Ultrasonography (USG) Imaging of Neonatal Periventricular Leukomalacia-Role of Serial USG Cranium Imaging: A Case Study

Periventricular leukomalacia (PVL) is a common CNS complication in preterm infants. It is otherwise known as neonatal White matter injury. After periventricular haemorrhage, PVL is the second most common CNS complication in preterm neonates. USG of cranium is a bedside examination & is fast, therefore ideal for premature infants. It is radiation free & can be repeated as required. The cause of PVL is ischemia but infection & vasculitis play an additional role. It occurs in premature infants born at less than 32 weeks gestation and less than 1500gm birth weight. In these neonates serial cranial USG is the standard of care as it is widely available, inexpensive & non-invasive. The modality is good for assessment in early stages of PVL & results are good predictors in sub acute and chronic stages. Detection of PVL is important as premature infants with PVL develop cerebral palsy, intellectual impairment or visual disturbances. At most half of infants with PVL develop cerebral palsy. USG scans often shows cystic periventricular leucomalacia within 14 days after injury. So, serial USG cranial scans with high resolution probe after 2 weeks of life is required to find out all cases of PVL. It is classified into four grades. In term infants it may also be seen in small percentage of cases. MRI is important in acute as well as subacute and chronic phases.