Role of Transcranial Ultrasound for Hypoxic Ischemic Insult Keeping MRI as a Gold Standard
DOI:
https://doi.org/10.70749/ijbr.v3i7.2863Keywords:
Diagnostic Imaging, Hypoxia-ischemia, Brain, Infant, Newborn, Magnetic Resonance Imaging, UltrasonographyAbstract
Background: Hypoxic-ischemic insult is an important cerebral pathology in neonates, which is caused by reduced oxygen and blood flow during parturition. Early diagnosis of hypoxic-ischemic insult in neonates is important to prevent sequelae. Magnetic resonance imaging is considered an effective diagnostic tool; however, it is not easily accessible and is quite expensive. Objective: To determine the diagnostic accuracy of transcranial ultrasound in detecting hypoxic ischemic encephalopathy taking MRI as gold standard. Study Design: Cross sectional validation study. Duration and Place of Study: This study was conducted from 2 January 2025 to 2 May 2025 in Department of Radiology, Gujranwala Teaching Hospital Gujranwala. Methodology: A total of 156 newborns with birth asphyxia and gestational age more than 32 weeks were included. Transcranial ultrasound was performed using high frequency probe through anterior fontanelle. Magnetic resonance imaging was done on 1.5 tesla machine. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were calculated by 2×2 contingency table. Results: Mean gestational age was 36.87±1.99 weeks and mean birth weight was 2.66±0.51 kg. Sensitivity was 85.5%, specificity 70.3%, diagnostic accuracy 75.6%, positive predictive value 61% and negative predictive value 89.9%. Conclusion: Transcranial ultrasound is useful screening tool with good sensitivity and high negative predictive value for detecting hypoxic ischemic insult in neonates.
Downloads
References
1. Uzianbaeva, L., Yan, Y., Joshi, T., Yin, N., Hsu, C., Hernandez-Andrade, E., & Mehrmohammadi, M. (2021). Methods for monitoring risk of hypoxic damage in fetal and neonatal brains: A review. Fetal Diagnosis and Therapy, 49(1-2), 1-24.
https://doi.org/10.1159/000520987
2. Lorain, P., Bower, A., Gottardi, E., Dommergues, M., Foix L’Helias, L., Guellec, I., & Kayem, G. (2022). Risk factors for hypoxic–ischemic encephalopathy in cases of severe acidosis: A case–control study. Acta Obstetricia et Gynecologica Scandinavica, 101(4), 471-478.
https://doi.org/10.1111/aogs.14326
3. Annoni, F., Peluso, L., Gouvêa Bogossian, E., Creteur, J., Zanier, E. R., & Taccone, F. S. (2021). Brain protection after anoxic brain injury: Is lactate supplementation helpful? Cells, 10(7), 1714.
https://doi.org/10.3390/cells10071714
4. Misser, S. K., Lotz, J. W., Zaharie, S., Mchunu, N., Archary, M., & Barkovich, A. J. (2022). A proposed magnetic resonance imaging grading system for the spectrum of central neonatal parasagittal hypoxic–ischaemic brain injury. Insights into Imaging, 13(1).
https://doi.org/10.1186/s13244-021-01139-7
5. Wisnowski, J. L., Wintermark, P., Bonifacio, S. L., Smyser, C. D., Barkovich, A. J., Edwards, A. D., De Vries, L. S., Inder, T. E., & Chau, V. (2021). Neuroimaging in the term newborn with neonatal encephalopathy. Seminars in Fetal and Neonatal Medicine, 26(5), 101304.
https://doi.org/10.1016/j.siny.2021.101304
6. Boos, V., & Bührer, C. (2024). Trends in Apgar scores and umbilical artery pH: A population-based cohort study on 10,696,831 live births in Germany, 2008–2022. European Journal of Pediatrics, 183(5), 2163-2172.
https://doi.org/10.1007/s00431-024-05475-w
7. Lin, Y., Hwang-Bo, S., Seo, Y., & Youn, Y. (2021). Clinical seizures and unfavorable brain MRI patterns in neonates with hypoxic ischemic encephalopathy. Medicine, 100(12), e25118.
https://doi.org/10.1097/md.0000000000025118
8. Francke, K. H., Støen, R., Thomas, N., & Aker, K. (2024). Biochemical profiles and organ dysfunction in neonates with hypoxic-ischemic encephalopathy post-hoc analysis of the THIN trial. BMC Pediatrics, 24(1).
