Diagnostic neuroimaging and early detection of germinal matrix hemorrhage-intraventricular hemorrhage

Germinal matrix hemorrhage-intraventricular hemorrhage (GMH-IVH) continues to be a common form of brain injury in very preterm infants. Cranial ultrasonography (cUS) is the most widely used neuroimaging modality for the diagnosis of GMH-IVH, and serial cUS enables early detection, accurate grading, and monitoring of complications. Brain magnetic resonance imaging (MRI) is being used more commonly in neonates and is superior to cUS for detecting subtle hemorrhages in the temporal and occipital regions, concurrent white matter injury, and cerebellar hemorrhage, as well as for providing prognostic information. Despite major advances in perinatology and neonatology, GMH-IVH remains associated with high rates of neurodevelopmental impairment, especially when complicated by progressive post-hemorrhagic ventricular dilatation or periventricular hemorrhagic infarction. In this review, we present the neuroimaging modalities used in the neonatal intensive care unit and their role in the detection of GMH-IVH, with a focus on preterm infants.