Feasibility of Cerebellar Measurements with Phased Array Sonography through the Anterior Fontanelle in Comparison to MRI

Abstract

Objective Cerebral sonography (CS) through the anterior fontanelle is a neonatal brain imaging method that has become an integral part of modern neonatal bedside care for both screening and diagnostic purposes. Premature infants with cognitive delay have a reduction in cerebellar size at term corrected age on magnetic resonance imaging (MRI). We aimed to determine the level of agreement between postnatal MRI and CS for cerebellar biometry and to determine the level of agreement within one and between different examiners.

Study Design Cerebellar sonography and MRI measurements of the cerebellum from 30 term infants was assessed by Bland–Altman plots. Measurements between both modalities were compared using Wilcoxon's signed rank test. A p-value < 0.01 was considered statistically significant. Intraclass correlation coefficients (ICC) for intra- and interrater reliabilities of CS measurements were calculated.

Results There was no statistically significant difference between CS and MRI for linear measurements, but the measurements of perimeter and surface area differed significantly between the two techniques. There was a systematic bias between both modalities for most measurements except for anterior–posterior (AP) width and vermis height (VH). For measurements that were not statistically different from MRI, we found excellent intrarater ICC for the AP width, VH, and cerebellar width. The interrater ICC was excellent for the AP width and VH, but poor for the transverse cerebellar width.

Conclusion With a strict imaging protocol, cerebellar measurements of the AP width and the VH can be used as an alternative to MRI for diagnostic-screening purposes in a neonatal department where multiple clinicians perform bedside CS.

Key Points

• Abnormal cerebellar growth and injuries affect neurodevelopmental outcome.

• Cerebral sonography through the anterior fontanelle is used for bedside imaging.

• Postnatal sonographic cerebellar measurements are not validated against MRI.

• Measuring vermis height and anterior–posterior width are reliable.

• Measuring transverse cerebellar width through anterior fontanelle is unreliable.

Keywords

newborns - cerebellum - cerebral sonography - MRI

Ethics Approval

Ethics approval not required as per HRA Guidance. Approved by local Hospital Trust Governance Committee.

Note

This manuscript has not been published or is being submitted elsewhere.

Publication History

Received: 04 February 2023

Accepted: 16 June 2023

Accepted Manuscript online:
20 June 2023

Article published online:
21 July 2023

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