Abstract
Objectives: The aim of this study is to explore if manually segmented total brain volume (TBV) from 3D ultrasonography (US) is comparable to TBV estimated by magnetic resonance imaging (MRI). We then wanted to test 2D based TBV estimation obtained through three linear axes which would enable monitoring brain growth in the preterm infant during admission.Methods: We included very low birth weight preterm infants admitted to our neonatal intensive care unit (NICU) with normal neuroimaging findings. We measured biparietal diameter, anteroposterior axis, vertical axis from US and MRI and TBV from both MRI and 3D US. We calculated intra- and interobserver agreement within and between techniques using the intraclass correlation coefficient and Bland-Altman methodology. We then developed a multilevel prediction model of TBV based on linear measurements from both US and MRI, compared them and explored how they changed with increasing age. The multilevel prediction model for TBV from linear measures was tested for internal and external validity and we developed a reference table for ease of prediction of TBV.Results: We used measurements obtained from 426 US and 93 MRI scans from 118 patients. We found good intra- and interobserver agreement for all the measurements. US measurements were reliable when compared to MRI, including TBV which achieved excellent agreement with that of MRI [ICC of 0.98 (95% CI 0.96–0.99)]. TBV estimated through 2D measurements of biparietal diameter, anteroposterior axis, and vertical axis was comparable among both techniques. We estimated the population 95% confidence interval for the mean values of biparietal diameter, anteroposterior axis, vertical axis, and total brain volume by post-menstrual age. A TBV prediction table based on the three axes is proposed to enable easy implementation of TBV estimation in routine 2D US during admission in the NICU.Conclusions: US measurements of biparietal diameter, vertical axis, and anteroposterior axis are reliable. TBV segmented through 3D US is comparable to MRI estimated TBV. 2D US accurate estimation of TBV is possible through biparietal diameter, vertical, and anteroposterior axes.
Highlights
Very low birth weight infants (VLBWI) are a population at high risk for cognitive, motor, neurosensory, and behavioral disability [1]
US linear measurement of the three orthogonal axis and 3D US brain volume manual segmentation was performed in each US of all 118 patients, with 426 US measured with a median of 4 US per patient [IQR 2–7]
The same measurements were performed in 93 magnetic resonance imaging (MRI) that were available from 62 patients (31 patients had 2 MRIs)
Summary
Very low birth weight infants (VLBWI) are a population at high risk for cognitive, motor, neurosensory, and behavioral disability [1]. To improve reproducibility in assessment of brain growth, composite and global scores have been developed that include a combination of subjective items and objective measures These composite scores incorporate quantitative measurements of different structures such as corpus callosum thickness, lateral ventricles width, biparietal diameter, cerebellar height and diameter, subarachnoid space dimensions, and interhemispheric distance [7,8,9]. While these scores are undoubtedly useful for the neonatologist, an approach to US total brain volume estimation could provide new useful information
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