Cystic Periventricular Leukomalacia in the Neonate: Analysis of Sequential Sonographic Findings and Neurologic Outcomes

ABSTRACT

PURPOSE: To analyse the sequential sonographic findings of cystic PVL and to evaluate relationship between sonographic grading of PVL and patterns of neurologic outcomes. MATERIALS AND METHODS: Authors have retrospectively analysed the sequential sonographic findings of 36 cases of PVL in the preterm neonates. Initial sonographic features done within 3 days of life were divided into 3 patterns such as normal, localized, and diffuse hyperechogenic flare. Grading of PVL confirmed by follow-up studies was classified as involvement of one lobe (grade 1), two lobes (grade 2) and more than extent of grade 2(grade 3). The relationship between sonographic grading of leukomalacia and later neurologic outcomes were also analysed. RESULTS: Initial sonographic patterns according to grading of PVL were normal pattern in seven of nine (77.8%) of grade 1, diffuse hyperechogenic flares in five of eight cases of grade 2 and in 13 of 16 cases of grade 3. There was a significant difference bewteen the grades and frequency of pattern of diffuse hyperechoic flare (p=0.021). Average detection timing of cystic PVL was 38.4+/-18.9 days in grade 1, 29.8+/-14 days in grade 2, and 19.1+/-5.6 days in grade 3 with a significant statistical difference between the detection time and grades (p=0.037). Cerebral palsy has occurred in 62.5% of grade 1 and 100% of grade 2 and grade 3 (p=0.043). Frequency of spastic quadriplegia was higher in grade 3 (76.5%) than in grade 1 (25%) and grade 2 (12.5%) (p=0.001). CONCLUSION: Most of grade 1 cystic PVL revealed normal pattern of white matter echogenicity in initial ultrasonography and needed follow up examination over one month period. Spastic quadriplegia occured mainly in patients with grade 3 cystic PVL.