Role of Trans-Cranial Ultrasound in Correlation with Magnetic Resonance Imaging in Diagnosis of Neonatal Hypoxic-Ischemic Encephalopathy

Background: Neonatal encephalopathy (NE) is a major cause of death and morbidity, most commonly from hypoxic-ischemic injury(HII), MRI and cranial ultrasound being key diagnostic tools. This study aimed to evaluate correlation between trans-cranial ultrasound and magnetic resonance imaging (MRI) as a diagnostic instrument for diagnosis of neonatal brain encephalopathy including the term and preterm infants. Methods: This cross-sectional observational research has been performed at the Radiodiagnosis Department, Zagazig University, on 24 neonates with clinically diagnosed brain injury who underwent transcranial ultrasound and MRI, after applying inclusion/exclusion criteria and obtaining ethical approval. Results: In this study of 24 neonates with hypoxic-ischemic encephalopathy (HIE), males predominated (70.8%), and most cases were preterm (66.7%). Stage II (moderate) encephalopathy was most common (54.2%), followed by Stage I (33.3%) and Stage III (12.5%). TCUS detected abnormalities in 17 neonates (70.8%), while MRI was positive in 20 cases (83.3%). Compared with MRI, TCUS demonstrated 16 true positives, 1 false positive, 4 false negatives, and 3 true negatives, yielding sensitivity 80%, specificity 75%, overall accuracy 79.2%, PPV 94%, and NPV 42.9%. Among Stage I cases, most had normal imaging, while Stage II and III showed predominantly abnormal TCUS and MRI findings. Both modalities demonstrated a significant correlation with clinical staging, with abnormal imaging increasing in frequency and severity alongside worsening encephalopathy. Conclusion: The study on 24 neonates with HIE showed that transcranial ultrasound detected most cases but was not reliable to rule out injury. MRI, especially diffusion imaging, remains the most accurate tool for diagnosis and staging.