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<meta name="DC.Title" content="Sonography, CT, and MR Imaging: A Prospective Comparison of Neonates with Suspected Intracranial Ischemia and Hemorrhage" />
<meta name="DC.Date" content="2000-01-01" />
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<meta name="DC.Description" content="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 hemorrhage and to determine the prognostic value(s) of neuroimaging in neonates suspected 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. Sonography 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 agreement was conducted using three independent observers. Infants underwent neurodevelopmental assessment at ages 2 months (n = 47) and 2 years (n = 26).

RESULTS: CT and MR imaging had significantly higher interobserver agreement ( P &lt; .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 revealed 10 instances of intraparenchymal hemorrhage (&gt;1 cm, including Grade IV GMH) compared with sonography, which depicted five. The negative predictive 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 agreement for cortical HII and GMH/intraventricular hemorrhage and can reveal more instances of intraparenchymal hemorrhage compared with sonography. The absence of neuroimaging findings on sonograms, CT scans, or MR images does not rule out later neurologic dysfunction." />
<meta name="DC.Contributor" content="Francis G. Blankenberg" />
<meta name="DC.Contributor" content="Nyu-Nyu Loh" />
<meta name="DC.Contributor" content="Paige Bracci" />
<meta name="DC.Contributor" content="Helen E. D'Arceuil" />
<meta name="DC.Contributor" content="William D. Rhine" />
<meta name="DC.Contributor" content="Alexander M. Norbash" />
<meta name="DC.Contributor" content="Barton Lane" />
<meta name="DC.Contributor" content="Angela Berg" />
<meta name="DC.Contributor" content="Brenda Person" />
<meta name="DC.Contributor" content="Michelle Coutant" />
<meta name="DC.Contributor" content="Dieter R. Enzmann" />
<meta name="article:published_time" content="2000-01-01" />
<meta name="article:section" content="PEDIATRICS" />
<meta name="citation_title" content="Sonography, CT, and MR Imaging: A Prospective Comparison of Neonates with Suspected Intracranial Ischemia and Hemorrhage" />
<meta name="citation_abstract" lang="en" content="&lt;p&gt;&lt;i&gt;BACKGROUND AND PURPOSE:&lt;/i&gt; 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 hemorrhage and to determine the prognostic value(s) of neuroimaging in neonates suspected of having hypoxic-ischemic injury (HII).&lt;/p&gt;&lt;p&gt;&lt;i&gt;METHODS:&lt;/i&gt; 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. Sonography 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 agreement was conducted using three independent observers. Infants underwent neurodevelopmental assessment at ages 2 months (n = 47) and 2 years (n = 26).&lt;/p&gt;&lt;p&gt;&lt;i&gt;RESULTS:&lt;/i&gt; CT and MR imaging had significantly higher interobserver agreement (&lt;i&gt;P&lt;/i&gt; &amp;lt; .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 revealed 10 instances of intraparenchymal hemorrhage (&amp;gt;1 cm, including Grade IV GMH) compared with sonography, which depicted five. The negative predictive values of neuroimaging, irrespective of technique used, were 53.3% and 58.8% at the 2-month and 2-year follow-up examinations, respectively.&lt;/p&gt;&lt;p&gt;&lt;i&gt;CONCLUSION:&lt;/i&gt; CT and MR imaging have significantly better interobserver agreement for cortical HII and GMH/intraventricular hemorrhage and can reveal more instances of intraparenchymal hemorrhage compared with sonography. The absence of neuroimaging findings on sonograms, CT scans, or MR images does not rule out later neurologic dysfunction.&lt;/p&gt;" />
<meta name="citation_journal_title" content="American Journal of Neuroradiology" />
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<meta name="citation_author" content="Francis G. Blankenberg" />
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<meta name="citation_author" content="Paige Bracci" />
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<meta name="citation_author" content="Alexander M. Norbash" />
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<meta name="twitter:title" content="Sonography, CT, and MR Imaging: A Prospective Comparison of Neonates with Suspected Intracranial Ischemia and Hemorrhage" />
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<meta name="twitter:description" content="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 hemorrhage and to determine the prognostic value(s) of neuroimaging in neonates suspected 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. Sonography 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 agreement was conducted using three independent observers. Infants underwent neurodevelopmental assessment at ages 2 months (n = 47) and 2 years (n = 26).

RESULTS: CT and MR imaging had significantly higher interobserver agreement ( P &lt; .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 revealed 10 instances of intraparenchymal hemorrhage (&gt;1 cm, including Grade IV GMH) compared with sonography, which depicted five. The negative predictive 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 agreement for cortical HII and GMH/intraventricular hemorrhage and can reveal more instances of intraparenchymal hemorrhage compared with sonography. The absence of neuroimaging findings on sonograms, CT scans, or MR images does not rule out later neurologic dysfunction." />
<meta name="og-title" property="og:title" content="Sonography, CT, and MR Imaging: A Prospective Comparison of Neonates with Suspected Intracranial Ischemia and Hemorrhage" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/21/1/213" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="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 hemorrhage and to determine the prognostic value(s) of neuroimaging in neonates suspected 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. Sonography 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 agreement was conducted using three independent observers. Infants underwent neurodevelopmental assessment at ages 2 months (n = 47) and 2 years (n = 26).

