Modern Head Ultrasound: Normal Anatomy, Variants, and Pitfalls That May Simulate Disease

Correlation between increased serum malondialdehyde and spectrum of cranial ultrasonography findings in hypoxic ischemic encephalopathy: could it be used as a predictor of disease severity?

Background

Hypoxic ischemic encephalopathy (HIE) is a major cause of mortality and morbidity in neonates. Malondialdehyde (MDH) is a colorless lipid that can be used as a marker for oxidative stress. Cranial ultrasound sensitivity and specificity in detection of neonatal HIE ought to be further investigated. This study aims to detect whether serum (MDH) can be used as an indicator for HIE severity and to assess the role of cranial ultrasound in diagnosis of HIE neurological disorders, correlating ultrasound findings to MDA levels.

Results

Statistically significant differences were found between the serum MDA levels in patients compared to controls as well as among serum MDA in patients with advancing Sarnat stages (I, II, III) P value < 0.001. Statistically significant levels of serum MDA were found in patients with ischemic US findings compared to those with normal scan; 36.4% of cases with ischemic US findings were diagnosed as Sarnat stage II while 63.6% were diagnosed with stage III with a statistically significant difference (P = 0.016).

Conclusion

Cranial ultrasound can be used for diagnosis of neonatal hypoxic ischemic insults, with lower sensitivity in mild cases and increased sensitivity in severe cases; and when combined with measuring serum MDA levels, it can be used as a diagnostic marker and as a predictor for severity of HIE.

State-of-the-art cranial sonography: Part 1, modern techniques and image interpretation

OBJECTIVE

In this era of radiation awareness, high-quality ultrasound is more important than ever. Although cranial sonography equipment has advanced greatly, application of modern techniques has not been utilized in a fashion commensurate to other cross-sectional modalities. This article will describe modern cranial sonography techniques, including the utility of linear imaging, use of additional fontanels, and screening Doppler imaging.

CONCLUSION

When modern protocols are used, cranial sonography is highly accurate for the detection of cranial abnormalities.

State-of-the-art cranial sonography: Part 2, pitfalls and variants

OBJECTIVE

In the first part of this article, modern cranial sonography techniques and interpretation were discussed, emphasizing ways in which the application of modern imaging technology and techniques are able to enhance detection of pathologic abnormalities on cranial sonography.

CONCLUSION

In this part of the article, we will describe pitfalls and variants that may be confused with pathologic abnormalities. Emphasis will be placed on recognizing normal variations and distinguishing them from pathologic abnormalities that may require additional imaging or clinical follow-up.