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Open Access 04-01-2025 | Magnetic Resonance Imaging | Original Article

Cerebellar hemorrhage in neonates: pattern analysis by ultrasonography and magnetic resonance imaging

Authors: Gayoung Choi, Young Hun Choi, Seul Bi Lee, Yeon Jin Cho, Seunghyun Lee, Jung-Eun Cheon, Seung Han Shin, Bo-Kyung Je

Published in: Pediatric Radiology

Abstract

Background

Cerebellar hemorrhage in neonates is increasingly being identified but is still underdiagnosed. While magnetic resonance imaging (MRI) is the optimal imaging modality for cerebellar hemorrhage evaluation, ultrasonography (US) is commonly used for screening. Characterizing the patterns and distribution of cerebellar hemorrhage lesions can help facilitate its detection by aiding to focus on prevailing type of cerebellar hemorrhage.

Objective

This study aimed to analyze the patterns of cerebellar hemorrhage in neonates, comparing US findings with MRI.

Materials and methods

This was a retrospective study of 765 neonatal intensive care unit (NICU)-admitted neonates who underwent brain MRI due to various clinical and radiological requirements. Two pediatric radiologists reviewed brain MRI and US in consensus, and cerebellar hemorrhage patterns were classified based on MRI findings: type 1, punctate cerebellar hemorrhage without cerebellar volume loss; type 2, focal cerebellar hemorrhage with cerebellar volume loss; type 3, ovoid/crescent cerebellar hemorrhage in the periphery of the cerebellar hemisphere; type 4, isolated vermian cerebellar hemorrhage; type 5, cerebellar hemorrhage involving almost the entire cerebellar hemisphere. The distribution and US detection rates of cerebellar hemorrhage were compared according to the cerebellar hemorrhage type.

Results

A total of 56 (33 male, 23 female) cases (7.32%) among 765 MRIs showed cerebellar hemorrhage (median gestational age, 27 + 1 weeks [IQR 5 + 2]; median birth weight, 955 g [IQR 882.5]). The most common pattern was type 1 (60.7%). Type 3 cerebellar hemorrhage was more commonly observed in the inferior and peripheral cerebellum compared to types 1 and 2 cerebellar hemorrhage (P=0.002). In retrospective review of images, type 3 was the most commonly missed type of cerebellar hemorrhage (initial US detection rate, 33.3%; retrospective US detection rate, 75%).

Conclusion

This study underscores the importance of understanding cerebellar hemorrhage patterns and suggests that careful inspection of inferior and periphery of the cerebellum is important to avoid missed diagnosis of cerebellar hemorrhage.

Graphical Abstract

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Title: Cerebellar hemorrhage in neonates: pattern analysis by ultrasonography and magnetic resonance imaging
Authors: Gayoung Choi
Young Hun Choi
Seul Bi Lee
Yeon Jin Cho
Seunghyun Lee
Jung-Eun Cheon
Seung Han Shin
Bo-Kyung Je
Publication date: 04-01-2025
Publisher: Springer Berlin Heidelberg
Keywords: Magnetic Resonance Imaging
Magnetic Resonance Imaging
Cranial MRI
Published in: Pediatric Radiology
Print ISSN: 0301-0449
Electronic ISSN: 1432-1998
DOI: https://doi.org/10.1007/s00247-024-06126-w

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Abstract

Background

Objective

Materials and methods

Results

Conclusion

Graphical Abstract

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