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Tang L, Li Q, Xiao F, Gao Y, Zhang P, Cheng G, Wang L, Lu C, Ge M, Hu L, Xiao T, Yin Z, Yan K, Zhou W. Neurosonography: Shaping the future of neuroprotection strategies in extremely preterm infants. Heliyon 2024; 10:e31742. [PMID: 38845994 PMCID: PMC11154624 DOI: 10.1016/j.heliyon.2024.e31742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 05/13/2024] [Accepted: 05/21/2024] [Indexed: 06/09/2024] Open
Abstract
This review aims to explore the current application of Cranial Ultrasound Screening (CUS) in the diagnosis and treatment of brain diseases in extremely preterm infants. It also discusses the potential role of emerging ultrasound-derived technologies such as Super Microvascular Structure Imaging (SMI), Shear Wave Elastography (SWE), Ultrafast Doppler Ultrasound (UfD), and 3D ventricular volume assessment and automated segmentation techniques in clinical practice. A systematic search of medical databases was conducted using the keywords "(preterm OR extremely preterm OR extremely low birth weight) AND (ultrasound OR ultrasound imaging) AND (neurodevelopment OR brain development OR brain diseases OR brain injury OR neuro*)" to identify relevant literature. The titles, abstracts, and full texts of the identified articles were carefully reviewed to determine their relevance to the research topic. CUS offers unique advantages in early screening and monitoring of brain diseases in extremely preterm infants, as it can be performed at the bedside without the need for anesthesia or special monitoring. This technique facilitates early detection and intervention of conditions such as intraventricular hemorrhage, white matter injury, hydrocephalus, and hypoxic-ischemic injury in critically ill preterm infants. Continuous refinement of the screening and follow-up processes provides reliable clinical decision-making support for healthcare professionals and parents. Emerging ultrasound technologies, such as SWE, SMI, and UfD, are being explored to provide more accurate and in-depth understanding of brain diseases in extremely preterm infants. SWE has demonstrated its effectiveness in assessing the elasticity of neonatal brain tissue, aiding in the localization and quantification of potential brain injuries. SMI can successfully identify microvascular structures in the brain, offering a new perspective on neurologic diseases. UfD provides a high-sensitivity and quantitative imaging method for the prevention and treatment of neonatal brain diseases by detecting subtle changes in red blood cell movement and accurately assessing the status and progression of brain diseases. CUS and its emerging technologies have significant applications in the diagnosis and treatment of brain diseases in extremely preterm infants. Future research aims to address current technical challenges, optimize and enhance the clinical decision-making capabilities related to brain development, and improve the prevention and treatment outcomes of brain diseases in extremely preterm infants.
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Affiliation(s)
- Lukun Tang
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
- Kunming Medical University Affiliated Dehong Hospital, Dehong, Yunnan, China
- Graduate School, Kunming Medical University, Kunming, Yunnan, China
| | - Qi Li
- Department of Intensive Care Medicine, The Sixth Medical Center of PLA General Hospital, China
| | - Feifan Xiao
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
| | - Yanyan Gao
- Department of Ultrasound, Children's Hospital of Fudan University, China
| | - Peng Zhang
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
| | - Guoqiang Cheng
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
| | - Laishuan Wang
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
| | - Chunmei Lu
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
- Department of Nursing, Children's Hospital of Fudan University, China
| | - Mengmeng Ge
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
| | - Liyuan Hu
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
| | - Tiantian Xiao
- Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Zhaoqing Yin
- Kunming Medical University Affiliated Dehong Hospital, Dehong, Yunnan, China
- Graduate School, Kunming Medical University, Kunming, Yunnan, China
| | - Kai Yan
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
| | - Wenhao Zhou
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
- Key Laboratory of Neonatology, National Health Care Commission, Shanghai, China
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Faure F, Alison M, Francavilla M, Boizeau P, Guilmin Crepon S, Lim C, Planchette G, Prigent M, Frérot A, Tanter M, Demené C, Baud O, Biran V. Transfontanellar shear wave elastography of the neonatal brain for quantitative evaluation of white matter damage. Sci Rep 2024; 14:11827. [PMID: 38782968 PMCID: PMC11116529 DOI: 10.1038/s41598-024-60968-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 04/29/2024] [Indexed: 05/25/2024] Open
Abstract
Cerebral white matter damage (WMD) is the most frequent brain lesion observed in infants surviving premature birth. Qualitative B-mode cranial ultrasound (cUS) is widely used to assess brain integrity at bedside. Its limitations include lower discriminatory power to predict long-term outcomes compared to magnetic resonance imaging (MRI). Shear wave elastography (SWE), a promising ultrasound imaging modality, might improve this limitation by detecting quantitative differences in tissue stiffness. The study enrolled 90 neonates (52% female, mean gestational age = 30.1 ± 4.5 weeks), including 78 preterm and 12 term controls. Preterm neonates underwent B-mode and SWE assessments in frontal white matter (WM), parietal WM, and thalami on day of life (DOL) 3, DOL8, DOL21, 40 weeks, and MRI at term equivalent age (TEA). Term infants were assessed on DOL3 only. Our data revealed that brain stiffness increased with gestational age in preterm infants but remained lower at TEA compared to the control group. In the frontal WM, elasticity values were lower in preterm infants with WMD detected on B-mode or MRI at TEA and show a good predictive value at DOL3. Thus, brain stiffness measurement using SWE could be a useful screening method for early identification of preterm infants at high WMD risk.Registration numbers: EudraCT number ID-RCB: 2012-A01530-43, ClinicalTrial.gov number NCT02042716.
