Lenticulostriate vasculopathy in extremely low gestational age newborns: Inter-rater variability of cranial ultrasound readings, antecedents and postnatal characteristics

Article type: Research Article

Authors: Sisman, Julide | Logan, J. Wells^; | Westra, Sjirk J.^; | Allred, Elizabeth N.^{; ;} | Leviton, Alan^;

Affiliations: Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA | Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Nationwide Children's Hospital, Columbus, OH, USA | Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Ohio State University Medical Center, Columbus, OH, USA | Department of Radiology, Harvard Medical School, Boston, MA, USA | Department of Radiology, Massachusetts General Hospital for Children, Boston, MA, USA | Department of Biostatistics, Harvard School of Public Health, Boston, MA, USA | Department of Neurology, Boston Children's Hospital, Boston, MA, USA | Department of Neurology, Harvard Medical School, Boston, MA, USA

Note: [] Correspondence: Julide Sisman, MD, Department of Pediatrics, Division of Neonatal-Perinatal Medicine, 5323 Harry Hines Blvd., University of Texas Southwestern Medical Center, Dallas, TX 75390-9063, USA. Tel.: +1 214 648 3903; Fax: +1 214 648 2481; E-mail: [email protected]

Abstract: Although lenticulostriate vasculopathy (LSV) was first detected on a cranial ultrasound nearly 30 years ago, its clinical implications and significance remain unknown. The objective of this study was to evaluate the inter-rater reliability of cranial ultrasound readings of LSV, and to explore relationships with potential antecedents and developmental correlates in extremely low gestational age newborns. Of the 1506 infants enrolled during the years 2002–2004, 1450 had at least one set of ultrasound scans evaluated for LSV and 939 had all three sets. To evaluate the inter-rater agreement for identifying LSV, we compared readings from two independent radiologists on days 1–4, 5–14, and on or after day 15. We then evaluated the relationships between LSV and maternal, antenatal, and postnatal characteristics. Our results showed that kappa values were 0.18, 0.33, and 0.36 on days 1–4, days 5–14, and day 15 or greater. Infants who were identified as LSV positive by two readers had higher Score for Neonatal Acute Physiology-II (an illness severity indicator), higher rates of tracheal infection and bacteremia, lower partial pressure of arterial oxygen and pH levels on 2 of the first 3 postnatal days, and they were more likely to have a lower psychomotor development index at age 2 years. Positive agreement on the presence of LSV was low, as was the kappa value, an index of inter-rater reliability. Infants with high illness severity scores and their correlates were at increased risk of developing LSV, while those who develop LSV appear to be at increased risk of motor dysfunction.

Keywords: Lenticulostriate vasculopathy, cranial ultrasound, thalamus, basal ganglia

DOI: 10.3233/JPN-140661

Journal: Journal of Pediatric Neurology, vol. 12, no. 4, pp. 183-193, 2014