinical practice and clinical research. Whether this systematic assessment will improve prediction of outcome in preterm infants with WMI still needs to be evaluated in prospective studies.