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. 2021 Mar 8;9:618236. doi: 10.3389/fped.2021.618236

Figure 7.

Figure 7

Spectrum of ischemic white matter injury. (A–C) Grade 1 WMI. Ultrasound scan in a preterm infant (GA 26 weeks) with transient abnormal white matter echodensities. (A,B) Coronal and left parasagittal scans show inhomogeneous moderately increased echogenicity (“flaring” or PVE) of the parietal periventricular white matter (arrows). No IVH. (C) Parasagittal scan 5 weeks later shows full resolution of the echodensities. White matter echogenicity is now homogeneous and normal, and no cysts developed. (D–F) Grade 2 WMI. Ultrasound scan in a preterm infant (GA 27 weeks). (D) Coronal scan at the level of the body of the lateral ventricles shows asymmetric inhomogeneous PVE (“flaring”) in the left parietal periventricular white matter (arrow). (E,F) Coronal and left parasagittal scans 9 weeks later showing small localized cystic lesions in the fronto-parietal white matter of both hemispheres (arrows). The tiny, right-sided cysts developed despite any convincing increased white matter echogenicity detected on early cUS exams. (G–I) Grade 3 WMI. Ultrasound scan in a preterm infant (GA 30 weeks with giant omphalocele partially repaired at day 4 of birth) with significant WMI. (G) Coronal scan 3 days after birth, at the level of the frontal horns of the lateral ventricles, shows only limited patchy areas of echodensity (arrows) not with certainty distinguishable from physiologic frontal echogenic areas in the periventricular white matter. No IVH. (H,I) Coronal and left parasagittal scans 4 weeks later show evolution of the WMI with extensive cystic lesions extending from the frontal white matter to the posterior parietal white matter (arrows) not expected by the only limited patchy echogenicity seen on day 3. The subcortical white matter is not involved. Dilated ventricles are passive in origin and resulting from tissue volume loss. (J–L) Grade 4 WMI. Ultrasound scan in a preterm infant (GA 25 weeks) with significant WMI. (J) Coronal scan 5 days after birth, at the level of the body of the lateral ventricles, shows patchy areas of echodensity (arrows) in the periventricular frontoparietal white matter. No IVH. (K,L) Coronal and right parasagittal scans 3 weeks later show evolution of the WMI with extensive cystic lesions extending from the frontal to the posterior parietal white matter. The progression of WMI could be recognized thanks to serial cUS exams as its severity was not expected by the limited patchy echodensity originally seen on day 5. Dilated lateral ventricles are passive in origin and result from tissue volume loss.