https://doi.org/10.1186/s12887-024-04523-6
9. Hung, S., Tu, Y., Hunter, S. E., & Guimaraes, C. (2024). MRI predictors of long-term outcomes of neonatal hypoxic ischaemic encephalopathy: A primer for radiologists. British Journal of Radiology, 97(1158), 1067-1077.
https://doi.org/10.1093/bjr/tqae048
10. Manwar, R., Islam, M. T., Ranjbaran, S. M., & Avanaki, K. (2022). Transfontanelle photoacoustic imaging: Ultrasound transducer selection analysis. Biomedical Optics Express, 13(2), 676.
https://doi.org/10.1364/boe.446087
11. Ní Leidhin, C., Paddock, M., Parizel, P. M., Warne, R. R., Shipman, P., & Lakshmanan, R. (2025). Paediatric cranial ultrasound: Abnormalities of the brain in term neonates and young infants. Insights into Imaging, 16(1).
https://doi.org/10.1186/s13244-025-02031-4
12. Tierradentro-García, L. O., Saade-Lemus, S., Freeman, C., Kirschen, M., Huang, H., Vossough, A., & Hwang, M. (2021). Cerebral blood flow of the neonatal brain after hypoxic–ischemic injury. American Journal of Perinatology, 40(05), 475-488.
https://doi.org/10.1055/s-0041-1731278
13. Aun, A. E., Hassan, H. A., Ali, W. I., & Ataky, M. M. (2019). Transcranial ultrasound in comparison to MRI in evaluation of hypoxic ischemic injury in neonates. The Egyptian Journal of Hospital Medicine, 74(4), 842-852.
https://doi.org/10.21608/ejhm.2019.25263
14. Moolchandani, G., Moolchandani, J., Maheswari, J., D. M., Minhas, K., Islam, A., Mujahid, S. (2022). Prevalence of hypoxic ischemic encephalopathy among neonates in a tertiary care hospital Karachi. Ann Rom Soc Cell Biol. 26(1), 2642-2650.
http://www.annalsofrscb.ro/index.php/journal/article/view/11212/7934
15. Khan, M. W., Wahid, G., Ihtesham, R., Badshah, U., Khan, S., & Iftikhar, S. (2025). To determine the diagnostic accuracy of transcranial ultrasound in the detection of hypoxic ischemic injury in neonates keeping magnetic resonance imaging as a gold standard. Khyber Journal of Medical Sciences, 18(1), 16-22.
https://doi.org/10.70520/kjms.v18i1.519
16. Zhu, X., Li, Y., Xia, W., & Wang, W. (2024). Diagnostic accuracy of transcranial ultrasonography for detecting stenosis in patients with acute ischaemic stroke: a systematic review and meta-analysis. Medical Ultrasonography, 27(3).
https://doi.org/10.11152/mu-4413
17. Sheikh, M., & Shabbir, S. (2024). Diagnostic accuracy of cranial ultrasound for the detection of intracranial hemorrhage in preterm neonates using magnetic resonance imaging as the gold standard. Cureus.
https://doi.org/10.7759/cureus.73732
18. Maji, S., Roy, A., Dhir, Y. R., & Karim, R. (2023). Predictive accuracy of trans-cranial ultrasound and diffusion–weighted magnetic resonance imaging in detection of hypoxic ischemic encephalopathy among early neonates (first 7 days). Int J Acad Med Pharm, 5(3), 2149-55.
19. Sinha, T., Maji, S., & Karim, R. (2025). A comparative study between Mri and Transcranial Usg in Etiological diagnosis of neonatal seizure. Journal of Neonatal Surgery, 14(9S), 1088-1098.
https://doi.org/10.63682/jns.v14i9s.9108
20. SOHAIL, M., SARWAR, S., & ZAIDI, H. (2023). Positive predictive value of transcranial ultrasound in evaluation of hypoxic-ischemic encephalopathy keeping mri as a gold standard. Biological and Clinical Sciences Research Journal, 2023(1).
https://doi.org/10.54112/bcsrj.v2023i1.379
21. Thakkar, H., Sonone, S., & Khodke, R. (2019). Transcranial ultrasound in evaluation of hypoxic-ischemic encephalopathy and bleed in preterm neonates. Int J Sci Stud. 7(4), 27-38.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Indus Journal of Bioscience Research

This work is licensed under a Creative Commons Attribution 4.0 International License.