Extensive cystic leucomalacia: Correlation of cranial ultrasound, magnetic resonance imaging and clinical findings in sequential studies

Cranial ultrasound (US) was used in 14 neonates to define three categories of extensive cystic leucomalacia, namely periventricular, mixed, and subcortical. The initial US findings were compared with serial magnetic resonance imaging (MRI) and the neurodevelopmental outcome of the children. In the infants with periventricular leucomalacia, MRI showed a decrease in the size of the cystic areas with age. Six of these seven children showed an increase in the level of myelination upon follow-up examination, although white matter development was slower in the vicinity of the cysts. The lateral ventricles of these children were slightly enlarged and the occipital horns showed an irregular angular outline. In the infants with mixed leucomalacia, MRI showed cystic areas which remained obvious at the final examination. Myelination was grossly delayed in these patients. The lateral ventricles were enlarged and remained unchanged, with the exception of one infant whose ventricles collapsed after shunt revision. In the three children with subcortical leucomalacia, MRI confirmed shrinkage of the cysts in two of the three infants upon the first follow-up examination but thereafter the cysts remained unchanged. No supratentorial myelination was demonstrated in these patients. The ventricles were enlarged and the cortical sulci were prominent in all these infants. A strong correlation was shown between the MRI appearances and the clinical outcome in these children. MRI may be most useful for making the diagnosis of cystic leucomalacia in children not submitted to US examination as neonates or in whom only some of the classical US features have been identified.