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Affiliation(s)
- Flora Faure
- Institute Physics for Medicine Paris, Inserm U1273, ESPCI Paris, CNRS UMR 8063, PSL University, 75015, Paris, France
| | - Marianne Alison
- Assistance Publique-Hôpitaux de Paris, Pediatric Radiology Department, Robert Debré University Hospital, 75019, Paris, France
| | | | - Priscilla Boizeau
- Assistance Publique-Hôpitaux de Paris, Unit of Clinical Epidemiology, Inserm U1123 and CIC-EC 1426, Robert Debré Children's Hospital, University of Paris Cité, Paris, France
| | - Sophie Guilmin Crepon
- Assistance Publique-Hôpitaux de Paris, Unit of Clinical Epidemiology, Inserm U1123 and CIC-EC 1426, Robert Debré Children's Hospital, University of Paris Cité, Paris, France
| | - Chung Lim
- Assistance Publique-Hôpitaux de Paris, Pediatric Radiology Department, Robert Debré University Hospital, 75019, Paris, France
| | - Gregory Planchette
- Assistance Publique-Hôpitaux de Paris, Pediatric Radiology Department, Robert Debré University Hospital, 75019, Paris, France
| | - Mickael Prigent
- Assistance Publique-Hôpitaux de Paris, Pediatric Radiology Department, Robert Debré University Hospital, 75019, Paris, France
| | - Alice Frérot
- Department of Neonatal Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Robert Debré Children's Hospital, Paris, France
| | - Mickael Tanter
- Institute Physics for Medicine Paris, Inserm U1273, ESPCI Paris, CNRS UMR 8063, PSL University, 75015, Paris, France
| | - Charlie Demené
- Institute Physics for Medicine Paris, Inserm U1273, ESPCI Paris, CNRS UMR 8063, PSL University, 75015, Paris, France
| | - Olivier Baud
- Division of Neonatology and Paediatric Intensive Care, Children's University Hospital of Geneva and University of Geneva, Geneva, Switzerland
| | - Valérie Biran
- Department of Neonatal Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Robert Debré Children's Hospital, Paris, France.
- Inserm U1141, University of Paris Cité, Paris, France.
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Močnik M, Marčun Varda N. Ultrasound Elastography in Children. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1296. [PMID: 37628295 PMCID: PMC10453784 DOI: 10.3390/children10081296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 07/25/2023] [Accepted: 07/26/2023] [Indexed: 08/27/2023]
Abstract
Ultrasound elastography is a novel ultrasound technique, being extensively researched in children in the last decade. It measures tissue elasticity with the observation of tissue response after an external stimulus. From research to clinical practice, ultrasound elastography has evolved significantly in liver fibrosis evaluation in children; however, several other applications of the technique are available in both clinical practice and research environments. Practically, in children any organ can be assessed, including the brain in early ages, along with muscle and connective tissue elasticity evaluation, spleen, kidney, skin, lymphatic tissue, etc. The elastography method, age, body mass index and technical points should be considered when performing ultrasound elastography. This review highlights its vast potential as a diagnostic tool in the pediatric population, where ultrasound is a dominant imaging tool; however, the indications and exam protocol for its clinical use in several fields in pediatrics have yet to be elucidated.
