What is the role of cranial ultrasonography in the workup of hypoxic-ischemic encephalopathy (HIE)?

Updated: Jul 18, 2018
  • Author: Santina A Zanelli, MD; Chief Editor: Dharmendra J Nimavat, MD, FAAP  more...
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Although portable and convenient, cranial ultrasonography has a low sensitivity (50%) for the detection of anomalies associated with HIE. Findings include global increase in cerebral echogenicity and obliteration of cerebrospinal fluid (CSF) containing spaces suggestive of cerebral edema. Increase in the echogenicity of deep gray matter structures may also be identified, typically when ultrasonography is performed after 7 days of life. Finally, head ultrasonography has a very limited role to rule out intracerebral or intraventricular hemorrhages, and it is not very useful to learn the extent of brain injury.

In small studies, ultrasonography-based semi-quantitative markers such as the white matter/gray matter echogenicity ratio, as well as the resistive index, have emerged as potentially helpful tools to assess HIE severity and to assist in prognosis formulation early in the disease course. These studies indicate that in infants with HIE, white matter/gray matter echogenicity ratios are increased. Furthermore, neonates with a resistive index below 0.6 have an increased risk of neurodevelopmental impairment at age 20-32 months. [49, 50]

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