Abstract
Objective:
Head ultrasonography (HUS) is a reliable and easy to perform bedside imaging technique that can give valuable information about degree of brain injury/edema after perinatal asphyxia in term neonates. The goals of our study were to determine whether semiquantitative markers such as standardized white matter/gray matter (WM/GM) echogenicity ratio and resistive index (RI) value measured by HUS differs between asphyxiated term neonates and healthy controls.
Study Design:
Thirty-one carefully selected term neonates who suffered from perinatal hypoxic–ischemic encephalopathy (HIE) were included in the study. The ratio of the WM/GM echogenicity of the cingulate gyrus was calculated. In addition, the RI value was measured in the anterior cerebral artery. US scalars were compared with 11 healthy neonates.
Result:
WM/GM ratio is significantly increased and RI value significantly decreased in asphyxiated term neonates compared with healthy subjects.
Conclusion:
WM/GM ratio and RI value allows discriminating between asphyxiated neonates and healthy subjects. These US scalars may serve as valuable, easy to acquire semiquantitative bedside markers of brain HIE, when magnetic resonance imaging is unavailable or cannot be performed in the acute setting.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Rent or buy this article
Prices vary by article type
from$1.95
to$39.95
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Wu YW, Backstrand KH, Zhao S, Fullerton HJ, Johnston SC . Declining diagnosis of birth asphyxia in california: 1991-2000. Pediatrics 2004; 114 (6): 1584–1590.
Smith J, Wells L, Dodd K . The continuing fall in incidence of hypoxic-ischemic encephalopathy in term infants. BJOG 2000; 107 (4): 461–466.
Gluckman PD, Wyatt JS, Azzopardi D, Ballard R, Edwards AD, Ferriero DM et al. Selective head cooling with mild systemic hypothermia after neonatal encephalopathy: multicentre randomised trial. Lancet 2005; 365 (9460): 663–670.
Shankaran S, Laptook AR, Ehrenkranz RA, Tyson JE, McDonald SA, Donovan EF et al. Whole-body hypothermia for neonates with hypoxic-ischemic encephalopathy. N Engl J Med 2005; 353 (15): 1574–1584.
Laptook AR . Use of therapeutic hypothermia for term infants with hypoxic-ischemic encephalopathy. Pediatr Clin North Am 2009; 56 (3): 601–661.
Shah PS . Hypothermia: a systematic review and meta-analysis of clinical trials. Semin Fetal Neonatal Med 2010; 15 (5): 238–246.
Blankenberg FG, Loh NN, Bracci P, D’Arceuil HE, Rhine WD, Norbash AM et al. Sonography, CT, and MR imaging: a prospective comparison of neonates with suspected intracranial ischemia and hemorrhage. AJNR Am J Neuroradiol 2000; 21 (1): 213–218.
Childs AM, Cornette L, Ramenghi LA, Tanner SF, Arthur RJ, Martinez D et al. Magnetic resonance and cranial ultrasound characteristics of periventricular white matter abnormalities in newborn infants. Clin Radiol 2001; 56 (8): 647–655.
Sie LT, van der Knaap MS, van Wezel-Meijler G, Taets van Amerongen AH, Lafeber HN, Valk J . Early mr features of hypoxic-ischemic brain injury in neonates with periventricular densities on sonograms. AJNR Am J Neuroradiol 2000; 21 (5): 852–861.
Daneman A, Epelman M, Blaser S, Jarrin JR . Imaging of the brain in full-term neonates: does sonography still play a role? Pediatr Radiol 2006; 36 (7): 636–646.
Epelman M, Daneman A, Kellenberger CJ, Aziz A, Konen O, Moineddin R et al. Neonatal encephalopathy: a prospective comparison of head US and MRI. Pediatr Radiol 2010; 40 (10): 1640–1650.
Kuban K, Adler I, Allred EN, Batton D, Bezinque S, Betz BW et al. Observer variability assessing us scans of the preterm brain: The Elgan study. Pediatr Radiol 2007; 37 (12): 1201–1208.
Simaeys B, Philips W, Lemahieu I, Govaert P . Quantitative analysis of the neonatal brain by ultrasound. Comput Med Imaging Graph 2000; 24 (1): 11–18.
Padilla NF, Enriquez G, Jansson T, Gratacos E, Hernandez-Andrade E . Quantitative tissue echogenicity of the neonatal brain assessed by ultrasound imaging. Ultrasound Med Biol 2009; 35 (9): 1421–1426.
Chao CP, Zaleski CG, Patton AC . Neonatal hypoxic-ischemic encephalopathy: multimodality imaging findings. Radiographics 2006; 26 (Suppl 1): S159–S172.
Archer LN, Levene MI, Evans DH . Cerebral artery doppler ultrasonography for prediction of outcome after perinatal asphyxia. Lancet 1986; 2 (8516): 1116–1118.
Ilves P, Lintrop M, Talvik I, Muug K, Maipuu L, Metsvaht T . Low cerebral blood flow velocity and head circumference in infants with severe hypoxic ischemic encephalopathy and poor outcome. Acta Paediatr 2009; 98 (3): 459–465.
Levene MI, Fenton AC, Evans DH, Archer LN, Shortland DB, Gibson NA . Severe birth asphyxia and abnormal cerebral blood-flow velocity. Dev Med Child Neurol 1989; 31 (4): 427–434.
Stark JE, Seibert JJ . Cerebral artery doppler ultrasonography for prediction of outcome after perinatal asphyxia. J Ultrasound Med 1994; 13 (8): 595–600.
Brady KM, Lee JK, Kibler KK, Easley RB, Koehler RC, Shaffner DH . Continuous measurement of autoregulation by spontaneous fluctuations in cerebral perfusion pressure: comparison of 3 methods. Stroke 2008; 39 (9): 2531–2537.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no conflict of interest.
Rights and permissions
About this article
Cite this article
Pinto, P., Tekes, A., Singhi, S. et al. White–gray matter echogenicity ratio and resistive index: sonographic bedside markers of cerebral hypoxic–ischemic injury/edema?. J Perinatol 32, 448–453 (2012). https://doi.org/10.1038/jp.2011.121
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/jp.2011.121
Keywords
This article is cited by
-
Quantitative ultrasonographic examination of cerebral white matter by pixel brightness intensity as marker of middle-term neurodevelopment: a prospective observational study
Scientific Reports (2023)
-
Using Doppler sonography resistive index for the diagnosis of perinatal asphyxia: a multi-centered study
BMC Neurology (2022)
-
Early postnatal color Doppler changes in neonates receiving delivery room resuscitation with low 5 min Apgar score—a pilot study
Journal of Perinatology (2021)
-
Spectral-domain OCT changes in retina and optic nerve in children with hypoxic–ischaemic encephalopathy
Graefe's Archive for Clinical and Experimental Ophthalmology (2021)
-
The development and validation of a cerebral ultrasound scoring system for infants with hypoxic-ischaemic encephalopathy
Pediatric Research (2020)