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Affiliation(s)
- Mirjam Močnik
- Department of Paediatrics, University Medical Centre Maribor, 2000 Maribor, Slovenia;
| | - Nataša Marčun Varda
- Department of Paediatrics, University Medical Centre Maribor, 2000 Maribor, Slovenia;
- Faculty of Medicine, University of Maribor, 2000 Maribor, Slovenia
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Ko TS, Catennacio E, Shin SS, Stern J, Massey SL, Kilbaugh TJ, Hwang M. Advanced Neuromonitoring Modalities on the Horizon: Detection and Management of Acute Brain Injury in Children. Neurocrit Care 2023; 38:791-811. [PMID: 36949362 PMCID: PMC10241718 DOI: 10.1007/s12028-023-01690-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 01/31/2023] [Indexed: 03/24/2023]
Abstract
Timely detection and monitoring of acute brain injury in children is essential to mitigate causes of injury and prevent secondary insults. Increasing survival in critically ill children has emphasized the importance of neuroprotective management strategies for long-term quality of life. In emergent and critical care settings, traditional neuroimaging modalities, such as computed tomography and magnetic resonance imaging (MRI), remain frontline diagnostic techniques to detect acute brain injury. Although detection of structural and anatomical abnormalities remains crucial, advanced MRI sequences assessing functional alterations in cerebral physiology provide unique diagnostic utility. Head ultrasound has emerged as a portable neuroimaging modality for point-of-care diagnosis via assessments of anatomical and perfusion abnormalities. Application of electroencephalography and near-infrared spectroscopy provides the opportunity for real-time detection and goal-directed management of neurological abnormalities at the bedside. In this review, we describe recent technological advancements in these neurodiagnostic modalities and elaborate on their current and potential utility in the detection and management of acute brain injury.
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Affiliation(s)
- Tiffany S Ko
- Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, Philadelphia, USA.
| | - Eva Catennacio
- Division of Neurology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Samuel S Shin
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - Joseph Stern
- Department of Radiology, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, USA
| | - Shavonne L Massey
- Division of Neurology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Todd J Kilbaugh
- Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Misun Hwang
- Department of Radiology, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, USA
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Yang H, Li H, Liao J, Yuan X, Shi C, Liang W. Compression Elastography and Shear Wave Ultrasound Elastography for Measurement of Brain Elasticity in Full-Term and Premature Neonates: A Prospective Study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:221-231. [PMID: 35929079 DOI: 10.1002/jum.16075] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 07/18/2022] [Accepted: 07/21/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES To investigate the brain tissue elasticity in normal term and premature neonates using compression elastography and shear wave elastography. METHODS This prospective observational study enrolled term and premature neonates admitted to the Third Affiliated Hospital of Guangzhou Medical University between July 2019 and December 2020. RESULTS A total of 106 neonates, including 65 premature neonates and 41 term neonates, were enrolled. The elastic modulus of the frontal white matter in males was significantly lower than in females (11.67 ± 0.98 versus 12.25 ± 1.31, P = .030), but the shear wave velocity of the thalamus in males was significantly lower than in females (1.18 ± 0.13 versus 1.82 ± 0.10, P < .001). There was no significant correlation between real-time body weight and brain tissue elasticity including elastic modulus and shear wave velocity. But, the shear wave velocity of parietal white matter (r = 0.319, P = .014) and thalamus (r = -0.268, P = .040) and the elastic modulus of parietal white matter (r = 0.356, P = .006) were correlated with corrected gestational age. CONCLUSIONS Clinicians may consider using elastography to determine brain tissue elasticity in term and preterm neonates.
