To evaluate the sensitivity and specificity of head ultrasound (HUS) in the detection of intracranial hemorrhage in premature neonates compared with brain MRI using susceptibility-weighted imaging (SWI).

Ultrasound (US) and MRI scans of the brain using SWI in premature neonates were retrospectively evaluated for grade I–III germinal matrix hemorrhage (GMH), periventricular hemorrhagic infarction (PVHI), intra-axial hemorrhage other than PVHI, extra-axial hemorrhage in each cerebral hemisphere and cerebellar hemorrhage in each cerebellar hemisphere. The impact of these hemorrhagic findings on short-term clinical management was also reviewed.

Twelve neonates (mean age: 9.8 days; range: 3–23 days) with a mean gestational age of 32.8 weeks (range: 29.6–35.4 weeks) were included in the study. HUS had high sensitivity (100%) and specificity (93.3%) in detecting grade III GMH using SWI as a reference, but poor sensitivity (0%) in the detection of intraventricular hemorrhage with normal-sized ventricles (grade II GMH). US was not sensitive in detecting either small cerebellar or extra-axial hemorrhage.

HUS was highly sensitive and specific in the evaluation of grade III GMH, whereas SWI was superior to HUS in detecting small intra-axial or extra-axial hemorrhage, and had no impact on short-term management. Given the low cost, lack of radiation and advantages of bedside evaluation, HUS should continue to be the first line of imaging for brain injury in the evaluation of premature neonates with suspected intracranial hemorrhage. However, the usefulness of SWI for predicting long-term neurological outcomes has yet to be determined.