ACCURACY OF CRANIAL SONOGRAPHY IN IDENTIFYING HYPOXIC-ISCHEMIC ENCEPHALOPATHY IN PRETERM INFANTS COMPARED WITH MRI

Abstract

Background: Hypoxic-ischemic encephalopathy (HIE) is a significant neonatal cause of morbidity and mortality, especially in premature babies. Magnetic resonance imaging (MRI) is the gold standard for diagnosis of HIE, but because of limited availability, cost and logistical issues, other imaging modalities may be required. Although cranial sonography is a portable, easily available and cost-effective modality, some studies report that it is not as accurate as others. Objective: To compare the diagnostic value of sonography in the head with MRI as the standard for the diagnosis of HIE in infants suspected of having HIE. Duration and Place of study: This study was conducted at Fatima Jinnah Institute of Chest Disease Quetta from June 2025 to June 2026. Data collection Method: Cross-sectional study. Materials and Methods: A cross-sectional validation study of 150 premature neonates who were clinically suspected of having HIE. Cranial ultrasonography was performed on all infants followed by MRI. The results of the cranial sonography were correlated with those of MRI and sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy were calculated. Results: 150 neonates were studied by cranial sonography and MRI. 98 were diagnosed with HIE by cranial ultrasound, whereas, 104 were diagnosed on MRI. Cranial ultrasound was found to be 84.6% sensitive, 78.0% specific, 89.8% PPV, 68.4% NPV and 82.0% overall diagnostic accuracy when compared to MRI. The results suggest high agreement between cranial sonography and MRI, especially when HIE is considered to be moderate or severe. Conclusions: Cranial sonography was effective in the diagnosis of HIE in premature infants and can be used as an effective imaging modality where MRI is not available or suitable. There are, however, some limitations in the detection of subtle or deep brain lesions that emphasizes the need for additional studies that include long term neurodevelopmental outcomes and MRI correlation to further strengthen evidence for its diagnostic usefulness.