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Affiliation(s)
- Huihui Yang
- Department of Medical Imaging Center, The First Affiliated Hospital of Jinan University, Guangdong, China
- Department of Ultrasound Medicine, The Third Affiliated Hospital of Guangzhou Medical University, Guangdong, China
| | - Huibing Li
- Department of Neurosurgery, Guangdong 999 Brain Hospital, Guangdong, China
| | - Jianyi Liao
- Department of Ultrasound Medicine, The Third Affiliated Hospital of Guangzhou Medical University, Guangdong, China
| | - Xiaoyan Yuan
- Department of Ultrasound Medicine, The Third Affiliated Hospital of Guangzhou Medical University, Guangdong, China
| | - Changzheng Shi
- Department of Medical Imaging Center, The First Affiliated Hospital of Jinan University, Guangdong, China
| | - Weixiang Liang
- Department of Ultrasound Medicine, The Third Affiliated Hospital of Guangzhou Medical University, Guangdong, China
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Hwang M, Zhang Z, Katz J, Freeman C, Kilbaugh T. Brain contrast-enhanced ultrasonography and elastography in infants. Ultrasonography 2022; 41:633-649. [PMID: 35879109 PMCID: PMC9532200 DOI: 10.14366/usg.21224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 03/20/2022] [Accepted: 03/30/2022] [Indexed: 11/19/2022] Open
Abstract
Advanced ultrasound techniques, including brain contrast-enhanced ultrasonography and elastography, are increasingly being explored to better understand infant brain health. While conventional brain ultrasonography provides a convenient, noninvasive means of assessing major intracranial pathologies, its value in revealing functional and physiologic insights into the brain lags behind advanced imaging techniques such as magnetic resonance imaging. In this regard, contrast-enhanced ultrasonography provides highly precise functional information on macrovascular and microvascular perfusion, while brain elastography offers information on brain stiffness that may be associated with relevant physiological factors of diagnostic, therapeutic, and/or prognostic utility. This review details the technical background, current understanding and utility, and future directions of these two emerging advanced ultrasound techniques for neonatal brain applications.
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Affiliation(s)
- Misun Hwang
- Department of Radiology, Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Zeng Zhang
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Joseph Katz
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Colbey Freeman
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Todd Kilbaugh
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Hwang M, Tierradentro-García LO, Hussaini SH, Cajigas-Loyola SC, Kaplan SL, Otero HJ, Bellah RD. Ultrasound imaging of preterm brain injury: fundamentals and updates. Pediatr Radiol 2022; 52:817-836. [PMID: 34648071 DOI: 10.1007/s00247-021-05191-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/22/2021] [Accepted: 08/12/2021] [Indexed: 11/25/2022]
Abstract
Neurosonography has become an essential tool for diagnosis and serial monitoring of preterm brain injury. Preterm infants are at significantly higher risk of hypoxic-ischemic injury, intraventricular hemorrhage, periventricular leukomalacia and post-hemorrhagic hydrocephalus. Neonatologists have become increasingly dependent on neurosonography to initiate medical and surgical interventions because it can be used at the bedside. While brain MRI is regarded as the gold standard for detecting preterm brain injury, neurosonography offers distinct advantages such as its cost-effectiveness, diagnostic utility and convenience. Neurosonographic signatures associated with poor long-term outcomes shape decisions regarding supportive care, medical or behavioral interventions, and family members' expectations. Within the last decade substantial progress has been made in neurosonography techniques, prompting an updated review of the topic. In addition to the up-to-date summary of neurosonography, this review discusses the potential roles of emerging neurosonography techniques that offer new functional insights into the brain, such as superb microvessel imaging, elastography, three-dimensional ventricular volume assessment, and contrast-enhanced US.
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Affiliation(s)
- Misun Hwang
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Luis O Tierradentro-García
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Syed H Hussaini
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Stephanie C Cajigas-Loyola
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Summer L Kaplan
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Hansel J Otero
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Richard D Bellah
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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8
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Freeman CW, Hwang M. Advanced Ultrasound Techniques for Neuroimaging in Pediatric Critical Care: A Review. CHILDREN (BASEL, SWITZERLAND) 2022; 9:170. [PMID: 35204891 PMCID: PMC8870205 DOI: 10.3390/children9020170] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/24/2022] [Accepted: 01/26/2022] [Indexed: 12/31/2022]
Abstract
Because of its portability, safety profile, and accessibility, ultrasound has been integral in pediatric neuroimaging. While conventional B-mode and Doppler ultrasound provide anatomic and limited flow information, new and developing advanced ultrasound techniques are facilitating real-time visualization of brain perfusion, microvascular flow, and changes in tissue stiffness in the brain. These techniques, which include contrast-enhanced ultrasound, microvascular imaging, and elastography, are providing new insights into and new methods of evaluating pathologies affecting children requiring critical care, including hypoxic-ischemic encephalopathy, stroke, and hydrocephalus. This review introduces advanced neurosonography techniques and their clinical applications in pediatric neurocritical care.