RESULTS: CT and MR imaging had significantly higher interobserver agreement ( P &lt; .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 revealed 10 instances of intraparenchymal hemorrhage (&gt;1 cm, including Grade IV GMH) compared with sonography, which depicted five. The negative predictive 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 agreement for cortical HII and GMH/intraventricular hemorrhage and can reveal more instances of intraparenchymal hemorrhage compared with sonography. The absence of neuroimaging findings on sonograms, CT scans, or MR images does not rule out later neurologic dysfunction." />
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      <h1 class="highwire-cite-title" id="page-title">Sonography, CT, and MR Imaging: A Prospective Comparison of Neonates with Suspected Intracranial Ischemia and Hemorrhage</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">Francis G. Blankenberg</span>, <span class="highwire-citation-author" data-delta="1">Nyu-Nyu Loh</span>, <span class="highwire-citation-author" data-delta="2">Paige Bracci</span>, <span class="highwire-citation-author" data-delta="3">Helen E. D'Arceuil</span>, <span class="highwire-citation-author" data-delta="4">William D. Rhine</span>, <span class="highwire-citation-author" data-delta="5">Alexander M. Norbash</span>, <span class="highwire-citation-author" data-delta="6">Barton Lane</span>, <span class="highwire-citation-author" data-delta="7">Angela Berg</span>, <span class="highwire-citation-author" data-delta="8">Brenda Person</span>, <span class="highwire-citation-author" data-delta="9">Michelle Coutant</span> and <span class="highwire-citation-author" data-delta="10">Dieter R. Enzmann</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">January 2000,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">21 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(1) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">213-218; </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-2124--81114111677" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">Francis G. Blankenberg </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Radiology (F.G.B., N.-N.L., H.E.D., A.M.N., B.L., D.R.E.), Stanford University School of Medicine, Stanford, the Department of Epidemiology and Biostatistics (P.B.), Cancer Epidemiology Studies, San Francisco, and the Departments of Pediatrics, Neonatal Medicine (W.D.R.) and Pediatric Radiology (A.B., B.P., M.C.), Lucile Salter Packard Children's Hospital, Palo Alto, CA.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Francis%2BG.%2BBlankenberg%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Blankenberg%20FG&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AFrancis%2BG.%2BBlankenberg%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">Nyu-Nyu Loh </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Radiology (F.G.B., N.-N.L., H.E.D., A.M.N., B.L., D.R.E.), Stanford University School of Medicine, Stanford, the Department of Epidemiology and Biostatistics (P.B.), Cancer Epidemiology Studies, San Francisco, and the Departments of Pediatrics, Neonatal Medicine (W.D.R.) and Pediatric Radiology (A.B., B.P., M.C.), Lucile Salter Packard Children's Hospital, Palo Alto, CA.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Nyu-Nyu%2BLoh%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Loh%20N&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3ANyu-Nyu%2BLoh%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">Paige Bracci </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Radiology (F.G.B., N.-N.L., H.E.D., A.M.N., B.L., D.R.E.), Stanford University School of Medicine, Stanford, the Department of Epidemiology and Biostatistics (P.B.), Cancer Epidemiology Studies, San Francisco, and the Departments of Pediatrics, Neonatal Medicine (W.D.R.) and Pediatric Radiology (A.B., B.P., M.C.), Lucile Salter Packard Children's Hospital, Palo Alto, CA.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Paige%2BBracci%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Bracci%20P&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3APaige%2BBracci%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">Helen E. D'Arceuil </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Radiology (F.G.B., N.-N.L., H.E.D., A.M.N., B.L., D.R.E.), Stanford University School of Medicine, Stanford, the Department of Epidemiology and Biostatistics (P.B.), Cancer Epidemiology Studies, San Francisco, and the Departments of Pediatrics, Neonatal Medicine (W.D.R.) and Pediatric Radiology (A.B., B.P., M.C.), Lucile Salter Packard Children's Hospital, Palo Alto, CA.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Helen%2BE.%2BD%27Arceuil%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=D%27Arceuil%20HE&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AHelen%2BE.%2BD%2527Arceuil%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-4"><div class="author-tooltip-name">William D. Rhine </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Radiology (F.G.B., N.-N.L., H.E.D., A.M.N., B.L., D.R.E.), Stanford University School of Medicine, Stanford, the Department of Epidemiology and Biostatistics (P.B.), Cancer Epidemiology Studies, San Francisco, and the Departments of Pediatrics, Neonatal Medicine (W.D.R.) and Pediatric Radiology (A.B., B.P., M.C.), Lucile Salter Packard Children's Hospital, Palo Alto, CA.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=William%2BD.%2BRhine%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Rhine%20WD&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AWilliam%2BD.%2BRhine%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-5"><div class="author-tooltip-name">Alexander M. Norbash </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Radiology (F.G.B., N.-N.L., H.E.D., A.M.N., B.L., D.R.E.), Stanford University School of Medicine, Stanford, the Department of Epidemiology and Biostatistics (P.B.), Cancer Epidemiology Studies, San Francisco, and the Departments of Pediatrics, Neonatal Medicine (W.D.R.) and Pediatric Radiology (A.B., B.P., M.C.), Lucile Salter Packard Children's Hospital, Palo Alto, CA.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Alexander%2BM.%2BNorbash%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Norbash%20AM&amp;link_type=AUTHORSEARCH" 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Neonatal Medicine (W.D.R.) and Pediatric Radiology (A.B., B.P., M.C.), Lucile Salter Packard Children's Hospital, Palo Alto, CA.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Michelle%2BCoutant%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Coutant%20M&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AMichelle%2BCoutant%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-10"><div class="author-tooltip-name">Dieter R. 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      <div class="highwire-cite-title">Sonography, CT, and MR Imaging: A Prospective Comparison of Neonates with Suspected Intracranial Ischemia and Hemorrhage</div>  
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    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Jan 2000, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">21 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(1) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">213-218; </span></div>
  
  
  
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    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Jan 2000, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">21 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(1) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">213-218; </span></div>
  
  
  
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