Usefulness of 3D sonography of the central nervous system in neonates and infants in the assessment of intracranial bleeding and its consequences when examined through the anterior fontanelle

Pediatri pratiğinde transfontanel ultrasonografi

Amaç: Bu çalışmada, pediatri pratiğinde çeşitli endikasyonlar nedeni ile transfontanel ultrasonografi (TFUSG) istenilen hastaların tanısal profilinin ortaya çıkarılması hedeflenmiştir. Gereç ve Yöntem: Bu çalışmada, 01.08.2019-18.10.2021 tarihleri arasında, Balıkesir Üniversitesi Tıp Fakültesi çocuk sağlığı ve hastalıkları ile çocuk nöroloji polikliniklerinde çeşitli endikasyonlar ile transfontanel ultrasonografi istenilen 0-2 yaş arasındaki hastaların dosyaları retrospektif olarak incelendi. TFUSG bulguları normal/normalin varyasyonları ve anormal olarak ikiye ayrıldı. Bulgular: 77’si (%42,1) kız ve 106’sı (%57,9) erkek olmak üzere toplam 183 olgu çalışmaya dahil edildi. Olguların yaş ortalaması 119,55±134,52 gün (1-700 gün) idi. En sık TFUSG istem nedenleri; çeşitli etiyolojiler (n=79, %43,2), nöbet (n=37, %20,2), ve yenidoğan yoğun bakım ünitesine yatış öyküsü (n=23, %12,6) idi. 30 (%16,4) olguda TFUSG anormal olarak raporlandı. En sık anormal TFUSG bulguları; beyin omurilik sıvısı (BOS) mesafelerinde genişleme (n=8,%4,4), hidrosefali (n=7, %3,8), subaraknoid mesafede genişleme (n=5, %2,7) idi. TFUSG normal veya anormal olanlar arasında cinsiyet, gestasyon yaşına göre doğum ağırlığı ve baş çevresi açısından istatiksel olarak anlamlı farklılık saptandı (p=0,007, p=0,048, p=0,00). Sonuç: 0-2 yaş arası hastalarda TFUSG bulgularında cinsiyet, gestasyon yaşına göre doğum ağırlığı ve baş çevresi açısından anlamlı farklılık saptanması çalışmamızı öne çıkaran özelliktir ve üzerinde daha kapsamlı çalışılması gereken bir bulgudur.

Development of a 3D printed patient-specific neonatal brain simulation model using multimodality imaging for perioperative management

BACKGROUND

Medical-imaging-based three-dimensional (3D) printed models enable improvement in skills training, surgical planning, and decision-making. This pilot study aimed to use multimodality imaging and to add and compare 3D ultrasound as a future standard to develop realistic neonatal brain models including the ventricular system.

METHODS

Retrospective computed tomography (CT), magnetic resonance imaging (MRI), and 3D ultrasound-based brain imaging protocols of five neonatal patients were analyzed and subsequently segmented with the aim of developing a multimodality imaging-based 3D printed model. The ventricular anatomy was analyzed to compare the MRI and 3D ultrasound modalities.

RESULTS

A realistic anatomical model of the neonatal brain, including the ventricular system, was created using MRI and 3D ultrasound data from one patient. T2-weighted isovoxel 3D MRI sequences were found to have better resolution and accuracy than 2D sequences. The surface area, anatomy, and volume of the lateral ventricles derived from both MRI and 3D ultrasound were comparable.

CONCLUSIONS

We created an ultrasound- and MRI-based 3D printed patient-specific neonatal brain simulation model that can be used for perioperative management. To introduce 3D ultrasound as a standard for 3D models, additional dimensional correlations between MRI and ultrasound need to be examined.

IMPACT

We studied the feasibility of implementing 3D ultrasound as a standard for 3D printed models of the neonatal brain. Different imaging modalities were compared and both 3D isotropic MRI and 3D ultrasound imaging are feasible for printing neonatal brain models with good dimensional accuracy and anatomical replication. Further dimensional correlations need to be defined to implement it as a standard to produce 3D printed models.

Pediatric encephalic ultrasonography: the essentials

Nowadays, cranial ultrasonography (US) of the newborn represents the first imaging method in brain damage study and its possible outcomes. This exam is performed using the natural fontanelles, especially the anterior one. It is fast, non-invasive and does not produce any side effect. Ultrasonographic examination is usually performed in cases of prematurity, especially in children with birth weight less than 1500 g, because important informations about the possible presence of pathologies such as cerebral hemorrhage and hypoxic-ischemic encephalopathy are given. This approach can be useful also in the study of pre- and post-natal infections, for example, type II Herpes Simplex virus or Cytomegalovirus infections, or pointing out vascular malformations such as vein of Galen aneurysm. Although less important than methods such as computed tomography (CT) and magnetic resonance imaging (MRI) in the evaluation of trauma and tumors, ultrasound can provide useful informations or be used in first instance in the suspicion of a brain mass.