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Affiliation(s)
- Colbey W. Freeman
- Department of Radiology, University of Pennsylvania Health System, Philadelphia, PA 19104, USA;
| | - Misun Hwang
- Department of Radiology, University of Pennsylvania Health System, Philadelphia, PA 19104, USA;
- Department of Radiology, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
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Wang J, Zhang Z, Xu X, Lu X, Wu T, Tong M. Real-time shear wave elastography evaluation of the correlation between brain tissue stiffness and body mass index in premature neonates. Transl Pediatr 2021; 10:3230-3236. [PMID: 35070837 PMCID: PMC8753477 DOI: 10.21037/tp-21-513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 12/14/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Real-time shear wave elastography (SWE) is non-invasive and reliable for quantitatively evaluate stiffness of tissues and organs. Until now, little researches have applied SWE to evaluate brain tissue of premature neonates. This study sought to compare differences in the average brain tissue elasticity modulus (Emean) values of neonates, and explore the factors affecting these differences. METHODS In total, 159 neonates admitted from December 2019 to February 2021 were taken as the study subjects and divided into 2 groups based on their time of birth. Premature neonates, full-term neonates, and neonates with neonatal pneumonia were included in this study. Of the 159 neonates, 76 were premature and 83 were full-term. SWE was used to quantitatively evaluate the Emean of bilateral paraventricular white matter, thalamus, and choroid, and to analyze the relationship between body mass index (BMI) and Emeans in both groups of neonates. RESULTS The Emeans of the paraventricular white matter, thalamus, and choroid of the premature neonates were lower than those of the full-term neonates (P<0.001). The BMI of the premature and full-term neonates was positively correlated to the bilateral paraventricular white matter, thalamus, and choroid Emean. CONCLUSIONS SWE can be used to quantitatively evaluate the brain tissue stiffness of neonates, and as a reference for neonatal brain-related diseases.
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Affiliation(s)
- Jiabing Wang
- Department of Pediatric Functional Examination, Lanzhou University Second Hospital, Lanzhou, China
| | - Zhilong Zhang
- Department of Radiotherapy, Lanzhou University Second Hospital, Lanzhou, China
| | - Xin Xu
- Department of Pediatric Functional Examination, Lanzhou University Second Hospital, Lanzhou, China
| | - Xuefeng Lu
- Department of Pediatric Functional Examination, Lanzhou University Second Hospital, Lanzhou, China
| | - Tingting Wu
- Department of Pediatric Functional Examination, Lanzhou University Second Hospital, Lanzhou, China
| | - Minghui Tong
- Department of Pediatric Functional Examination, Lanzhou University Second Hospital, Lanzhou, China
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Garcés Iñigo E, Llorens Salvador R, Escrig R, Hervás D, Vento M, Martí-Bonmatí L. Quantitative Evaluation of Neonatal Brain Elasticity Using Shear Wave Elastography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:795-804. [PMID: 32876366 DOI: 10.1002/jum.15464] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 07/09/2020] [Accepted: 07/12/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To demonstrate the feasibility of 2-dimensional brain ultrasound shear wave elastography (SWE) and to define the average elasticity values of the gray and white matter in term neonates. METHODS This work was a prospective observational single-center study including 55 healthy term neonates consecutively recruited in the maternity ward between the second and third postnatal days. All were successfully evaluated with a cerebral SWE examination performed with a multifrequency 4-9-MHz transducer. Bilateral sagittal planes of the thalamus and corona radiata were used to measure stiffness using a quantitative SWE method. Several elastograms with 5 to 15 nonoverlapping areas were obtained from the 2 different anatomic locations. The 5 most central measurements were averaged as representative values. RESULTS The 55 neonates ranged from 37 to 40 weeks' gestation. The estimated mean velocity values of the thalamus (1.17 m/s; 95% confidence interval, 1.13, 1.22 m/s) and corona radiata (1.60 m/s; 95% confidence interval, 1.57, 1.64 m/s) were statistically different (P < .001). There was no significant influence of laterality, gestational age, cephalic perimeter, sex, length, or type of delivery on the stiffness measurements. CONCLUSIONS Brain ultrasound SWE is feasible and allows measurements of neonatal brain elasticity. The elasticity of the thalamus and corona radiata at the frontal white matter in healthy term neonates is different. The knowledge of normal SWE ranges in term neonates allows comparative studies under pathologic conditions.
