A study recently published in Pediatric Radiology calls for more precise ultrasound inspection to prevent delayed diagnosis of cerebellar hemorrhage in neonates.
Cerebellar hemorrhage is a subset of intracranial hemorrhage (ICH), a potentially life-threatening complication of fetal and neonatal alloimmune thrombocytopenia (FNAIT). During a cerebellar hemorrhage, a blood vessel ruptures in the cerebellum, a part of the brain responsible for coordination, balance, movement, and other functions.
“Although magnetic resonance imaging (MRI) has superior sensitivity and provides additional information for evaluating cerebellar hemorrhage in neonates, ultrasonography (US) is recommended as the initial imaging modality for screening cerebellar hemorrhage in neonates,” the authors explained.
This retrospective study included 765 infants who were admitted to the neonatal intensive care unit, all of whom underwent brain MRI and US. Using the MRI images as a reference, a team of pediatric radiologists reviewed the scans and classified cases of cerebellar hemorrhage into subtypes based on their location in the cerebellum and the extent of hemorrhage. They then analyzed the US scans for evidence of cerebellar hemorrhage, comparing their findings to the original US reports.
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The investigators detected 56 cases of cerebellar hemorrhage based on MRI imaging, comprising 7.32% of the study population. Only 8 cases were identified in the original US reports, resulting in a detection rate of 14.3%. The authors successfully identified 18 total cases of cerebellar hemorrhage in their retrospective review of the US images, making their US detection rate 32.1%.
The most common subtype of cerebellar hemorrhage in the study was type 1 (34/56 cases). None of these cases were identified in the original ultrasound reports, with just one case being detected during the retrospective review.
Type 3 cerebellar hemorrhages, which are larger and often more clinically significant than type 1 hemorrhages, were the most commonly overlooked type of hemorrhage by the original readers of the US images. While 33.3% of cases were detected in original reports, 75% were identified during the retrospective review, representing a 2.25-fold increase in detection rate.
“Our study suggests a need for a more careful examination of the peripheral and inferior parts of the cerebellum to improve the detection of type 3 cerebellar hemorrhage,” the investigators wrote.
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