Intraobserver and interobserver reliability in assessment of neonatal cranial ultrasounds

Intraobserver and interobserver reliability in assessing neonatal cranial ultrasounds for periventricular-intraventricular hemorrhage (PVH-IVH) is not well studied; therefore, studies were designed to address this. For intraobserver reliability 180 cranial ultrasounds (360 hemispheres) were randomly selected from greater than 2000 ultrasounds and read twice by one radiologist in a blinded fashion. Ninety-eight percent were interpreted identically; of the 2% reinterpreted differently, all were initially abnormal but normal on the second reading. The least agreement occurred when interpreting ventricular size. Only four infants (1.1%) were placed in an unfavorable prognostic category (grades III and IV) on the first reading and a favorable prognostic category on the second interpretation (no bleed, grades I and II). To determine interobserver reliability, 20 sonograms were interpreted by eight independent observers representing five institutions. Using the multiple rater kappa kappa statistic, we determined interobserver agreement on overall impression (normal vs. abnormal), presence and extent of PVH-IVH (i.e. grade), presence of residual cyst, and ventricular dilatation. Greatest degree of agreement occurred when determining normal vs. abnormal, residual cyst, no bleed, and grades III and IV PVH-IVH. Poorest agreement occurred when reading grades I and II PVH-IVH and ventricular dilatation. After condensing interpretations of cranial ultrasounds into two prognostic categories, i.e. favorable (no bleed, grades I and II) and unfavorable (grades III and IV), there was excellent agreement among the observers.

Neonatal intracranial hemorrhage: I. Changing pattern in inborn low-birth-weight infants

Many reports of the occurrence of periventricular-intraventricular hemorrhage (PVH-IVH) are biased by the inclusion of both inborn and outborn infants. To obviate this selection bias we examined a large inborn population of low-birth-weight infants to determine if the incidence of PVH-IVH changed over a 3-year interval from March, 1982 through February, 1985. Serial cranial ultrasonography was performed in 463 consecutive infants of birth weight less than or equal to 1500 g who survived for more than 8 h. The incidence of PVH-IVH decreased from 31.5% and 29.3% in years 1 and 2, respectively, to 23.7% in year 3 (P less than 0.05). The latter reflected a fall in the incidence of grades III and IV PVH-IVH, but no change in the incidence of grades I and II. This observation was not attributable to changes in mortality, the distribution of infants by birth weight and estimated gestational age in each year of the study, or infants excluded from the analysis. Contrary to most reports, 21.9% of all PVH-IVH during the 3 years were first diagnosed after 14 days postnatal age and were predominantly grade I. These results document not only a change in the epidemiology of PVH-IVH in an inborn population, but also the importance of serial cranial ultrasonography beyond the first week of life.

Neonatal intracranial hemorrhage: II. Risk factor analysis in an inborn population

The ability to predict the occurrence of neonatal periventricular-intraventricular hemorrhage (PVH-IVH) would be useful in the design of clinical trials to prevent its occurrence. Therefore, data were collected from 463 consecutive infants less than or equal to 1500 g birth weight delivered between March 1, 1982 and February 28, 1985. This large population made it feasible to divide the infants into two groups, using one group to develop a model predictive of ICH and the second group to test the validity of the model. Infants were randomly grouped by sex, race, gestational age, birth weight, month of birth, mortality, and incidence and grade of worst PVH-IVH. In Group A (n = 232), respiratory distress syndrome, ventilator therapy, PaCO2 greater than or equal to 60 mmHg, PO2 less than or equal to 40 mmHg greater than or equal to 2 h, lower 1- and 5-min Apgar scores, lower pediatric estimation of gestational age, and pneumothorax were significantly associated with PVH-IVH by univariant analyses (chi 2, P less than 0.03). Multivariant discriminant analysis performed on Group A revealed that pneumothorax, cesarean section, PaCO2, and ventilator therapy were most predictive of PVH-IVH, but sensitivity was 55% and specificity 78%. Applying the model to Group B, sensitivity decreased to 21% while specificity rose to 93%. Logistic regression, which takes into account non-normally distributed variables, did not improve predictability.(ABSTRACT TRUNCATED AT 250 WORDS)

Computer reconstructed sagittal and coronal CT scans. Applications in neurological disorders of infants and children

Recent technical advances in computed tomography (CT) allow sagittal and coronal image reconstruction by computer manipulation of data from thin-section transverse scans. Three cases are presented to illustrate this new supplementary modality in the pediatric patient. The technique, diagnostic implications and value of orthogonal plane image reconstruction are discussed.

Craniocerebral computed tomography in the neonate

Craniocerebral computed tomography (CT) is an extremely important component of the armanentarium for diagnosis of neurological disorders in the neonate. The indications, techniques, normal anatomy, and pathologic abnormalities of CT scans in newborn infants are presented. Hydrocephalus and intracranial hemorrhage are discussed in depth.

CT diagnosis of intracranial cystic abnormalities in children

The introduction of computed axial tomography has been of tremendous importance in the evaluation of intracranial pathology in children. The broad spectrum of cystic intracranial lesions of congenital, infectious, traumatic, vascular and neoplastic origin are discussed. Their CT findings, pathology and pathogenesis are emphasized.

Computed tomography in the evaluation of sella and parasella lesions: the value of sagittal and coronal reconstructions

A method is described whereby contiguous, thin-section (3 mm) axial CT scans are obtained followed by computer manipulation of the data to reconstruct good quality images in sagittal and coronal planes. The application of this technique in the evaluation of sella and parasella abnormalities is discussed. In our experience, this has resulted in an increased sensitivity of CT scanning for the detection of abnormalities around the sella. In addition, it has been possible to more accurately define the true extrasella extension of pituitary tumors.