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Affiliation(s)
| | | | - Raquel Escrig
- Department of Pediatrics, Neonatal Research Unit, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - David Hervás
- Data Science, Biostatistics, and Bioinformatics Platform, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Máximo Vento
- Department of Pediatrics, Neonatal Research Unit, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Luis Martí-Bonmatí
- Department of Radiology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
- Research Group on Biomedical Imaging, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
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11
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Mathon B, Clemenceau S, Carpentier A. Intraoperative Ultrasound Shear-Wave Elastography in Focal Cortical Dysplasia Surgery. J Clin Med 2021; 10:jcm10051049. [PMID: 33802551 PMCID: PMC7961510 DOI: 10.3390/jcm10051049] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 02/15/2021] [Accepted: 02/28/2021] [Indexed: 12/31/2022] Open
Abstract
Previous studies reported interest in intraoperative shear-wave elastography (SWE) guidance for brain-tumor and epilepsy surgeries. Focal cortical dysplasia (FCD) surgery is one of the most appropriate indications for using SWE guidance. The aim of this study was to evaluate the efficacy of ultrasound SWE techniques for the intraoperative detection of FCDs. We retrospectively analyzed data from 18 adult patients with drug-resistant epilepsy associated with FCD who had undergone SWE-guided surgery. Conventional B-mode images detected FCD in 2 patients (11.1%), while SWE detected FCD in 14 patients (77.8%). The stiffness ratios between MRI-positive and -negative cases were significantly different (3.6 ± 0.4 vs. 2.2 ± 0.6, respectively; p < 0.001). FCDs were significantly more frequently detected by interoperative SWE in women (OR 4.7, 95% CI (1.7–12.7); p = 0.004) and in patients in whom FCD was visible on magnetic resonance imaging (MRI; OR 2.3, 95% CI (1.3–4.3); p = 0.04). At 1 year after surgery and at last follow-up (mean = 21 months), seizure outcome was good (International League Against Epilepsy (ILAE) Class 1 or 2) in 72.2% and 55.6% of patients, respectively. Despite some limitations, our study highlighted the potential of SWE as an intraoperative tool to detect FCD. Future technical developments should allow for optimizing intraoperative surgical-cavity evaluation from the perspective of complete FCD resection. Interobserver reliability of SWE measurements should also be assessed by further studies.
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Affiliation(s)
- Bertrand Mathon
- Department of Neurosurgery, La Pitié-Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris, 75013 Paris, France; (S.C.); (A.C.)
- Faculty of Medicine, Sorbonne University, 75005 Paris, France
- Paris Brain Institute (ICM, INSERM, UMRS 1127, CNRS, UMR 7225), 75013 Paris, France
- Correspondence: ; Tel.: +33-1-4216-3408
| | - Stéphane Clemenceau
- Department of Neurosurgery, La Pitié-Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris, 75013 Paris, France; (S.C.); (A.C.)
| | - Alexandre Carpentier
- Department of Neurosurgery, La Pitié-Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris, 75013 Paris, France; (S.C.); (A.C.)
- Faculty of Medicine, Sorbonne University, 75005 Paris, France
- Paris Brain Institute (ICM, INSERM, UMRS 1127, CNRS, UMR 7225), 75013 Paris, France
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Ultrasound Elastography: Review of Techniques, Clinical Application, Technical Limitations, and Safety Considerations in Neonatology. ACTA MEDICA MARTINIANA 2020. [DOI: 10.2478/acm-2020-0009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Abstract
Ultrasound elastography is a relatively new non-invasive diagnostic imaging technology that maps elastic properties and the stiffness of soft tissue. In general, these methods can be classified into strain imaging methods that use internal or external compression stimuli and a shear wave imaging that use ultrasound-generated travelling shear wave stimuli. In this review we describe the basics of ultrasound elastography, discuss differences between various ultrasound elastography techniques, and review advantages, limitations, and the safety of these techniques in clinical practice, especially in neonatology. Furthermore, we review the potential of application of elastography in revealing brain injury and characterizing age dependent differences in preterm and term infants.
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Fowlkes JB. Safety considerations for shear-wave elastography of the infant brain. Pediatr Radiol 2020; 50:905-906. [PMID: 32444952 DOI: 10.1007/s00247-020-04657-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 03/04/2020] [Accepted: 03/10/2020] [Indexed: 10/24/2022]
Affiliation(s)
- J Brian Fowlkes
- Basic Radiological Sciences Division, Department of Radiology, University of Michigan Health System, 3226C Medical Sciences Building I, 1301 Catherine St., Ann Arbor, MI, 48109, USA.
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